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Derotational femoral osteotomy changes patella tilt, patella engagement and tibial tuberosity trochlear groove distance

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The aim was to assess the influence of femoral derotational osteotomy on patella tilt (PT), axial patella engagement (AEI) and tibial tuberosity trochlear groove distance (TTTG).

Methods

Derotational femoral osteotomy was performed on ten lower limbs of body donors embalmed with alcohol–glycerine. Femoral torsion, tibial torsion, knee torsion, PT, AEI and TTTG were evaluated on axial CT slices for an absolute femoral torsion of 15°, 20°, 25°, 30°, 35° and 40°. A linear mixed model analysis was used to estimate the effect of femoral torsion on PT, AEI, TTTG and knee torsion adjusted for correlation due to repeated observations. Estimates with 95% confidence intervals were used to represent the mean change in the dependent variables for one unit of change (degree, mm or AEI) in the predictor variable.

Results

A significant correlation was observed between femoral torsion and AEI (p < 0.001), PT (p < 0.001) and TTTG distance (p = 0.002). In cases of increased internal femoral torsion, a significant decreased AEI (estimate − 0.003, 95% CI − 0.003 to − 0.002), an increased PT (estimate 0.3, 95% CI 0.2–0.4) and an increased TTTG distance (estimate 0.1, 95% CI 0.1–0.2) were observed. No correlation was seen between change in femoral torsion and knee torsion (n.s.).

Conclusions

Derotational femoral osteotomy has a significant impact on patella tilt and axial patella engagement. Moreover, TTTG distance is slightly changed by a derotational femoral osteotomy, which has to be taken into account preoperatively when considering surgical procedures.

Level of evidence

Level V.

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Abbreviations

FT:

Femoral torsion

TT:

Tibial torsion

KT:

Knee torsion

PT:

Patellar tilt

AEI:

Axial engagement

TTTG:

Tibial tuberosity trochlear groove distance

MPFL:

Medial patellofemoral ligament

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Funding

The study was funded by the the affilated departements of the Medical University Innsbruck (Trauma Surgery, Orthopedic Surgery, Anatomy and Radiology).

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Authors and Affiliations

  1. Department of Trauma Surgery, Medical University Innsbruck, Innsbruck, Austria

    Peter Kaiser & Michael Schlumberger

  2. Department of Anatomy, Medical University Innsbruck, Innsbruck, Austria

    Marko Konschake

  3. Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, Innsbruck, Austria

    Fanny Loth

  4. Department of Radiology, Medical University Innsbruck, Innsbruck, Austria

    Michaela Plaikner

  5. Department of Orthopedic Surgery, Medical University Innsbruck, Innsbruck, Austria

    Michael Liebensteiner

  6. Center of Arthroscopy and Sports Medicine, Orthopedic Hospital Markgroeningen, Markgroeningen, Germany

    Michael Schlumberger

  7. Department of Traumatology, LKH Feldkirch, Carinagasse 47, 6807, Feldkirch, Austria

    Rene Attal

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  1. Peter Kaiser
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  2. Marko Konschake
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  3. Fanny Loth
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  7. Michael Schlumberger
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Contributions

All authors stated on the manuscript were fully involved in evaluating the study and writing the manuscript.

Corresponding author

Correspondence to Rene Attal.

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The authors declare that they have no competing interests.

Ethical approval

The bodies were donated to the Division of Clinical and Functional Anatomy of the Medical University Innsbruck by persons who prior to death had given informed consent for their use for scientific and educational purposes. Therefore approval by an ethics committee was not necessary by Austrian law.

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Kaiser, P., Konschake, M., Loth, F. et al. Derotational femoral osteotomy changes patella tilt, patella engagement and tibial tuberosity trochlear groove distance. Knee Surg Sports Traumatol Arthrosc 28, 926–933 (2020). https://doi.org/10.1007/s00167-019-05561-9

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  • DOI: https://doi.org/10.1007/s00167-019-05561-9

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