Femorale Osteotomien bei patellofemoraler Instabilität

Hinterwimmer, Stefan; Rosenstiel, Nikolaus; Lenich, Andreas; Waldt, Simone; Imhoff, Andreas B.

doi:10.1007/s00113-012-2198-8

Cited by 52 publications

(36 citation statements)

References 16 publications

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“…In a study published in 2010 comprising 61 knees subjected to tibial tuberosity transfer, Caton and Dejour registered excellent stability in 76.8% . The positive effect of isolated femoral varization osteotomy at a valgus axis causing patellofemoral dysbalance is also well known …”

Section: Discussionmentioning

confidence: 95%

“…30 The positive effect of isolated femoral varization osteotomy at a valgus axis causing patellofemoral dysbalance is also well known. 9 The first published study about torsional pathologies of the lower extremity is attributed to Somerville in 1957, 31 who found persistent internal torsion of the hip in early childhood and a resulting reactive tibial external torsion as the cause of a deformity. He described eight bifocal osteotomies; the patients were between 5 and 21 years of age.…”

Section: Discussionmentioning

confidence: 99%

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Torsional osteotomies of the femur

Dickschas

Harrer

Reuter

et al. 2014

Journal Orthopaedic Research

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Various pathologies of the hip or knee, such as patellofemoral malalignment or femoroacetabular impingement may be caused by a femoral torsional deformity. When diagnosed and analyzed, it is treated by femoral torsional osteotomy. Thirty femoral torsional osteotomies in 25 patients were included, the principal symptoms were patellar dislocation in 15 patients, anterior knee pain in 17, and femoroacetabular impingement in two. A computed‐tomography‐based measurement of the torsional angle was performed in all patients. Japanese Knee Society score, Tegner activity score, Lysholm score, and visual analog scale score were determined before surgery and at follow‐up after 41 (6–113) months. Femoral internal torsion was on average 40.9° (29° − 66°; normal 24°). Surgical treatment consisted of a femoral external torsional osteotomy of on average 13.8° (5° − 26°). Tegner activity score increased non‐significantly (p‐value 0.326) from 3.57 to 3.71. Japanese Knee Society score improved significantly from 72 to 87 (p‐value 0.004) while Lysholm score rose significantly from 66 to 84 points (p‐value 0.004). Pain relief was demonstrated by a significant decrease in the VAS score from 5.6 to 2.4 (p‐value 0.007). No further patellar dislocation was reported. Torsional deformities of the femur frequently cause symptoms in the knee or hip joint. After thorough assessment and diagnostic investigation, a femoral external torsional osteotomy provides significant pain relief as well as patellofemoral stability. © 2014 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 33:???–???, 2015.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Torsional osteotomies of the femur

Dickschas

Harrer

Reuter

et al. 2014

Journal Orthopaedic Research

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“…The assessment of femoral torsion is important in the cases of maltorsion after a femur fracture or in the cases of lateral patellar instability, as an excessive femoral internal torsion has been described as a risk factor [ 2 , 6 , 7 , 12 , 19 , 22 ]. In the cases of recurrent patellar instability, femoral internal torsion of more than 15°–25° is considered to represent an indication for derotational femoral osteotomy [ 1 , 2 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

Significant differences in femoral torsion values depending on the CT measurement technique

Kaiser

Attal

Kammerer

et al. 2016

Arch Orthop Trauma Surg

141

113

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IntroductionThis study compared the feasibility of six different CT-based measurement techniques for establishing an indication for derotational osteotomy in the cases of patellar instability or femoral fracture.Materials and methodsCT scans of 52 single human cadaver femora were measured using six different torsion measurement techniques (described by Waidelich, Murphy, and Yoshioka on transverse images and Hernandez, Jarrett, and Yoshioka on oblique images). All measurements were performed by four observers twice to assess intraobserver and interobserver agreement. The intraclass correlation coefficient (ICC), ANOVA, and Bonferroni post hoc test were used for the statistical analysis.ResultsSignificant differences (P < 0.001) between the values for femoral torsion were observed with all techniques except Yoshioka’s techniques on transverse and oblique slices (P = 1.000) (transverse images: Waidelich 22.4° ± 6.8°, Murphy 17.5° ± 7.0°, Yoshioka 13.4° ± 6.9°; oblique images: Hernandez 11.4° ± 7.4°, Jarrett 14.9° ± 7.5°, Yoshioka oblique 13.4° ± 7.1°). Intraobserver and interobserver agreement showed a high level of reproducibility (ICC 0.877–0.986; mean 0.8°–2.9°) for all techniques, with the greatest difference being observed with Hernandez’s technique (11.4°/10°).ConclusionsFemoral torsion values depend on the measurement technique. When derotational osteotomy is being considered, it is essential to use different threshold values depending on the measurement technique.

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“…2). 12,16,17 An externally rotating torsional osteotomy can improve the patellar tracking, which is why clinical results published in the past have been mostly good. 1,5,15,18,19 Both deformities-valgus or torsional-can be addressed by DFO if associated with patellofemoral pathologies.…”

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confidence: 99%

Clinical Results after Combined Distal Femoral Osteotomy in Patients with Patellar Maltracking and Recurrent Dislocations

et al. 2018

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The purpose of this study is to analyze the clinical results after treatment of patellofemoral instability and maltracking caused by torsional or axial deformities of the lower extremity by combined distal femoral osteotomies (DFOs). We analyzed 31 DFOs (25 patients) with patellar maltracking and instability, treated in our clinic. Torsional angles and the leg axis in the frontal plane were measured preoperatively. Standardized scoring systems were determined pre- and postoperatively including a clinical examination. Nineteen cases of torsional and 12 cases of axis deformities were evaluated 27 (12–64) months postoperatively. Among those with torsional deformity, mean femoral torsion was –39.0 ± 8.8 degrees, tibial tuberosity to trochlear groove (TT-TG) 20.3 ± 4.5 mm. We performed 19 torsional (+11.4 ± 2.4 degrees) DFOs with medial patellofemoral ligament (MPFL) augmentation (n = 19), tibial tuberosity transfer (n = 14, 10.9 ± 6.0 mm), varus (n = 4, 3.3 ± 1.0 degrees), or valgus (n = 1, 7.0 degrees) correction. Among valgus deformities, the leg axis was 6.7 ± 2.3 degrees valgus and TT-TG 19.3 ± 5.0 mm. We performed 12 medially closing-wedge DFOs (7.6 ± 2.8 degrees) with MPFL augmentation (n = 12) and tibial tubercle transfer (n = 9, 11.4 ± 7.3 mm). Visual analogue pain scale improved from 6.2 to 1.5 (p = 0.000), Kujala score from 45.0 to 81.5 (p = 0.000), Lysholm score from 40.3 to 83.9 (p = 0.000), and Tegner score from 2.1 to 3.9 (p = 0.000). Preoperative cartilage damage significantly influences the postoperative functional outcome (Lysholm score) (p = 0.026) as well as the improvement in terms of the Kujala score (p = 0.045) in the overall collective. No redislocation was observed. Patellofemoral maltracking and instability in torsional and axis deformities can successfully be treated by combined DFOs with excellent clinical results. The coexistence of risk factors for patellar instability requires a combination of additional procedures to complement the osteotomy. Preoperative cartilage lesions significantly influence the clinical outcome.

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Femorale Osteotomien bei patellofemoraler Instabilität

Cited by 52 publications

References 16 publications

Torsional osteotomies of the femur

Torsional osteotomies of the femur

Significant differences in femoral torsion values depending on the CT measurement technique

Clinical Results after Combined Distal Femoral Osteotomy in Patients with Patellar Maltracking and Recurrent Dislocations

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