Proximal tibial derotation osteotomy for torsional tibial deformities generating patello-femoral disorders

Fouilleron, N.; Marchetti, E.; Autissier, G.; Gougeon, F.; Migaud, Henri; Girard, Julien

doi:10.1016/j.otsr.2010.04.008

Cited by 53 publications

(58 citation statements)

References 13 publications

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“…This, however, could be important information when planning a derotational osteotomy. Currently, debate still surrounds the ideal site for an osteotomy, which can be performed proximally or distally [4,8,9,21,22]. If an osteotomy is performed at the site of the deformity, normal anatomy can be restored [6].…”

Section: Discussionmentioning

confidence: 99%

“…While the treatment of deformities in frontal or sagittal plane is based on well-established rules drawing on the concept of the centre of rotation of angulation (CORA) [6,7], there are no specific treatment rules for femoral torsional deformities. Hence, disagreement still prevails on whether an osteotomy should be performed proximally or distally in patients with pathologic femoral torsion [8,9]. Knowing the segment of the femur in which a torsional deformity is actually localized (i.e., concept of CORA) could help us in this discussion and eventually improve treatment guidelines.…”

Section: Introductionmentioning

confidence: 99%

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Segmental torsion assessment is a reliable method for in-depth analysis of femoral alignment in Computer Tomography

Ferlic

Runer

Seeber

et al. 2017

International Orthopaedics (SICOT)

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Purpose De-rotational osteotomies are indicated in patients with pathologic femoral torsion. However, there is disagreement whether an osteotomy should be performed proximally or distally. Conventionally only the total torsion is measured, which does not allow differentiation between a torsional deformity located in the proximal or distal metaphysis or the diaphysis. The aim of this study is to validate a new multilevel measurement protocol for evaluation of the magnitude of torsion of the respective femoral segments in CT. Patients and methods The torsional profile of 30 femora was evaluated in CT scans. For separate measurements of the torsion of the metaphysis and the diaphysis, four axes where determined: one through the femoral neck, a second determined by the midpoint of the femoral shaft and the lesser trochanter, a third determined by a tangent dorsal to the popliteal surface, and a fourth axis posterior to the condyles. The total femoral torsion was measured between the first and the fourth axis, proximal torsion between the first and the second, mid torsion between the second and the third, and distal torsion between the third and the fourth axis. Four investigators performed all measurements independently and intraclass correlation coefficients (ICC) were calculated to evaluate intra-and inter-rater reliability. Results Average total femoral torsion was 22.6 ± 8.7°, proximal torsion 47.7 ± 10.6°, mid torsion −33.4 ± 9.9°, and distal torsion 8.3 ± 3.2°. Intra-rater ICC ranged between 0.504 and 0.957 and inter-rater ICC between 0.643 and 0.992. The majority of the ICC were graded as Balmost perfect^and some as Bsubstantial^agreement. Conclusion Evaluation of the segmental torsion of the femur allows in-depth analysis of femoral alignment. High reliability was shown for this measuring method in computed tomography, which can be deployed when studying interdependencies between joint pathologies and torsional deformities or when planning the site for an osteotomy. Level of evidence Level III.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Segmental torsion assessment is a reliable method for in-depth analysis of femoral alignment in Computer Tomography

Ferlic

Runer

Seeber

et al. 2017

International Orthopaedics (SICOT)

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“…32 The relationship between these factors is complex, with both dynamic and static forces acting on the patella in all three cardinal planes. While proximal alignment (e.g., Q-angle, 40, 41 femoral rotation 16, 43 ) and muscle imbalances (e.g., vasti medialis-lateralis weakness, 37, 50 altered EMG timing between the vastus medialis and lateralis 9, 49 ) have been extensively studied in cohorts with PFP, the potential contribution of lateralization of the patellar tendon in this population has not been evaluated in a large cohort of individuals with isolated PFP..…”

Section: Introductionmentioning

confidence: 99%

“…Yet, TT osteotomy has been performed in patients with isolated PFP without a clear understanding that the direction of pull on the patella from the patellar tendon is a likely contributing factor to PFP. 4, 16, 17, 19, 24, 34, 47 …”

Section: Introductionmentioning

confidence: 99%

The Tibial Tubercle–Trochlear Groove Distance Is Greater in Patients With Patellofemoral Pain: Implications for the Origin of Pain and Clinical Interventions

et al. 2017

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Background The distance between the tibial tubercle (TT) and trochlear groove (TT-TG distance) is known to be greater in patients with patellar instability. However, the potential role and prevalence of pathological TT-TG distances in a large cohort of skeletally mature patients with isolated patellofemoral pain (PFP) are not clear. Purpose To determine if the mean TT-TG distance is greater in patients with PFP, who lack a history of patellar dislocations, knee trauma, or osteoarthritis, relative to healthy controls. Study Design Cross-sectional study; Level of evidence, 3. Methods A total of 50 knees (38 patients) with PFP and 60 knees (56 controls) without PFP formed the basis of this study. Magnetic resonance imaging was used to determine the TT-TG distance from 3-dimensional static scans. Results The cohort with PFP demonstrated a significantly greater mean TT-TG distance, relative to asymptomatic controls (13.0 vs 10.8 mm, respectively; P = 0.001). Among the cohort with PFP, 15 knees (30%) demonstrated TT-TG distances ≥15 mm, and 3 knees (6%) demonstrated TT-TG distances ≥ 20 mm. Conclusion Most adult patients with isolated PFP have elevated TT-TG distances compared with controls, which likely contributes to the force imbalance surrounding the knee..

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“…Fouilleron et al reported on a technique to correct both varus and rotation but did not compare this to varus correction alone. 8 Some of the effects of external tibial torsion have been elucidated 9,10 but more likely exist. It is plausible that the correction of genu varum without addressing tibial torsion will lead to an inferior outcome.…”

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confidence: 99%

Does the Surgical Correction of Tibial Torsion with Genu Varum Produce Outcomes Similar to Those in Varus Correction Alone?

et al. 2017

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The aim of this article is to study the relationship between tibia vara and external tibial torsion in adults. The following questions were asked: (1) what is the incidence of rotational deformity in patients with genu varum and (2) do patients who undergo correction of tibial torsion with genu varum have similar outcomes to those who undergo simple tibia vara correction? In this study, 69 patients (138 limbs) underwent bilateral proximal tibial osteotomy for the correction of genu varum. Patients with simple coronal plane deformity (varus alone) were treated with either a monolateral external fixator or a hexapod frame. Those with concomitant external tibial torsion were treated with circular external fixation. The primary outcome was the ability to achieve the desired correction of alignment in the coronal, sagittal, and axial planes. Secondary outcomes included a postoperative Knee Injury and Osteoarthritis Outcome Score (KOOS) and a routine patient satisfaction questionnaire. The incidence of tibial torsion among the entire group of patients with bilateral tibia vara was 46% and overwhelmingly external in direction. The two groups had some significant differences in demographics with torsion patients tending to be younger and thinner. The final mechanical axis deviation and medial proximal tibial angle values for both groups did not differ significantly ( = 0.956). The postcorrection thigh-foot axis was not significantly different between the two groups ( = 0.666). Time to union was not significant ( > 0.999). KOOS was not different between the two groups in symptoms, pain, activities of daily living, and return to sport. There was a difference in the quality of life score between the two groups ( = 0.044). There was no difference between the two groups regarding the patient questionnaire. Based on the finding of this analysis, the incidence of rotational malalignment with genu varum is close to 50%. The recognition of this close association with external tibial torsion deformity may allow for further insights into the role of rotation in varus deformity-related knee pathology and treatment. Patients can expect nearly identical outcomes from this surgery.

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Proximal tibial derotation osteotomy for torsional tibial deformities generating patello-femoral disorders

Abstract: level IV. Retrospective study.

Cited by 53 publications

References 13 publications

Segmental torsion assessment is a reliable method for in-depth analysis of femoral alignment in Computer Tomography

Segmental torsion assessment is a reliable method for in-depth analysis of femoral alignment in Computer Tomography

The Tibial Tubercle–Trochlear Groove Distance Is Greater in Patients With Patellofemoral Pain: Implications for the Origin of Pain and Clinical Interventions

Does the Surgical Correction of Tibial Torsion with Genu Varum Produce Outcomes Similar to Those in Varus Correction Alone?

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