Case 3, presented by Daniel W. Green, MD, MS, FAAP, FACS, Roger F. Widmann, MD, and Timothy Downey-Zayas describes a 9-year-old girl with hypophosphatemic rickets who presented to Hospital for Special Surgery with a chief complaint of patella instability and knock knee deformity. Physical examination revealed severe bilateral genu valgum approximately 20 degrees on each side. The patient underwent a series of staged procedures, including a bilateral distal femur medial guided growth procedure using tension plates and Medial Patellar Femoral Ligament (MPFL) reconstruction with hamstring autograft, quadriceps lengthening, and lateral release on each knee. Upon follow-up six weeks later, the patient was doing well, with excellent quad strength and patella alignment. Clinically, deformity correction was achieved and the patient had good strength in both knees. Postoperative imaging confirmed good anatomic alignment.
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