Knee Malalignment

Knee malalignment is defined not only as angular deviation from the physiological weight-bearing axis but also by the presence of limiting symptoms. Even small deviations may alter the complex interactions between knee joint structures, thus accelerating osteoarthritis progression. Clinical and radiological evaluation represent two key factors to confirm the diagnosis, define the most appropriate treatment and plan the surgery. Radiological evaluation should include specific views of both knees, as well as magnetic resonance imaging can further delineate the status of the intra-articular knee structures. The goal of correction is quite controversial. However, excessive overcorrection should be avoided, so as not to compromise the unaffected compartment. Knee osteotomies have been demonstrated to significantly delay joint degenerative progression and improve quality of life, as long as rigorous patient selection is undertaken.