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
References
Askenberger M, Janarv PM, Finnbogason T, Arendt EA (2017) Morphology and anatomic patellar instability risk factors in first-time traumatic lateral patellar dislocations. Am J Sports Med 45:50–58
Balcarek P, Oberthur S, Hopfensitz S, Frosch S, Walde TA, Wachowski MM et al (2014) Which patellae are likely to redislocate? Knee Surg Sports Traumatol Arthrosc 22:2308–2314
Balcarek P, Radebold T, Schulz X, Vogel D (2019) Geometry of torsional malalignment syndrome: trochlear dysplasia but not torsion predicts lateral patellar instability. Orthop J Sports Med. https://doi.org/10.1177/2325967119829790
Beck PR, Thomas AL, Farr J, Lewis PB, Cole BJ (2005) Trochlear contact pressures after anteromedialization of the tibial tubercle. Am J Sports Med 33:1710–1715
Chassaing V, Zeitoun JM, Camara M, Blin JL, Marque S, Chancelier MD (2017) Tibial tubercle torsion, a new factor of patellar instability. Orthop Traumatol Surg Res 103:1173–1178
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 45:2105–2110
Dejour H, Walch G, Nove-Josserand L, Guier C (1994) Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc 2:19–26
Delgado ED, Schoenecker PL, Rich MM, Capelli AM (1996) Treatment of severe torsional malalignment syndrome. J Pediatr Orthop 16:484–488
Dickschas J, Harrer J, Pfefferkorn R, Strecker W (2012) Operative treatment of patellofemoral maltracking with torsional osteotomy. Arch Orthop Trauma Surg 132:289–298
Duerr RA, Chauhan A, Frank DA, DeMeo PJ, Akhavan S (2016) An algorithm for diagnosing and treating primary and recurrent patellar instability. JBJS Rev. https://doi.org/10.2106/JBJS.RVW.15.00102
Fithian DC, Paxton EW, Stone ML, Silva P, Davis DK, Elias DA et al (2004) Epidemiology and natural history of acute patellar dislocation. Am J Sports Med 32:1114–1121
Frosch KH, Schmeling A (2016) A new classification system of patellar instability and patellar maltracking. Arch Orthop Trauma Surg 136:485–497
Fulkerson JP, Schutzer SF, Ramsby GR, Bernstein RA (1987) Computerized tomography of the patellofemoral joint before and after lateral release or realignment. Arthroscopy 3:19–24
Guilbert S, Chassaing V, Radier C, Hulet C, Remy F, Chouteau J et al (2013) Axial MRI index of patellar engagement: a new method to assess patellar instability. Orthop Traumatol Surg Res 99:S399–S405
Imhoff FB, Cotic M, Liska F, Dyrna FGE, Beitzel K, Imhoff AB et al (2019) Derotational osteotomy at the distal femur is effective to treat patients with patellar instability. Knee Surg Sports Traumatol Arthrosc 27:652–658
Jend HH, Heller M, Dallek M, Schoettle H (1981) Measurement of tibial torsion by computer tomography. Acta Radiol Diagn (Stockh) 22:271–276
Kaiser P, Attal R, Kammerer M, Thauerer M, Hamberger L, Mayr R et al (2016) Significant differences in femoral torsion values depending on the CT measurement technique. Arch Orthop Trauma Surg 136:1259–1264
Kaiser P, Schmoelz W, Schoettle P, Zwierzina M, Heinrichs C, Attal R (2017) Increased internal femoral torsion can be regarded as a risk factor for patellar instability—a biomechanical study. Clin Biomech (Bristol, Avon) 47:103–109
Kaiser P, Schmoelz W, Schottle PB, Heinrichs C, Zwierzina M, Attal R (2019) Isolated medial patellofemoral ligament reconstruction for patella instability is insufficient for higher degrees of internal femoral torsion. Knee Surg Sports Traumatol Arthrosc. 27:758–765
Lee TQ, Anzel SH, Bennett KA, Pang D, Kim WC (1994) The influence of fixed rotational deformities of the femur on the patellofemoral contact pressures in human cadaver knees. Clin Orthop Relat Res 302:69–74
Liodakis E, Doxastaki I, Chu K, Krettek C, Gaulke R, Citak M et al (2012) Reliability of the assessment of lower limb torsion using computed tomography: analysis of five different techniques. Skeletal Radiol 41:305–311
Liska F, von Deimling C, Otto A, Willinger L, Kellner R, Imhoff AB et al (2018) Distal femoral torsional osteotomy increases the contact pressure of the medial patellofemoral joint in biomechanical analysis. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-018-5165-2
Mullaji AB, Sharma AK, Marawar SV, Kohli AF (2008) Tibial torsion in non-arthritic Indian adults: a computer tomography study of 100 limbs. Indian J Orthop 42:309–313
Ostermeier S, Holst M, Bohnsack M, Hurschler C, Stukenborg-Colsman C, Wirth CJ (2007) In vitro measurement of patellar kinematics following reconstruction of the medial patellofemoral ligament. Knee Surg Sports Traumatol Arthrosc 15:276–285
Ostermeier S, Stukenborg-Colsman C, Hurschler C, Wirth CJ (2006) In vitro investigation of the effect of medial patellofemoral ligament reconstruction and medial tibial tuberosity transfer on lateral patellar stability. Arthroscopy 22:308–319
Petri M, Liodakis E, Hofmeister M, Despang FJ, Maier M, Balcarek P et al (2013) Operative vs conservative treatment of traumatic patellar dislocation: results of a prospective randomized controlled clinical trial. Arch Orthop Trauma Surg 133:209–213
Post WR, Teitge R, Amis A (2002) Patellofemoral malalignment: looking beyond the viewbox. Clin Sports Med 21(521–546):x
Prakash J, Seon JK, Woo SH, Jin C, Song EK (2016) Comparison of radiological parameters between normal and patellar dislocation groups in korean population: a rotational profile CT-based study. Knee Surg Relat Res 28:302–311
Roger J, Viste A, Cievet-Bonfils M, Pracros JP, Raux S, Chotel F (2018) Axial patellar engagement index and patellar tilt after medial patello-femoral ligament reconstruction in children and adolescents. Orthop Traumatol Surg Res. https://doi.org/10.1016/j.otsr.2018
Schueda MA, Astur DC, Bier RS, Bier DS, Astur N, Cohen M (2015) Use of computed tomography to determine the risk of patellar dislocation in 921 patients with patellar instability. Open Access J Sports Med 6:55–62
Seitlinger G, Scheurecker G, Hogler R, Labey L, Innocenti B, Hofmann S (2012) Tibial tubercle-posterior cruciate ligament distance: a new measurement to define the position of the tibial tubercle in patients with patellar dislocation. Am J Sports Med 40:1119–1125
Shen J, Qin L, Yao WW, Li M (2017) The significance of magnetic resonance imaging in severe femoral trochlear dysplasia assessment. Exp Ther Med 14:5438–5444
Strecker W, Dickschas J (2015) Torsional osteotomy: operative treatment of patellofemoral maltracking. Oper Orthop Traumatol 27:505–524
Strecker W, Keppler P, Gebhard F, Kinzl L (1997) Length and torsion of the lower limb. J Bone Jt Surg Br 79:1019–1023
Takagi S, Sato T, Watanabe S, Tanifuji O, Mochizuki T, Omori G et al (2018) Alignment in the transverse plane, but not sagittal or coronal plane, affects the risk of recurrent patella dislocation. Knee Surg Sports Traumatol Arthrosc 26:2891–2898
Teitge RA (2006) Osteotomy in the treatment of patellofemoral instability. Tech Knee Surg 5:2–18
Testa EA, Camathias C, Amsler F, Henle P, Friederich NF, Hirschmann MT (2017) Surgical treatment of patellofemoral instability using trochleoplasty or MPFL reconstruction: a systematic review. Knee Surg Sports Traumatol Arthrosc 25:2309–2320
Van Haver A, De Roo K, De Beule M, Labey L, De Baets P, Dejour D et al (2015) The effect of trochlear dysplasia on patellofemoral biomechanics: a cadaveric study with simulated trochlear deformities. Am J Sports Med 43:1354–1361
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 157:245–251
Wilson PL, Black SR, Ellis HB, Podeszwa DA (2018) Distal femoral valgus and recurrent traumatic patellar instability: Is an isolated varus producing distal femoral osteotomy a treatment option? J Pediatr Orthop 38:e162–e167
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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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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