Derotational osteotomy at the distal femur is effective to treat patients with patellar instability
- 165 Downloads
Increased femoral antetorsion influences patellofemoral joint kinematics. The aim of this study was to retrospectively evaluate the clinical outcome after derotational osteotomies and combined procedures in patients with patellofemoral instability.
All patients with derotational osteotomies and combined procedures in patients with patellofemoral instability and increased femoral antetorsion performed between 2007 and 2016 were retrospectively analyzed. Exclusion criteria were open growth plates, posttraumatic deformities, and a follow-up period less than 12 months. Simple radiography and magnetic resonance imaging to evaluate cartilage lesions, trochlear dysplasia, tubercle distance, and osseous malalignment as frontal axis and torsion were performed on every patient. Patients were evaluated pre- and postoperatively using the visual analog scale (VAS) for pain, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, the subjective IKDC evaluation form, the Lysholm score, and the Tegner activity score.
Out of 222 femoral osteotomies, a total of 42 patients (44 knees) met the inclusion criteria. Mean preoperative femoral antetorsion of 31° (SD ± 9°) and mean valgus malalignment of 1° (SD ± 3°) were observed. An intended derotation of 12° (SD ± 5°) was set overall. The additional procedures included correction of valgus in 50% (n = 22), MPFL reconstruction in 64% (n = 28), patellofemoral arthroplasty in 18% (n = 8), trochleoplasty in 14% (n = 6), tibial tubercle transfer in 14% (n = 6). During the mean follow-up period of 44 months (SD ± 27, range 12–88), a total of five patients were lost to follow-up, resulting in a follow-up rate of 89% (n = 39). A significant pain relief from VAS 4 (SD ± 3) to VAS 2 (SD ± 2) (p = 0.006) as well as improved scores, WOMAC: from 80 (SD ± 14) to 88 (SD ± 16) (p = 0.007), Lysholm: from 46 (SD ± 21) to 71 (SD ± 24) (p < 0.001), IKDC: from 54 (SD ± 13) to 65 (SD ± 17) (p < 0.001), were observed postoperatively. During the follow-up period, no patellar re-dislocation was observed.
Combined derotational osteotomy is a suitable treatment for patellar instability due to torsional malformity, as it leads to a significant reduction of pain, and a significant increase of knee function with good-to- excellent results in the short-term follow-up.
Level of evidence
KeywordsDerotational osteotomy Torsional maltracking Patellofemoral instability Alignment correction
FI had done several surgeries within the study group, carried out the study design and drafted the manuscript. MC helped with study design, patient acquisition, data processing and statistical analysis. FL helped with data collection and interpretation of the data, and performed surgeries. FD carried out coordination of the patient’s follow-up, participated in surgeries and helped to draft the manuscript. KB performed the surgeries, assessed the radiological analysis and served as internal reviewer of the manuscript. AI performed the surgeries, assessed the radiological analysis and served as internal reviewer of the manuscript. EH made substantial contribution to the study design, defined study variables and drafted the manuscript. All authors read and approved the final manuscript.
There was no financial conflict of interest with regards to this study.
Compliance with ethical standards
Conflict of interest
FI, MC, FL, FD report none. KB is a consultant of Arthrex GmbH. AI is a consultant for Arthrex and receives grants and royalties from Arthrex.
Ethical approval was obtained from the Ethics Committee of the Technical University Munich. All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 9.Eckhoff DG, Montgomery WK, Kilcoyne RF, Stamm ER (1994) Femoral morphometry and anterior knee pain. Clin Orthop Relat Res 302:64–68Google Scholar
- 10.Fabry G, Cheng LX, Molenaers G (1994) Normal and abnormal torsional development in children. Clin Orthop Relat Res 302:22–26Google Scholar
- 11.Feucht MJ, Cotic M, Beitzel K, Baldini JF, Meidinger G, Schottle PB et al (2017) A matched-pair comparison of inlay and onlay trochlear designs for patellofemoral arthroplasty: no differences in clinical outcome but less progression of osteoarthritis with inlay designs. Knee Surg Sports Traumatol Arthrosc 25:2784–2791CrossRefGoogle Scholar
- 19.Nelitz M, Dreyhaupt J, Williams SR, Dornacher D (2015) Combined supracondylar femoral derotation osteotomy and patellofemoral ligament reconstruction for recurrent patellar dislocation and severe femoral anteversion syndrome: surgical technique and clinical outcome. Int Orthop 39:2355–2362CrossRefGoogle Scholar