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Rotational Osteotomy. Principles, Surgical Technique, Outcomes and Complications

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Anterior Knee Pain and Patellar Instability

Abstract

There is growing evidence that increased external tibial torsion and femoral anteversion (FAV) play a major role in the genesis of anterior knee pain (AKP) and patellar instability (PI).

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References

  1. Cooke TD, Price N, Fisher B, et al. The inwardly pointing knee. An unrecognized problem of external rotational malalignment. Clin Orthop Relat Res. 1990;(260):56–60.

    Google Scholar 

  2. Meister K, James SL. Proximal tibial derotation osteotomy for anterior knee pain in the miserably malaligned extremity. Am J Orthop (Belle Mead NJ). 1995;24(2):149–55.

    CAS  PubMed  Google Scholar 

  3. Cameron JC, Saha S. External tibial torsion: an underrecognized cause of recurrent patellar dislocation. Clin Orthop Relat Res. 1996;328:177–84.

    Article  Google Scholar 

  4. Delgado ED, Schoenecker PL, Rich MM, et al. Treatment of severe torsional malalignment syndrome. J Pediatr Orthop. 1996;16(4):484–8.

    Article  CAS  PubMed  Google Scholar 

  5. Server F, Miralles RC, Garcia E, et al. Medial rotational tibial osteotomy for patellar instability secondary to lateral tibial torsion. Int Orthop. 1996;20(3):153–8.

    Article  CAS  PubMed  Google Scholar 

  6. Bruce WD, Stevens PM. Surgical correction of miserable malalignment syndrome. J Pediatr Orthop. 2004;24(4):392–6.

    Article  PubMed  Google Scholar 

  7. Teitge RA. Patellofemoral syndrome a paradigm for current surgical strategies. Orthop Clin N Am. 2008; 287–311.

    Google Scholar 

  8. Paulos L, Swanson SC, Stoddard GJ, et al. Surgical correction of limb malalignment for instability of the patella: a comparison of 2 techniques. Am J Sports Med. 2009;37(7):1288–300.

    Article  PubMed  Google Scholar 

  9. Fouilleron N, Marchetti E, Autissier G, et al. Proximal tibial derotation osteotomy for torsional tibial deformities generating patello-femoral disorders. Orthop Traumatol Surg Res. 2010;96(7):785–92.

    Article  CAS  PubMed  Google Scholar 

  10. Dickschas J, Harrer J, Pfefferkorn R, et al. Operative treatment of patellofemoral maltracking with torsional osteotomy. Arch Orthop Trauma Surg. 2012;132(3):289–98.

    Article  PubMed  Google Scholar 

  11. Teitge RA. Does lower limb torsion matter? Tech Knee Surg. 2012;11:137–46.

    Article  Google Scholar 

  12. Drexler M, Dwyer T, Dolkart O, et al. Tibial rotational osteotomy and distal tuberosity transfer for patella subluxation secondary to excessive external tibial torsion: surgical technique and clinical outcome. Knee Surg Sports Traumatol Arthrosc. 2014;22(11):2682–9.

    Article  CAS  PubMed  Google Scholar 

  13. Leonardi F, Rivera F, Zorzan A, et al. Bilateral double osteotomy in severe torsional malalignment syndrome: 16 years follow-up. J Orthop Traumatol. 2014;15(2):131–6.

    Article  PubMed  Google Scholar 

  14. Stevens PM, Gililland JM, Anderson LA, et al. Success of torsional correction surgery after failed surgeries for patellofemoral pain and instability. Strateg Trauma Limb Reconstr. 2014;9(1):5–12.

    Article  Google Scholar 

  15. Nelitz M, Dreyhaupt J, Robert S, et al. 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. 2015;39(12):2355–62.

    Article  PubMed  Google Scholar 

  16. Dickschas J, Harrer J, Reuter B, et al. Torsional osteotomies of the femur. J Orthop Res. 2015;33(3):318–24.

    Article  PubMed  Google Scholar 

  17. Dickschas J, Tassika A, Lutter C, et al. Torsional osteotomies of the tibia in patellofemoral dysbalance. Orthop Trauma Surg. 2017;137(2):179–85.

    Article  Google Scholar 

  18. Naqvi G, Stohr K, Rehm A. Proximal femoral derotation osteotomy for idiopathic excessive femoral anteversion and intoeing gait. SICOT J. 2017;3:49.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Iobst CA, Ansari A. Femoral derotational osteotomy using a modified intramedullary nail technique. Tech Orthop. 2018;33(4):267–70.

    Article  PubMed  Google Scholar 

  20. Stambough JB, Davis L, Szymanski DA, et al. Knee pain and activity outcomes after femoral derotation osteotomy for excessive femoral anteversion. J Pediatr Orthop. 2018;38(10):503–9.

    Article  PubMed  Google Scholar 

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

    Article  Google Scholar 

  22. Frings J, Krause M, Akoto R, et al. Clinical results after combined distal femoral osteotomy in patients with patellar maltracking and recurrent dislocations. J Knee Surg. 2019;32(9):924–33.

    Article  PubMed  Google Scholar 

  23. Imhoff FB, Cotic M, Liska F, et al. Derotational osteotomy at the distal femur is effective to treat patients with patellar instability. Knee Surg Sports Traumatol Arthrosc. 2019;27(2):652–8.

    Article  PubMed  Google Scholar 

  24. Manilov R, Chahla J, Maldonado S, et al. High tibial derotation osteotomy for distal extensor mechanism alignment in patients with squinting patella due to increased external tibial torsion. Knee. 2020;27(6):1931–41.

    Article  PubMed  Google Scholar 

  25. Tian G, Yang G, Zuo L, et al. Femoral derotation osteotomy for recurrent patellar dislocation. Orthop Trauma Surg. 2020;140(12):2077–84.

    Article  Google Scholar 

  26. Zhang Z, Song G, Li Y, et al. Medial patellofemoral ligament reconstruction with or without derotational distal femoral osteotomy in treating recurrent patellar dislocation with increased femoral anteversion: a retrospective comparative study. Am J Sports Med. 2021;49(1):200–6.

    Article  CAS  PubMed  Google Scholar 

  27. Lee TQ, Anzel SH, Bennett KA, et al. The influence of fixed rotational deformities of the femur on the patellofemoral contact pressures in human cadaver knees. Clin Orthop and Relat Res. 1994;302:69–74.

    Article  Google Scholar 

  28. Lee TQ, Morris G, Csintalan RP. The influence of tibial and femoral rotation on patellofemoral contact area and pressure. J Orthop Sports Phys Ther. 2003;33(11):686–93.

    Article  PubMed  Google Scholar 

  29. Diederichs G, Kohlitz T, Kornaropoulos E, et al. Magnetic resonance imaging analysis of rotational alignment in patients with patellar dislocations. Am J Sports Med. 2013;41(1):51–7.

    Article  PubMed  Google Scholar 

  30. Stephen JM, Teitge RA, Williams A, et al. A validated, automated, 3-Dimensional method to reliably measure tibial torsion. Am J Sports Med. 2021;49(3):747–56.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Scorcelletti M, Reeves ND, Rittweger J, et al. Femoral anteversion: significance and measurement. J Anat. 2020;237(5):811–26.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Cheng JC, Chan PS, Chiang SC, et al. Angular and rotational profile of the lower limb in 2630 Chinese children. J Pediatr Orthop. 1991;11:154–61.

    Article  CAS  PubMed  Google Scholar 

  33. Yoshioka Y, Cooke TD. Femoral anteversion: assessment based on function axes. J Orthop Res. 1987;5(1):86–91.

    Article  CAS  PubMed  Google Scholar 

  34. Yoshioka Y, Siu DW, Scudamore RA, et al. Tibial anatomy and functional axes. J Orthop Res. 1989;7(1):132–7.

    Article  CAS  PubMed  Google Scholar 

  35. Murphy SB, Simon SR, Kijewski PK, et al. Femoral anteversion. J Bone Joint Surg Am. 1987;69(8):1169–76.

    Article  CAS  PubMed  Google Scholar 

  36. Archibald HD, Petro KF, Liu RW. An anatomic study on whether femoral version originates in the neck or the shaft. J Pediatr Orthop. 2019;39:e50–3.

    Article  PubMed  Google Scholar 

  37. Seitlinger G, Moroder P, Scheurecker G, et al. The contribution of different femur segments to overall femoral torsion. Am J Sports Med. 2016;44(7):1796–800.

    Article  PubMed  Google Scholar 

  38. Sanchis-Alfonso V, Domenech-Fernández J, Beser-Robles M, et al. Pathological femoral anteversion in the anterior knee pain patient depends on both the neck and the shaft (Submitted).

    Google Scholar 

  39. Kim HY, Lee SK, Lee NK, et al. An anatomical measurement of medial femoral torsion. J Pediatr Orthop B. 2012;21(6):552–7.

    Article  PubMed  Google Scholar 

  40. Waisbrod G, Schiebel F, Beck M. Abnormal femoral antetorsion–a subtrochanteric deformity. J Hip Preserv Surg. 2017;4(2):153–8.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Kuroda R, Kambic H, Valdevit A, et al. Articular cartilage contact pressure after tibial tuberosity transfer. A cadaveric study. Am J Sports Med. 2001;29(4):403–09.

    Google Scholar 

  42. Winkler PhW, Lutz PM, Rupp MC, et al. Increased external tibial torsion is an infratuberositary deformity and is not correlated with a lateralized position of the tibial tuberosity. Knee Surg Sports Traumatol Arthrosc. 2021;29:1678–85.

    Article  PubMed  Google Scholar 

  43. Van Heerwaarden RJ, Teitge RA. Rotational osteotomy of the tibia. In: Parikh SN, editor. Patellar instability. Wolters Kluwer;2020.

    Google Scholar 

  44. Sanchis-Alfonso V, Domenech J, Ferras-Tarrago J, et al. The incidence of complications after derotational femoral and/or tibial osteotomies in patellofemoral disorders in adolescents and active adult patients. A Systematic Review with Meta-Analysis. Knee Surg Sports Traumatol Arthrosc. (In press).

    Google Scholar 

  45. James SL. Chondromalacia of the patella in the adolescent. In: Kennedy JC. editor. The injured adolescent knee. Baltimore: The Williams & Wilkins Company;1979.

    Google Scholar 

  46. Payne J, Rimmke N, Schmitt LC, et al. The incidence of complications of tibial tubercle osteotomy: a systematic review. Arthroscopy. 2015;31(9):1819–25.

    Article  PubMed  Google Scholar 

  47. Smith BE, Moffatt F, Hendrick P, et al. The experience of living with patellofemoral pain—loss, confusion and fear-avoidance: a UK qualitative study. BMJ Open. 2018;8: e018624. https://doi.org/10.1136/bmjopen-2017-018624.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Lutz PM, Winkler PW, Rupp MC, et al. Complex patellofemoral reconstruction leads to improved physical and sexual activity in female patients suffering from chronic patellofemoral instability. Knee Surg Sports Traumatol Arthrosc. 2021;29(9):3017–24.

    Article  PubMed  Google Scholar 

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Correspondence to Vicente Sanchis-Alfonso .

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Sanchis-Alfonso, V., Roselló-Añón, A., Ramírez-Fuentes, C., Teitge, R.A. (2023). Rotational Osteotomy. Principles, Surgical Technique, Outcomes and Complications. In: Sanchis-Alfonso, V. (eds) Anterior Knee Pain and Patellar Instability. Springer, Cham. https://doi.org/10.1007/978-3-031-09767-6_39

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  • DOI: https://doi.org/10.1007/978-3-031-09767-6_39

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