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Femoral derotation osteotomy for recurrent patellar dislocation

  • Knee Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Purpose

Excessive femoral internal torsion is an important risk factor for patellar dislocation. The aim of the present study was to estimate the effect of derotational osteotomy of the femur on the tibial tubercle trochlear groove (TTTG) distance or patellar tilt angle (PTA) and to report our clinical outcomes of recurrent patellar dislocation after femoral derotation osteotomy.

Methods

A retrospective analysis of 16 patients (17 knees) with recurrent patellar dislocation treated by femoral derotation osteotomy in our department from January 2016 to February 2019 was carried out. The procedure was performed with supracondylar femoral derotation. A few procedures were combined with soft tissue procedures. Knee function was evaluated by using the International Knee Documentation Committee (IKDC) score, Kujala score, Lysholm score, visual analog scale (VAS) score and patient satisfaction. Additionally, CT was used to assess the influence of femoral derotational osteotomy on TTTG distance and PTA.

Results

The average femoral antetorsion angle before surgery was 33° (SD ± 5°), and the intraoperative correction angle was 23° (SD ± 4°). A total of 17 femoral derotation osteotomies in 16 patients with patellar instability [11 females, 5 males, aged 20.8 (range 15–41) years] were included in the study. No dislocation occurred within 26.5 months after follow-up (range 12–49 months). The IKDC score, Kujala score, Lysholm score and VAS score significantly improved. The preoperative TTTG distance was 15.63 mm (SD ± 2.07 mm), and it was 14.69 mm (SD ± 1.78 mm) at the follow-up. The PTA decreased from 26.35° (SD ± 6.86°) to 11.65° (SD ± 2.85°). The powers of TTTG and PTA measurements are 0.78 and 1.00, respectively and all of these differences were statistically significant.

Conclusions

Derotational osteotomy of the femur for the treatment of recurrent patellar dislocation can achieve good clinical results, including improved TTTG distance and PTA and improved knee function.

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References

  1. Bruce WD, Stevens PM (2004) Surgical correction of miserable malalignment syndrome. J Pediatr Orthop 24(4):392–396

    Article  Google Scholar 

  2. Charles MD, Haloman S, Chen L, Ward SR, Fithian D, Afra R (2013) Magnetic resonance imaging-based topographical differences between control and recurrent patellofemoral instability patients. Am J Sports Med 41(2):374–384

    Article  Google Scholar 

  3. Christensen TC, Sanders TL, Pareek A, Mohan R, Dahm DL, Krych AJ (2017) Risk factors and time to recurrent ipsilateral and contralateral patellar dislocations. Am J Sports Med 45(9):2105–2110

    Article  Google Scholar 

  4. Clark D, Walmsley K, Schranz P, Mandalia V (2017) Tibial tuberosity transfer in combination with medial patellofemoral ligament reconstruction: surgical technique. Arthrosc Tech 6(3):e591–e597

    Article  Google Scholar 

  5. Dammerer D, Liebensteiner MC, Kujala UM et al (2018) Validation of the German version of the Kujala score in patients with patellofemoral instability: a prospective multi-centre study. Arch Orthop Trauma Surg 138(4):527–535

    Article  CAS  Google Scholar 

  6. Dejour H, Walch G, Nove-Josserand L, Guier C (1994) Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc 2(1):19–26

    Article  CAS  Google Scholar 

  7. Dickschas J, Harrer J, Pfefferkorn R, Strecker W (2012) Operative treatment of patellofemoral maltracking with torsional osteotomy. Arch Orthop Trauma Surg 132(3):289–298

    Article  Google Scholar 

  8. Diederichs G, Kohlitz T, Kornaropoulos E, Heller MO, Vollnberg B, Scheffler S (2013) Magnetic resonance imaging analysis of rotational alignment in patients with patellar dislocations. Am J Sports Med 41(1):51–57

    Article  Google Scholar 

  9. Du H, Tian XX, Guo FQ et al (2017) Evaluation of different surgical methods in treating recurrent patella dislocation after three-dimensional reconstruction. Int Orthop 41(12):2517–2524

    Article  Google Scholar 

  10. Eckhoff DG, Brown AW, Kilcoyne RF, Stamm ER (1997) Knee version associated with anterior knee pain. Clin Orthop Relat Res 339:152–155

    Article  Google Scholar 

  11. Franciozi CE, Ambra LF, Albertoni LJ et al (2017) Increased femoral anteversion influence over surgically treated recurrent patellar instability patients. Arthroscopy 33(3):633–640

    Article  Google Scholar 

  12. Hernigou J, Chahidi E, Bouaboula M et al (2018) Knee size chart nomogram for evaluation of tibial tuberosity-trochlear groove distance in knees with or without history of patellofemoral instability. Int Orthop 42(12):2797–2806

    Article  Google Scholar 

  13. Kaiser P, Konschake M, Loth F et al (2019) Derotational femoral osteotomy changes patella tilt, patella engagement and tibial tuberosity trochlear groove distance. Knee Surg Sports Traumatol Arthrosc 28:928

    Google Scholar 

  14. Kling TF Jr, Hensinger RN (1983) Angular and torsional deformities of the lower limbs in children. Clin Orthop Relat Res 176:136–147

    Google Scholar 

  15. Kolowich PA, Paulos LE, Rosenberg TD, Farnsworth S (1990) Lateral release of the patella: indications and contraindications. Am J Sports Med 18(4):359–365

    Article  CAS  Google Scholar 

  16. Nelitz M (2018) Femoral derotational osteotomies. Curr Rev Musculoskelet Med 11(2):272–279

    Article  Google Scholar 

  17. 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(12):2355–2362

    Article  Google Scholar 

  18. Nelitz M, Wehner T, Steiner M, Durselen L, Lippacher S (2014) The effects of femoral external derotational osteotomy on frontal plane alignment. Knee Surg Sports Traumatol Arthrosc 22(11):2740–2746

    Article  CAS  Google Scholar 

  19. Price CT (1985) Lower-extremity rotational problems in children. Normal values to guide management. J Bone Joint Surg Am 67(5):823–824

    Article  CAS  Google Scholar 

  20. Schottle PB, Fucentese SF, Pfirrmann C, Bereiter H, Romero J (2005) Trochleaplasty for patellar instability due to trochlear dysplasia: a minimum 2-year clinical and radiological follow-up of 19 knees. Acta Orthop 76(5):693–698

    Article  Google Scholar 

  21. Schottle PB, Romero J, Schmeling A, Weiler A (2008) Technical note: anatomical reconstruction of the medial patellofemoral ligament using a free gracilis autograft. Arch Orthop Trauma Surg 128(5):479–484

    Article  Google Scholar 

  22. Smith TO, Walker J, Russell N (2007) Outcomes of medial patellofemoral ligament reconstruction for patellar instability: a systematic review. Knee Surg Sports Traumatol Arthrosc 15(11):1301–1314

    Article  Google Scholar 

  23. Stambough JB, Davis L, Szymanski DA, Smith JC, Schoenecker PL, Gordon JE (2018) Knee pain and activity outcomes after femoral derotation osteotomy for excessive femoral anteversion. J Pediatr Orthop 38(10):503–509

    Article  Google Scholar 

  24. Steensen RN, Bentley JC, Trinh TQ, Backes JR, Wiltfong RE (2015) The prevalence and combined prevalences of anatomic factors associated with recurrent patellar dislocation: a magnetic resonance imaging study. Am J Sports Med 43(4):921–927

    Article  Google Scholar 

  25. Teitge RA (2018) The power of transverse plane limb mal-alignment in the genesis of anterior knee pain—clinical relevance. Ann Joint 3:70–70

    Article  Google Scholar 

  26. Teitge RA, Torga-Spak R (2011) Rotational femoral osteotomy. Springer, London, pp 441–442

    Google Scholar 

  27. Thompson P, Metcalfe AJ (2019) Current concepts in the surgical management of patellar instability. Knee 26(6):1171–1181

    Article  Google Scholar 

  28. Vacariu A, Studer K, Rutz E, Camathias C (2019) High failure rate 108 years after vastus medialis transfer and lateral release (Green's quadricepsplasty) for recurrent dislocation of the patella. Arch Orthop Trauma Surg. https://doi.org/10.1007/s00402-019-03322-4

    Article  PubMed  Google Scholar 

  29. Waidelich HA, Strecker W, Schneider E (1992) Computed tomographic torsion-angle and length measurement of the lower extremity. The methods, normal values and radiation load. Rofo 157(3):245–251

    Article  CAS  Google Scholar 

  30. Zheng X, Hu Y, Xie P et al (2019) Surgical medial patellofemoral ligament reconstruction versus non-surgical treatment of acute primary patellar dislocation: a prospective controlled trial. Int Orthop 43(6):1495–1501

    Article  Google Scholar 

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Authors and Affiliations

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

    Gengshuang Tian, Guangmin Yang, Lixiong Zuo, Faquan Li & Fei Wang

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  1. Gengshuang Tian
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  2. Guangmin Yang
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  3. Lixiong Zuo
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  4. Faquan Li
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  5. Fei Wang
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All authors stated on the manuscript were fully involved in evaluating the study and writing the manuscript.

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Correspondence to Fei Wang.

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Tian, G., Yang, G., Zuo, L. et al. Femoral derotation osteotomy for recurrent patellar dislocation. Arch Orthop Trauma Surg 140, 2077–2084 (2020). https://doi.org/10.1007/s00402-020-03598-x

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  • DOI: https://doi.org/10.1007/s00402-020-03598-x

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