Distal femoral varus osteotomy for unloading valgus knee malalignment: a biomechanical analysis

Quirno, Martin; Campbell, Kirk A.; Singh, Brian C.; Hasan, Saqib; Jazrawi, Laith M.; Kummer, F; Strauss, Eric J.

doi:10.1007/s00167-015-3602-z

Cited by 37 publications

(34 citation statements)

References 28 publications

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“…The joint was loaded to 500 N along the tibial axis at all flexion angles. 17 In each case, the joint load was increased linearly to 500 N over 15 seconds (33 N/s), held for 5 seconds, and unloaded at 50 N/s. The 500-N load magnitude was chosen after prior pilot studies indicated that the joint contact pattern and location of peak pressure were equivalent to those achieved at higher loads but without saturation of the pressure magnitude within discrete sensor elements.…”

Section: Methodsmentioning

confidence: 99%

“…Little is known about the biomechanical changes in the knee joint caused by DFO. A recent study by Quirno et al 17 simulated a 10° valgus load in cadaveric specimens in full extension and then sequentially performed 5°, 10°, and 15° distal femoral varus osteotomy. They found that 10° DFO equalized the medial and lateral tibiofemoral contact pressures in full extension and that 15° DFO shifted weightbearing to the medial compartment, effectively unloading the lateral compartment.…”

mentioning

confidence: 99%

“…They found that 10° DFO equalized the medial and lateral tibiofemoral contact pressures in full extension and that 15° DFO shifted weightbearing to the medial compartment, effectively unloading the lateral compartment. 17 However, specimens were only tested with the knee in full extension and were stripped of extra-articular soft tissue except for the collateral ligaments. Based on our understanding of femoral resection in total knee arthroplasty, DFO likely preferentially affects contact pressure of the tibiofemoral joint in full extension.…”

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confidence: 99%

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The Effect of Lateral Opening Wedge Distal Femoral Varus Osteotomy on Tibiofemoral Contact Mechanics Through Knee Flexion

et al. 2018

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Background: Lateral opening wedge distal femoral osteotomy (DFO) unloads a diseased lateral compartment of the knee in patients with genu valgum. To the best of our knowledge, there are no biomechanical studies investigating the effect of knee flexion on contact pressure and area after DFO. Hypothesis: As knee flexion angles increase, DFO will be less effective at unloading the lateral compartment of the knee. Study Design: Controlled laboratory study. Methods: Lateral opening wedge DFO was performed, correcting a mean of 7°, in 10 cadaveric knees using plate fixation. Tibiofemoral contact pressure was measured in 0°, 15°, 30°, 45°, 60°, and 75° of knee flexion before and after osteotomy using electronic sensors. Peak contact pressure (PCP), mean contact pressure (MCP), and contact area were measured for each condition. Anatomic dissection quantified the tibiofemoral contact position on the distal femur in all degrees of flexion. Mixed-effects regression analyses were used to compare the change in variables before and after osteotomy and between flexion angles. Results: One sample had to be excluded because of tibiofemoral arthritis. MCP decreased in the lateral compartment after DFO throughout all degrees of flexion (all P < .05) but to the greatest extent in 0° of flexion. When examining the percentage of MCP in the lateral compartment, this decreased after DFO at 0° (70.4% to 40.0%; P < .001), 15° (65.1% to 52.1%; P < .001), 30° (60.7% to 52.0%; P = .003), 45° (55.8% to 49.7%; P = .033), and 60° (51.9% to 44.2%; P = .010) but not at 75° (50.2% to 45.3%; P = .112). PCP decreased in the lateral compartment after DFO at 0° (2.41 to 1.34 MPa; P < .001), 15° (2.50 to 1.81 MPa; P < .001), 30° (2.28 to 1.93 MPa; P = .039), 45° (2.21 to 1.73 MPa; P = .005), 60° (2.15 to 1.71 MPa; P = .009), and 75° (1.95 to 1.49 MPa; P = .012). The percentage of contact area decreased in the lateral compartment in full extension (68.7% to 48.1%; P = .007) but not at any other degree of flexion (all P > .05). Conclusion: DFO decreased lateral compartment pressure. However, it had the greatest effect in full knee extension. Clinical Relevance: DFO decreased contact pressure in the lateral compartment but more effectively decreased contact pressure in the more anterior aspects of the femoral articular cartilage.

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Section: Methodsmentioning

confidence: 99%

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confidence: 99%

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The Effect of Lateral Opening Wedge Distal Femoral Varus Osteotomy on Tibiofemoral Contact Mechanics Through Knee Flexion

et al. 2018

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“…However, Quirno et al, in a recent biomechanical analysis, reported that over-correcting valgus deformity better unload the lateral compartment and better restore the normal biomechanics compared to correction to neutral alignment. The authors concluded that overcorrecting the osteotomy of 5° normalize contact pressure and contact areas in the lateral compartment (23). Similarly, others authors reported good clinical outcomes with valgus deformity over-correction (mechanical axis goal at 40-41% of tibial plateau) due to lateral compartment unloading and medial muscles' forces neutralization (20,24).…”

Section: Preoperative Settingmentioning

confidence: 88%

Femoral osteotomies for the valgus knee

Olivero¹,

Rosso²,

Dettoni³

et al. 2017

Ann. Joint

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Coronal limb malalignment is an important contributing factor to articular cartilage damage and to the development of knee osteoarthritis. Osteotomies around the knee are effective and well-recognized treatments for unloading the affected compartment. Valgus malalignment is less common than varus malalignment. Consequently, distal Femoral Osteotomies to correct the valgus knee are less commonly performed compared to high tibial osteotomy (HTO) for the varus knee. There are few papers describing the outcomes of distal femoral osteotomy (DFO) to treat valgus knee alignment and knee arthritis. In literature, there is still an open debate about the correct indication and contraindication, the best surgical technique (opening versus closing wedge), the amount of correction to achieve and the use of bone grafts to enhance osteotomies healing. However, with the correct indications, Distal Femoral Osteotomies showed good outcomes in the treatment of valgus knee. The aim of this manuscript is to review the literature about DFO in the valgus knee, summarizing the indications and contraindications, the available surgical techniques, outcomes, complications and failure rates.

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“…1 Distal femoral varus osteotomy (DFVO) can effectively correct valgus knee malalignment and unload the lateral compartment. 2 In fact, biomechanical analysis has demonstrated that the elevated contact pressures seen in the lateral compartment with valgus malalignment are normalized with corrective DFVO. 2 Good to excellent clinical results in nonathletes with symptomatic lateral compartment gonarthrosis have been reported with both medial closing wedge [3][4][5][6][7][8][9][10][11][12][13][14][15][16] and lateral opening wedge [17][18][19][20][21][22] DFVO.…”

Section: Introductionmentioning

confidence: 99%

Successful Return to Sport Following Distal Femoral Varus Osteotomy

Voleti

Degen

et al. 2017

CARTILAGE

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Objectives: Distal femoral varus osteotomy is an effective treatment for unloading valgus knee malalignment; however, there is limited evidence on the ability for patients to return to athletics following this procedure. The purpose of this study is to report the functional outcomes and return to sport for athletic patients that underwent distal femoral varus osteotomy. Methods: A consecutive series of athletic patients that had undergone distal femoral varus osteotomy for symptomatic lateral compartment overload and valgus knee malalignment were prospectively reviewed. All patients had a minimum of 2-year follow-up. Radiographs were assessed to determine pre-operative and post-operative alignment. Details regarding sport of interest, ability to return to sport, and timing of return were obtained from the patients. Prospective institutional registries were utilized to collect pre-operative and post-operative Marx Activity Scale and International Knee Documentation Committee Subjective Knee Evaluation Form (IKDC) scores; these values were compared using paired t-tests with p < 0.05 as the threshold for significance. Results: A total of 13 patients with a mean age of 24 years (range: 17-35) and a mean follow-up of 43 months (range: 24-74) were included in the study. Six patients underwent medial closing wedge osteotomy, and seven patients underwent lateral opening wedge osteotomy. The mean alignment correction was 8 degrees (range: 5-13). Nine patients underwent one or more concomitant procedures at the time of the osteotomy: 6 lateral femoral condyle osteochondral allografts, 2 partial lateral meniscectomies, 1 lateral meniscus allograft transplantation, and 1 revision anterior cruciate ligament reconstruction. All patients were able to successfully return to their sport of choice (4 soccer, 2 softball, 2 running, 1 football, 1 basketball, 1 ice hockey, 1 volleyball, 1 rowing) at a mean of 11 months (range: 9-13). Furthermore, all 13 patients demonstrated an improvement in both Marx Activity Scale and IKDC scores after surgery. The mean improvement in Marx Activity Scale was 7 (mean pre-op: 4, mean post-op: 11, p < 0.01), and the mean improvement in IKDC score was 36 (mean pre-op: 53, mean post-op: 89, p < 0.01). Conclusion: Valgus knee malalignment results in overload of the lateral compartment and can severely limit one's ability to participate in athletic activities. Correction of valgus knee malalignment through distal femoral varus osteotomy-either medial closing wedge or lateral opening wedge-can reliably result in improvement in function and return to sport, provided that concomitant chondral, meniscal, and ligamentous pathology is addressed. Therefore, distal femoral varus osteotomy should be considered in the athletic population for correction of symptomatic valgus knee malalignment.

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Distal femoral varus osteotomy for unloading valgus knee malalignment: a biomechanical analysis

Cited by 37 publications

References 28 publications

The Effect of Lateral Opening Wedge Distal Femoral Varus Osteotomy on Tibiofemoral Contact Mechanics Through Knee Flexion

The Effect of Lateral Opening Wedge Distal Femoral Varus Osteotomy on Tibiofemoral Contact Mechanics Through Knee Flexion

Femoral osteotomies for the valgus knee

Successful Return to Sport Following Distal Femoral Varus Osteotomy

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