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

Page updated August 2023 by Dr Sheila Strover (Clinical Editor)

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.

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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.

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Forum discussions

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Peer-reviewed papers

  • Double-level torsional osteotomy a treatment for the ‘inwardly pointing knee’ syndrome.

    Citation: Liße J, Perl M, Dickschas J. Double-level torsional osteotomy a treatment for the 'inwardly pointing knee' syndrome. Arch Orthop Trauma Surg. 2023 Jun;143(6):2863-2875. doi: 10.1007/s00402-022-04446-w. Epub 2022 May 12. PMID: 35551448; PMCID: PMC10191926.

    Quote: "The results show that double level torsional osteotomy is an effective treatment option for patients with patellar dislocation or subluxation associated to torsional deformities of femur and tibia. The patients achieved joint stability through the procedure."

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Torsional malalignment syndrome
Inwardly pointing knee
Torsional malalignment

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