Miserable malalignment is a specific combination of rotational deformities in the leg that may lead to patellar (kneecap) pain and instability.

miserable malalignment from above
A view from above showing the deformity.


What is miserable malalignment?

In this condition usually the femur is rotated outwards, but the tibia rotated inwards, and the kneecaps face towards one another (squinting or winking patellae). There is excessive force on the patella towards the lateral side. From the front, if the feet are aligned together the kneecaps appear to 'squint' towards one another, and if the kneecaps are aligned together, the feet are forced to turn outwards.


How is miserable malalignment managed?

Most cases are managed without surgery. Surgery, when indicated, is usually a de-rotation osteotomy of femur, tibia of both.

Torsional malalignment syndrome

Article with photos about the rotational deformities involved in the condition of miserable malalignment.

Discussing rotational problems with the log bones of the leg and how they can affect the kneecap.

Conditions interfering with patellofemoral mechanics

Part 4a of a course on Patellofemoral Pain by Dr Ronald Grelsamer of Mount Sinai Hospital in New York.

Part of a course by knee surgeon, Dr Ronald Grelsamer.



Bilateral double osteotomy in severe torsional malalignment syndrome: 16 years follow-up. Leonardi F, Rivera F, Zorzan A and Ali. SM J Orthop Traumatol. 2014 Jun; 15(2): 131–136.

See also -

Anterior Knee Pain - an approach to investigation - ebook