[ Music ]
>> Rotational deformities of the bone often get ignored by orthopedic surgeons.
People see bowlegs or knock knees or things that are obviously mal-aligned
or leg length discrepancy that you can see on an x-ray.
Rotational deformities are actually a deformity that's in something called the axial plane,
which means that it's not obvious when you're looking at an x-ray.
And these patients often get under diagnosed, they get ignored, and they're frustrated
because they often have pain in their knees and their hips and in their ankles.
[ Music ]
>> It started a while ago.
I was about 11, 12 years old.
I had a lot of pain when I was running, playing soccer mostly,
and it started getting a lot worse.
I saw a specialist at HSS who said I could possibly grow out of it.
So, listened to him and he was right.
I did some physical therapy for it, but I really did grow out of it.
And it came back in my 20's.
I was still having a lot of pain, and that's when I went back to HSS
and I saw a few different doctors that led me to Dr. Rozbruch.
I thought my problem was with my knees.
That was really the main thing that was hurting me.
And Dr. Rozbruch explained that it was pretty much everything except my knees.
So, my -- all the bones in my legs were crooked.
>> Femoral anteversion by itself means people walking in-toed.
Femoral retroversion by itself means people are walking external, or sort of duck walk.
External tibial torsion, which is the rotational deformity in the leg bone, not the thigh bone,
means that they're walking duck walk.
Internal tibial torsion means that they're walking in-toeing.
Now, sometimes you'll get combos of them, and that's a really interesting condition
which has been referred to commonly as miserable malalignment.
It's not a very nice term, but that's what has been out there and that's --
a lot of people recognize the condition from that.
And what that is, is as a combination of femoral anteversion,
which means the knees are turned in,
and external tibial torsion, where the feet are turned out.
So, if you think about it, because of this compensatory deformity between the thigh bone
and the leg bone, what's happening is the feet actually are walking straight, right?
The knees are turned in.
The feet are turned out, but they balance each other out.
So, the patient actually walks pretty straight
and on a regular long x-ray it looks pretty normal.
But what the problem is, is that the whole knee joint is completely torqued
in a completely different plane than the way the body is walking.
And these patients are frustrated.
They often have chronic knee pain, chronic hip pain, and they don't get validated
because they see people and they complain about it
and everyone just says it's normal, it's fine.
>> I didn't understand it when I was younger, to be honest.
So, I thought, you know, maybe I was complaining too much about pain that wasn't really there,
or nobody can see what was going on so how did I know that it was real, you know?
The only thing you could really see is that my knees would turn in a little bit.
That's why I thought it was a knee problem.
But yeah, I even saw a local orthopedist, who -- the surgery that I got are pretty new,
and he's the one that said I'm not too sure what's wrong.
It doesn't look like anything's wrong, but let me do my research.
He looked a few things up and he said, the only thing that I can think of is, you know,
cutting your bones, spinning your legs around.
And so, we were like, 12 years old, that's not happening.
And fast forward 10 years, and Dr. Rozbruch, his expertise and his extensive knowledge,
you can tell right away, and that's what really made me confident in this, that it could work.
Long distance running is a huge passion of mine.
So, right before I saw you, the first time I was on a charity cross-country run
and we ran relay style across the United States.
And during that I had a lot of knee pain, hip pain, ankle pain.
I thought it was normal.
It wasn't, but that's why I came to see you.
And before that I couldn't really walk up the stairs without buckling,
or driving I said was a big problem.
And now when I'm running, everything just feels so stable.
And that's the biggest thing for me is, I have so much more trust
in my body now, which was a problem.
I didn't really know how much of a problem it was before this,
but now I can trust my legs and really do what I love to do.
I've always loved being active.
In high school, I was on the soccer team, cross-country team, and just --
I had always loved being out there.
I'm not someone that wants to stay inside.
I just -- I just want to get out there and run.
[ Music ]
>> Your thigh bone was kind of twisted in like this.
>> Right.
>> It works well when the knee is going in the same direction as the body.
But when your knee is turned in relative to your hip,
what ends up happening is your knee is off plane and it creates this buckling or this sort
of instability and it creates a lot of abnormal forces, biomechanical forces, in the knee.
>> I would always be running cross-country or playing soccer wondering why my legs would go
out to the sides a little bit and wondering why I couldn't be fast like everyone else.
And Dr. Rozbruch helped explain that I would have
to actually physically take my legs back in in my stride.
So, I could never really achieve that speed that I wanted to.
It's really frustrating when I was younger and on cross-country
and I just couldn't really get the times that I wanted.
>> You're driving this way and your tires are turned in, it's just not --
>> That's what it felt like.
>> Right. It's not a good situation.
The way to correct them once it's diagnosed and once you understand what you're dealing with,
is to do an osteotomy, which means cut the bone and spin the knee relative
to the hip into a normal orientation.
Traditionally, this was done with big open incisions and plating techniques.
But actually, what we've come up with are very minimal incision techniques for this.
And what we do is we use an intramedullary rod.
So, what we are doing is making a tiny pinhole incision at the hip area,
gaining access into the hip through a small window, and once we're inside the bone,
the bone is like a pipe, it's hollow on the inside,
we're able to insert a rod inside the marrow cavity of the bone.
Once the rod is inside, the osteotomy can be rotated around the rod,
and we use very specific, very precise markers to note the amount
of rotational correction we're doing.
And I would say a typical rotational correction is anywhere from 20 to 30 degrees.
And so, we're spinning the knee relative to the hip.
It's very stable over the intramedullary rod.
And then rod is locked in place.
And the analogous procedure is done in the tibia.
We have a large experience with it.
It's been very successful.
Patients are able to improve their level of function
and decrease their level of pain substantially.
>> With all my injuries and other things, I've just -- I've gone through a lot.
And running, playing soccer, and just running in general has been my outlook for everything.
If I was having a bad day, I would just get out there on the pavement,
and it's just been my safe haven and I didn't want to lose that.
I was really nervous about losing that.
So, the fact that not only do I still have that, but it's going to be even better
than it was before, it just blows my mind.
>> And back.
That's great.
So much progress.
And you know what?
I will say that you still have -- you still have six months of improving ahead of you.
>> Really?
>> As you get stronger, as the bone gets stronger, it's going to feel even better.
>> Incredible.
>> I'm excited for you.
>> Me too, I'm so excited.
Thank you.
>> Awesome.
[ Music ]