Patellar instability treated with distal femoral osteotomy

Swarup, Ishaan; Elattar, Osama; Rozbruch, S. Robert

doi:10.1016/j.knee.2017.02.004

Cited by 50 publications

(86 citation statements)

References 17 publications

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“…This is because the valgus moment to the patella is reduced by decreasing the Q angle, and the congruity of the patella is thus Table 4 Results of patellofemoral joint congruity improved. However, these results deviate from our study, which showed that there is no effect on the patellar tilt or shift because combined procedures were proactively performed with DFO for patellar instability to improve patellar tracking, including tibial tuberosity osteotomy [23,26], medial reefing [23,25,26] and lateral release [23,26,27]. In our study, the mean preoperative tilt and shift were small at 5.1°and 6.8%, respectively, and there were no cases with patellar instability.…”

Section: Discussioncontrasting

confidence: 87%

“…In terms of the tilt and shift of the patella, there are some reports that suggest that DFO for patellar instability with valgus deformity of the knee may lead to significant improvement [23,[25][26][27]. This is because the valgus moment to the patella is reduced by decreasing the Q angle, and the congruity of the patella is thus Table 4 Results of patellofemoral joint congruity improved.…”

Section: Discussionmentioning

confidence: 99%

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Postoperative change in patellofemoral alignment following closing-wedge distal femoral osteotomy performed for valgus osteoarthritic knees

Akaoka

Nakayama

Iseki

et al. 2020

Knee Surg & Relat Res

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Purpose: To evaluate the postoperative change in patellar position after medial closed distal femoral osteotomy (DFO) performed for valgus osteoarthritic knees. Methods: The study included 21 consecutive knees in 20 patients undergoing DFO. A minimum of 2-year followup data was obtained for all subjects with a mean follow-up period of 42 months (range 31-59 months). The patellar position was evaluated on plain radiographs preoperatively, 1-year postoperatively, and 2-year postoperatively. For patellar height, the modified Insall-Salvati Index (mISI), modified Caton-Deschamps Index (mCDI) and modified Blackburne-Peel Index (mBPI) were measured on the standing lateral radiographs. Patellofemoral alignment on the axial plane was assessed on skyline views with 30°flexion based on the measurements for lateral patellar tilt (LPT) and lateral patellar shift (LPS). Measured values at pre-and postoperative phases were statistically compared using a two-way analysis of variance. Results: All indices including mISI, mCDI, mBPI, LPT and LPS showed no statistically significant postoperative changes. Conclusion: Medial closed-wedge DFO performed for valgus osteoarthritic knees did not significantly influence patellofemoral alignment either on the sagittal or axial plane. Therefore, to highlight the clinical relevance of our findings, medial closed-wedge DFO for the valgus knee does not adversely affect the patellofemoral joint. Level of evidence: Level IV, case series.

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Section: Discussioncontrasting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Postoperative change in patellofemoral alignment following closing-wedge distal femoral osteotomy performed for valgus osteoarthritic knees

Akaoka

Nakayama

Iseki

et al. 2020

Knee Surg & Relat Res

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“…13 Swarup et al observed the successful treatment of 10 cases of patellofemoral instability due to genu valgum with lateral opening wedge DFO. 14 In an own investigation of postoperative outcomes after combined DFO as a treatment for genua valga and patellar instability (n ¼ 20), a very low redislocation rate and excellent clinical results were observed, indicating the importance of a multifactorial approach for successful patella stabilization. 8 In this study, a subgroup analysis of genua valga revealed excellent clinical results with a high level of patient satisfaction, supporting a decisive approach to operative treatment of valgus deformity.…”

Section: Discussionmentioning

confidence: 96%

“…1,5,33 Treatment of patellofemoral instability and genu valgum with DFO has become increasingly recognized in recent literature. 8,13,14 Dickschas et al investigated in 18 cases of patellar instability or anterior knee pain and genu valgum, who were treated by DFO, and found significant improvements of patellar stability and knee function. 13 Swarup et al observed the successful treatment of 10 cases of patellofemoral instability due to genu valgum with lateral opening wedge DFO.…”

Section: Discussionmentioning

confidence: 99%

“…12 However, only few recent studies have reported about successful patellar stabilization in cases of patellofemoral instability due to a valgus deformity of the leg axis. 8,13,14 Torsional deformities of the lower extremity may be responsible for patellar maltracking in 12% of all cases, making a thorough preoperative analysis crucial for successful therapy. 1,5,7,15 Pathologically increased internal torsion of the Fig.…”

mentioning

confidence: 99%

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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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Tibial tuberosity‐trochlear groove distance is significantly decreased by medial closing wedge distal femoral osteotomy

Watrinet,

Joergens,

Blum

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeWhile medial closing wedge distal femoral osteotomy (MCWDFO) has been used to address patella instability combined with valgus malalignment, its impact on patellofemoral parameters remains uncharted. Hence, this study seeks to establish a three‐dimensional (3D) planning of MCWDFO and measure its effect on the tibial tubercle ‐ trochlear groove distance (TTTG) through simulation and calculation.MethodsMCWDFO with a stepwise increment of one‐degree varisation (1°–15°) was performed on 3D surface models of 14 lower extremities with valgus malalignment and 24 lower extremities with neutral alignment of the lower limb, resulting in a total of 608 simulations. Anatomic landmarks were employed to measure hip‐knee‐ankle angle (HKA), TTTG, and femoral torsion for each simulation. A mathematical formula was adopted to calculate TTTG changes following MCWDFO, and subsequently the mean simulated and calculated TTTG values were compared. Following a standardised protocol, MCWDFO was performed without rotational changes.ResultsMCWDFO exhibited an almost linear reduction in TTTG, at a rate of approximately −1.05 ± 0.13 mm per 1° of varisation, demonstrating a strong negative correlation (R = −0.83; p < 0.001). Limb alignment did not exert an influence on TTTG change; however, it correlated with tibial plateau width. The mean difference between the simulated and calculated TTTG values amounted to 0.03 ± 0.03 mm per 1° varisation (p < 0.001).ConclusionThe TTTG distance is linearly reduced by 1.05 mm for every 1° of varisation within the varus correction range of 0°–15° during MCWDFO. Patients with combined valgus and patellar instability may benefit from MCWDFO due to frequently pathological TTTG.Level of EvidenceLevel III, descriptive laboratory study.

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Patellar instability treated with distal femoral osteotomy

Cited by 50 publications

References 17 publications

Postoperative change in patellofemoral alignment following closing-wedge distal femoral osteotomy performed for valgus osteoarthritic knees

Postoperative change in patellofemoral alignment following closing-wedge distal femoral osteotomy performed for valgus osteoarthritic knees

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

Tibial tuberosity‐trochlear groove distance is significantly decreased by medial closing wedge distal femoral osteotomy

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