Abstract
BACKGROUND: Traditional methods for surgical correction of symptomatic genu valgum require extensive exposure, implants, and drilling. These factors increase morbidity, cost, and complication rates. This study aimed to evaluate the functional and radiological outcomes of a minimally invasive hardware-free supracondylar femoral osteotomy for genu valgum correction in adolescents and young adults. METHODS: A retrospective review of patients undergoing minimally invasive osteotomy for symptomatic genu valgum between October 2020 and August 2023. The implant-less technique involved a 1-cm stab incision, internal weakening of the cortices with an osteotome, and controlled varus force to achieve correction, followed by long leg, ankle-sparing cylinder casting. Radiological outcomes were assessed using Mechanical Axis Deviation Angle (MAD-A), while clinical outcomes were measured using Knee Injury and Osteoarthritis Outcome Score (KOOS) and Böstman scores. Statistical analysis was performed using paired t-tests or Wilcoxon signed-rank test. RESULTS: The study included 47 knees from 27 patients (24 females, 3 males) with a mean age of 15.3 ± 2.9 years (range, 11-25 years) and a follow-up period of 41.4 ± 24.6 months. The mean MAD-A improved significantly from 5.3° ± 2.1 (right) and 4.9° ± 2.4 (left) to -0.3° ± 0.6 and -0.5° ± 0.9, respectively (p < 0.001). KOOS scores improved modestly (88.9 ± 3.3 preoperatively to 89.9 ± 6.5 at final follow-up, p = 0.465), while Böstman scores increased significantly from 22.5 ± 1.8 at 6 weeks posteroperatively to 27.9 ± 2.2 at final follow-up (p < 0.001). One knee required supplemental fixation with a single Kirschner-wire. All patients achieved radiographic union by 6 weeks postoperatively. CONCLUSION: This minimally invasive hardware-free supracondylar femoral osteotomy achieves effective and stable deformity correction with excellent functional and radiological outcomes. It eliminates growth plate disruption and implant-related complications, offering a reliable, cost-efficient alternative, particularly suitable for resource-limited or low-compliance settings. LEVEL OF EVIDENCE: IV, therapeutic case series.