What is triple varus alignment?

Asked by Strauss 

Varus alignment is associated with higher rates of PLC (posterolateral corner) reconstruction failure. Hence, evaluation of triple varus alignment must be performed. 

Primary varus alignment: Due to tibiofemoral alignment due to loss of meniscus and articular cartilage (Bony) 

Secondary varus alignment: Bony + LCL deficiency contributing to increased lateral opening (Bony + LCL) 

Triple varus alignment: Bony + Soft tissue stretching + Deficiency of remaining PLC with overall varus recurvatum alignment (Bony + LCL + remaining PLC)

HTO is indicated in patients with varus malalignment who demonstrate a varus thrust on walking. An ACL reconstruction in these knees would not address the instability and would be expected to fail if the varus osseous malalignment was not corrected owing to the abnormal lateral tibiofemoral joint opening. A varus recurvatum or back-knee instability indicates a triple varus knee in which the posterolateral structures require reconstruction along with the ACL.

Reference: Frank R. Noyes, Sue D. Barber-Westin,

Chapter 31 - Primary, Double, and Triple Varus Knee Syndromes: Diagnosis, Osteotomy Techniques, and Clinical Outcomes,

Editor(s): Frank R. Noyes, Sue D. Barber-Westin,

Noyes' Knee Disorders: Surgery, Rehabilitation, Clinical Outcomes,

W.B. Saunders,

2010,

Pages 821-895,

ISBN 9781416054740,

https://doi.org/10.1016/B978-1-4160-5474-0.00031-X.

(https://www.sciencedirect.com/science/article/pii/B978141605474000031X)