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Purpose: Corrective osteotomy is the gold standard for varus angular deformity, but is a major surgical intervention with operative site morbidity. The proposed percutaneous technique adds a lot of privileges to corrective osteotomy . It is cosmetically accepted , minimize the risk of infection, acute correction, no need for plate fixation or for a staged operation to remove hardware. Patients and methods: 25 cases (30 limbs) were included in our study. 12 patients were males (14 limbs) and 13 patients were female (16 limbs). Six patients have bilateral genu varum, 19 have unilateral genu varum. The youngest was 13 years and the oldest was 50 years with average (20) years. All patients were treated with percutaneous upper tibial osteotomy technique and above knee casting. The protocol of postoperative rehabilitation was standardized. The patients were followed post-operatively for at least 3 months to evaluate the correction, time required for union, knee joint range of motion, and the overall functional result of the knee using bostman scoring system. Results: All patients treated with the percutaneous osteotomy consolidated and displayed a marked improvement of functional and radiological outcome measures.

Objective: In order to substantially improve crouch pattern in cerebral palsy, the existent patella alta needs to be addressed. This pilot study evaluates the effectiveness of a previously described infrapatellar tendon plication for the treatment of patella alta in crouch gait pattern in skeletally immature spastic cerebral palsy patients. Methods: In 10 skeletally immature patients (20 knees) with spastic diplegia and crouch gait, the previously described technique by Joseph et al. for infrapatellar tendon plication was evaluated within the setting of single event multilevel surgery (SEMLS). Outcome measures included knee extension lag, Koshino’s radiological index for patella alta, and the occurrence of complications. Patients were followed-up for a minimum of 12 months. Results: The extensor lag improved and was statistically significant in all cases of the study with no incidence of tibial apophyseal injury at the latest follow-up. Radiographic Koshino index normalized and was maintained all through the follow-up period except in one patient (5%) who was overcorrected. Two patients (4 knees, 20%) showed postoperative knee stiffness due to casting which resolved with physiotherapy within six weeks. One knee (5%) developed a superficial infection which also resolved uneventfully with repeated dressings. Conclusion: The described infra-patellar plication technique in skeletally immature spastic diplegics appears effective, safe, and reproducible.