Abstract
Physicians should be aware of the physiological variations of the knee angle in the local population to avoid unnecessary intervention in normal children. The normal development of the knee angle in children has been studied in various ethnic groups. However, there is a scarcity of such literature for Indian children. Using clinical methods, the tibiofemoral angles (TFAs) were measured in 215 healthy Indian children ranging from 2 to 15years of age. A record of the intermalleolar distance (IMD) and intercondylar distance (ICD) was also kept of all of the subjects. We found that physiological varus rarely persists beyond 2years of age in Indian children. A progressive increase in knee valgus occurs after 2years of age, with peak knee valgus averaging almost 8° at around 6years of age. Thereafter, the valgus at the knee decreases and, after the age of 10years, stabilizes to around 4-5° in most of the children. Indian girls show, overall, more valgus alignment of the knees as compared to boys. The overall pattern of development might be slightly different in Indian children, especially in Indian girls, with early reversal of physiological varus (<2years of age) and a late peak of maximal valgus at the knee (6years of age). Varus after 3years seems atypical for Indian children. We provide an elaborate set of data for the mean TFA of different age groups and believe that this data could be of potential benefit to the physicians while evaluating lower limb alignment in Indian children aged 2-15years.
Highlights
Development of the knee angle from bowlegs in the infant to knock knees in early childhood as a part of normal and physiological development is well known [1–5]
We found that physiological varus rarely persists beyond 2 years of age in Indian children
The overall pattern of development might be slightly different in Indian children, especially in Indian girls, with early reversal of physiological varus (\2 years of age) and a late peak of maximal valgus at the knee (6 years of age)
Summary
Development of the knee angle from bowlegs (varus) in the infant to knock knees (valgus) in early childhood as a part of normal and physiological development is well known [1–5] This physiological variation in knee angle (tibiofemoral angle [TFA]) often causes apprehension amongst the parents [1, 2, 6–8]. Several workers have studied knee angle variation in various parts of the world and many of them have tried to set standards for certain ethnic/social groups [3, 4, 9–11] Despite such a varied literature on the subject, misunderstandings regarding the physiological ranges of knee angles persist and often lead to unnecessary therapeutic interventions (such as bracing) on the part of physicians. This problem of improper understanding of the normal development of the knee angle in children might be more common in countries like India because of a scarcity of literature defining normal physiological ranges of knee angles in Indian children.
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