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Accuracy of three dimensional-planned patient-specific instrumentation in femoral and tibial rotational osteotomy for patellofemoral instability

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Abstract

Purpose

Patellofemoral instability can be caused by tibial or femoral torsional deformity. Established surgical treatment options are rotational osteotomies, but the transfer from pre-operative planning to surgical execution can be challenging. Patient-specific instruments (PSI) are proofed to be helpful tools in realignment surgery. However, accuracy of PSI in femoral and tibial rotational osteotomies remains still unknown. Goal of the present study was to evaluate the accuracy of PSI in femoral and tibial rotational osteotomies in a patient population suffering from patellofemoral instability.

Methods

All patients that underwent femoral or tibial rotational osteotomy using PSI in case of patellofemoral instability from October 2015 until April 2019 in our clinic were included. Twelve knees with twelve supracondylar femoral and seven supratuberositary tibial rotational osteotomies could be included. Accuracy of the correction was assessed using pre- and post-operative CT scans based on conventional measurements and, in 3D, based on 3D bone models of the respective patients.

Results

CT measurements revealed an absolute difference between planned and achieved rotation of 4.8° ± 3.1° for femoral and 7.9° ± 3.7° for tibial rotational osteotomies without significant difference (p = 0.069). Regarding 3D assessment, a significant difference could be observed for the residual error between femoral and tibial rotational osteotomies in the 3D angle (p = 0.014) with a higher accuracy for the femoral side.

Conclusion

The application of PSI for femoral and tibial rotational osteotomy is a safe surgical treatment option. Accuracy for femoral rotational osteotomies is higher compared with tibial rotational osteotomies using PSI.

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Authors and Affiliations

  1. Balgrist University Hospital, Department of Orthopedics, University of Zurich, Forchstrasse 340, 8008, Zürich, Switzerland

    Lukas Jud, Lazaros Vlachopoulos, Silvan Beeler, Timo Tondelli & Sandro F. Fucentese

  2. Research in Orthopedic Computer Science (ROCS), University Hospital Balgrist, University of Zurich, Zurich, Switzerland

    Philipp Fürnstahl

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  1. Lukas Jud
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  2. Lazaros Vlachopoulos
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  3. Silvan Beeler
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  4. Timo Tondelli
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  5. Philipp Fürnstahl
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  6. Sandro F. Fucentese
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Correspondence to Lukas Jud.

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The local ethical committee approved this study (Zurich Cantonal Ethics Committee, KEK 2018–02242) and all patients gave their informed consent for their participation in and the publication of this study.

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Jud, L., Vlachopoulos, L., Beeler, S. et al. Accuracy of three dimensional-planned patient-specific instrumentation in femoral and tibial rotational osteotomy for patellofemoral instability. International Orthopaedics (SICOT) 44, 1711–1717 (2020). https://doi.org/10.1007/s00264-020-04496-y

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