The development of the tibiofemoral angle in children

Abstract

The development of the tibiofemoral angle in children at different ages has been of extensive interest for many years. There are no published series in which the development itself was followed longitudinally during growth. As it is an important question in clinical orthopaedic surgery whether to correct extreme varus or valgus knees by osteotomy, the present series was collected in order to determine the tibiofemoral angle in children of various ages. The entire series comprised 1,480 examinations of the tibiofemoral angle done roentgenographically and clinically. The tibiofemoral angle in the newborn infants and in children less than one year old was in pronounced varus which then decreased with growth. At the age of about one and one half years the knees tended to straighten. During the second and third years the angle changed to a marked valgus position. The valgus position corrected itself in the following years. The development of the tibiofemoral angle was similar in boys and girls. Children, when they learn to walk, tend to hold their feet wide apart to increase stability. This may be why a pressure on the outer side of the knees exists and the medial part of the epiphyseal plate grows faster, resulting in the valgus position of the tibia. Whatever the reason for the development of the normal tibiofemoral angle in children during growth might be, it is obvious from this investigation that an operative procedure to correct the angle in normal children is seldom indicated.