Skip to main content
SpringerLink
Log in

Combined supracondylar femoral derotation osteotomy and patellofemoral ligament reconstruction for recurrent patellar dislocation and severe femoral anteversion syndrome: surgical technique and clinical outcome

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

Severly increased femoral anteversion is an important risk factor for patellofemoral instability. Recurrent dislocations cause a traumatic disruption of the medial patellofemoral ligament. Therefore a procedure that combines femoral derotation osteotomy and patellofemoral ligament reconstruction should be considered for patients with severely increased femoral anteversion. The aim of the study was to evaluate the subjective and objective outcomes after combined femoral derotation osteotomy and anatomical reconstruction of the MPFL.

Methods

12 consecutive patients (12 knees) with patellofemoral instability and severely increased femoral anteversion underwent combined femoral derotation osteotomy and anatomical reconstruction of the MPFL. Preoperative radiographic examination included AP and lateral views to assess patella alta. MRI was performed to evaluate trochlear dysplasia and tibial tubercle-trochlear groove (TT-TG) distance. Additionally, MRI assessment of the rotational profile was performed. Evaluation included evaluation of cartilage injuries, preoperative and postoperative physical examination, visual analog scale (VAS), Kujala score, International Knee Documentation Committee score (IKDC), Activity Rating Scale (ARS) and Tegner activity score.

Results

The average age at the time of operation was 18.2 years (range, 15–26 years). The average follow-up after operation was 16.4 months postoperatively (range, 12–28 months). No recurrent dislocation occurred. The results showed a significant improvement of the Kujala score, IKDC score and VAS (p < 0.01). The activity level according to the Tegner activity score and ARS did not show statistically significant changes (p = 0.75; p = 1.0).

Conclusion

Combined anatomical reconstruction of the MPFL and femoral derotation osteotomy resulted in significant improvement of knee function and good patient satisfaction in young patients with severely increased femoral anteversion. No re-dislocation of the patella occured.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Banke IJ, Kohn LM, Meidinger G, Otto A, Hensler D, Beitzel K, Imhoff AB, Schöttle PB (2014) Combined trochleoplasty and MPFL reconstruction for treatment of chronic patellofemoral instability: a prospective minimum 2-year follow-up study. Knee Surg Sports Traumatol Arthrosc 22:2591–2598

    Article  PubMed  Google Scholar 

  2. Bicos J, Fulkerson JP, Amis A (2007) Current concepts review: the medial patellofemoral ligament. Am J Sports Med 35:484–492

    Article  PubMed  Google Scholar 

  3. Brittberg M, Winalski CS (2003) Evaluation of cartilage injuries and repair. J Bone Joint Surg Am 85-A(Suppl 2):58–69

    PubMed  Google Scholar 

  4. Buckens CF, Saris DB (2010) Reconstruction of the medial patellofemoral ligament for treatment of patellofemoral instability: a systematic review. Am J Sports Med 38:181–188

    Article  PubMed  Google Scholar 

  5. Camp CL, Krych AJ, Dahm DL, Levy BA, Stuart MJ (2010) Medial patellofemoral ligament repair for recurrent patellar dislocation. Am J Sports Med 38:2248–2254

    Article  PubMed  Google Scholar 

  6. Cooke TD, Price N, Fisher B, Hedden D (1990) The inwardly pointing knee: an unrecognized problem of external rotational malalignment. Clin Orthop Relat Res 260:56–60

    PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  8. Diederichs G, Köhlitz 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 41:51–57

    Article  PubMed  Google Scholar 

  9. Eckhoff DG, Montgomery WK, Kilcoyne RF, Stamm ER (1994) Femoral morphometry and anterior knee pain. Clin Orthop Relat Res 302:64–68

    PubMed  Google Scholar 

  10. Feller JA, Richmond AK, Wasiak J (2014) Medial patellofemoral ligament reconstruction as an isolated or combined procedure for recurrent patellar instability. Knee Surg Sports Traumatol Arthrosc 22:2470–2476

    Article  PubMed  Google Scholar 

  11. Hawkins RJ, Bell RH, Anisette G (1986) Acute patellar dislocations: the natural history. Am J Sports Med 14:117–120

    Article  CAS  PubMed  Google Scholar 

  12. Howells NR, Barnett AJ, Ahearn N, Ansari A, Eldridge JD (2012) Medial patellofemoral ligament reconstruction: a prospective outcome assessment of a large single centre series. J Bone Joint Surg (Br) 94:1202–1208

    Article  CAS  Google Scholar 

  13. Insall J, Salvati E (1971) Patella position in the normal knee joint. Radiology 101:101–104

    Article  CAS  PubMed  Google Scholar 

  14. Irrgang JJ, Anderson AF, Boland AL, Harner CD, Kurosaka M, Neyret P, Richmond JC, Shelborne KD (2001) Development and validation of the international knee documentation committee subjective knee form. Am J Sports Med 29:600–613

    CAS  PubMed  Google Scholar 

  15. Kujala UM, Jaakkola LH, Koskinen SK, Taimela S, Hurme M, Nelimarkka O (1993) Scoring of patellofemoral disorders. Arthroscopy 9:159–163

    Article  CAS  PubMed  Google Scholar 

  16. Lee TQ, Morris G, Csintalan RP (2003) The influence of tibial and femoral rotation on patellofemoral contact pressure. J Orthop Sports Phys Ther 33:686–693

    Article  PubMed  Google Scholar 

  17. 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

    PubMed  Google Scholar 

  18. Marx RG, Stump TJ, Jones EC, Wickiewicz TL, Warren RF (2001) Development and evaluation of an activity rating scale for disorders of the knee. Am J Sports Med 29:213–218

    CAS  PubMed  Google Scholar 

  19. Mooney JF (2014) Lower extremity rotational and angular issues in children. Pediatr Clin North Am 61:175–1183

    Article  Google Scholar 

  20. Nelitz M, Dreyhaupt J, Lippacher S (2013) Combined trochleoplasty and patellofemoral ligament reconstruction for recurrent patellar dislocation in severe trochlear dysplasia. A minimum two years follow-up study. Am J Sports Med 41:1005–1012

    Article  PubMed  Google Scholar 

  21. Nelitz M, Williams SR (2014) Anatomical reconstruction of the medial patellofemoral ligament in children and adolescents using a pedicled quadriceps tendon graft. Arthrosc Tech 28(3):e303-8

    Google Scholar 

  22. Nelitz M, Williams SRM, Lippacher S, Reichel H, Dornacher D (2014) Analysis of failure and clinical outcome after unsuccessful medial patellofemoral ligament reconstruction in young patients. Int Orthopaedics 38:2265–2272

    Article  Google Scholar 

  23. Ntagiopoulos PG, Byn P, Dejour D (2013) Midterm results of comprehensive surgical reconstruction including sulcus-deepening trochleoplasty in recurrent patellar dislocations with high-grade trochlear dysplasia. Am J Sports Med 41:998–1004

    Article  PubMed  Google Scholar 

  24. Parikh S, Noyes FR (2011) Patellofemoral disorders: role of comput- ed tomography and magnetic resonance imaging in defining abnormal rotational lower limb alignment. Sports Health 3:158–169

    Article  PubMed Central  PubMed  Google Scholar 

  25. Payne LZ, DeLuca PA (1994) Intertrochanteric versus supracondylar osteotomy for severe femoral anteversion. J Pediatr Orthop 14:39–44

    Article  CAS  PubMed  Google Scholar 

  26. Ruwe PA, Gage JR, Ozonoff MB, DeLuca PA (1992) Clinical determination of femoral anteversion: a comparison with established techniques. J Bone Joint Surg Am 74:820–830

    CAS  PubMed  Google Scholar 

  27. Schoettle PB, Schmeling A, Rosenstiel N, Weiler A (2007) Radiographic landmarks for femoral tunnel placement in medial patellofemoral ligament reconstruction. Am J Sports Med 35:801–804

    Article  Google Scholar 

  28. Staheli LT, Corbett M, Wyss C (1985) Lower extremity rotational problems in children: normal values to guide management. J Bone Joint Surg Am 67:39

    CAS  PubMed  Google Scholar 

  29. 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 43:921–927

    Article  PubMed  Google Scholar 

  30. Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop 198:43–49

    PubMed  Google Scholar 

  31. Tomczak RJ, Guenther KP, Rieber A, Mergo P, Ros PR, Brambs HJ (1997) MR imaging measurement of the femoral antetorsional angle as a new technique: comparison with CT in children and adults. Am J Roentgenol 168:791–794

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. MVZ Oberstdorf, Clinics Kempten-Oberallgäu, Teaching Hospital of the University of Ulm, Trettachstraße 16, 87561, Oberstdorf, Germany

    Manfred Nelitz & Sean Robert March Williams

  2. Institute of Epidemiology and Medical Biometry, University of Ulm, Helmholtzstraße 18, 89081, Ulm, Germany

    Jens Dreyhaupt

  3. Department of Orthopaedic Surgery, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany

    Daniel Dornacher

Authors
  1. Manfred Nelitz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jens Dreyhaupt
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sean Robert March Williams
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Daniel Dornacher
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Manfred Nelitz.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nelitz, M., Dreyhaupt, J., Williams, S.R.M. 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. International Orthopaedics (SICOT) 39, 2355–2362 (2015). https://doi.org/10.1007/s00264-015-2859-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-015-2859-7

Keywords

Search

Navigation