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Derotational distal femur osteotomy combined with medial patellofemoral ligament reconstruction yields satisfactory results in recurrent patellar dislocation with excessive femoral anteversion angle and trochlear dysplasia

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The purpose of this study was to evaluate the clinical outcomes of medial patellofemoral ligament (MPFL) reconstruction combined with derotational distal femur osteotomy in patients with recurrent patellar dislocation who had excessive femoral anteversion angle and trochlear dysplasia.

Methods

Between 2015 and 2020, 64 patients (64 knees) with recurrent patellar dislocation, who had excessive femoral anteversion angle (≥ 25°) and trochlear dysplasia and were surgically treated using derotational distal femur osteotomy and MPFL reconstruction, were eligible for this retrospective study. These patients were assigned to two groups according to the grade of trochlear dysplasia. Group A (type A trochlear dysplasia, n = 33) and Group B (type B, C, D trochlear dysplasia, n = 31). Preoperative and postoperative patellar tilt angle (PTA), Caton–Deschamps index (CD-I), tibial tubercle–trochlear groove (TT–TG) distance and femoral anteversion angle were evaluated. Patient outcomes were assessed using the preoperative and postoperative International Knee Documentation Committee (IKDC) score, Kujala score, Lysholm score, Tegner score, and visual analog scale (VAS) score.

Results

A total of 64 patients (64 knees) were evaluated in this study, with a mean follow-up period of 28.4 ± 3.6 months. There were no cases of wound infection, osteotomy site fractures, deep venous thrombosis of the lower extremities, or re-dislocation in the two groups during the postoperative follow-up period. All patients returned to full extension and flexion. The postoperative Tegner score, Lysholm score, Kujala score, IKDC score, VAS score, PTA, CD-I, TT–TG distance, and femoral anteversion angle were significantly improved compared with the preoperative status (P < 0.05). There was no significant difference between the two groups (n.s.).

Conclusion

MPFL reconstruction combined with derotational distal femur osteotomy showed satisfactory clinical outcomes during follow-up in patients with recurrent patellar dislocation who had excessive femoral anteversion angle and trochlear dysplasia. Even patients with high-grade trochlear dysplasia showed satisfactory results. For those patients, additional surgery is not necessary.

Level of evidence

Level III.

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Data availability

The data used or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The authors would like to thank all the staff of the participating departments.

Funding

This work was supported by the Natural Science Foundation of Hebei Province of China (No.H2022206557).

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China

    Kezhen Zhou, Zhiwen Sun, Ao Feng, Hailong Guo, Ran Sun, Yingzhen Niu, Lei Liu & Xiaofeng Wang

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  1. Kezhen Zhou
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  2. Zhiwen Sun
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  3. Ao Feng
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  4. Hailong Guo
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  8. Xiaofeng Wang
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Contributions

KZ: writing the manuscript, evaluating the radiographs, collecting and analyzing the data. ZS, HG and AF: writing the manuscript, evaluating the radiographs, collecting and analyzing the data. XW and RS: evaluating the radiographs, collecting and analyzing the data. YN and LL: project coordinator, designing the study, writing the manuscript.

Corresponding author

Correspondence to Xiaofeng Wang.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the Academic Ethics Committee of the Third Hospital of Hebei Medical University.

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All patients provided informed consent.

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Zhou, K., Sun, Z., Feng, A. et al. Derotational distal femur osteotomy combined with medial patellofemoral ligament reconstruction yields satisfactory results in recurrent patellar dislocation with excessive femoral anteversion angle and trochlear dysplasia. Knee Surg Sports Traumatol Arthrosc 31, 4347–4354 (2023). https://doi.org/10.1007/s00167-023-07476-y

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