Idiopathic Adolescent Miserable Malalignment

(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.