Idiopathic Adolescent Miserable Malalignment.

Miserable malalignment syndrome (MMS), characterized by increased femoral anteversion and external tibial torsion, is a frequently overlooked cause of pain and dysfunction in adolescents. Unlike torsional abnormalities linked to neuromuscular diseases or recurrent patellofemoral instability, idiopathic MMS is often considered benign, despite evidence of significant biomechanical and clinical impacts. These effects include anterior knee and hip pain, altered gait mechanics, patellofemoral instability, and the potential to lead to degenerative joint changes. This review highlights the importance of recognizing idiopathic adolescent MMS as a clinically relevant condition and provides a framework for assessment, management, and future research. Key Concepts: (1)Miserable malalignment syndrome (MMS) is characterized by the coexistence of increased femoral anteversion and external tibial torsion, leading to dysfunction that is more severe than either deformity alone.(2)Idiopathic adolescent MMS is often overlooked and undertreated, yet it can cause hip and knee pain, gait issues, patellofemoral instability, and an increased risk of degenerative changes.(3)Accurate diagnosis relies on thorough physical exams, gait analysis, and advanced imaging techniques such as computed tomography, magnetic resonance imaging, and 2D/3D low-dose radiography.(4)Derotational osteotomy of the femur and/or tibia leads to significant improvements in pain, function, and biomechanics, although standardized treatment guidelines and long-term outcome data remain limited.