Reflections on Rotational Osteotomies around the Patellofemoral Joint

Biedert, Roland M.

doi:10.3390/jcm10030474

Cited by 6 publications

(3 citation statements)

References 22 publications

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“…Increased FA could cause a laterally directed force vector acting on the patella, which might increase pressure on the reconstructed MPFL and even result in graft failure and patellar re‐dislocation [16, 26, 29], accompanied by increased contact stress on the lateral patellofemoral joint, abnormal gait pattern, increased TT–TG distance, and dysplastic trochlea [2, 3, 15, 21, 29]. Therefore, performing DDFO to reduce increased FA should be taken into consideration.…”

Section: Discussionmentioning

confidence: 99%

Medial patellofemoral ligament reconstruction combined with derotational distal femoral osteotomy yields better outcomes than isolated procedures in patellar dislocation with increased femoral anteversion

Hao

Niu

Kong

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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PurposeThe purpose of this study was to evaluate and compare clinical and radiological outcomes between isolated medial patellofemoral ligament reconstruction (MPFLR) and MPFLR combined with derotational distal femoral osteotomy (DDFO) for patellar dislocation with increased femoral anteversion (FA). MethodsBetween 2014 and 2019, 36 patients who underwent isolated MPFLR and 31 patients who underwent MPFLR combined with DDFO were retrospectively included. Clinical outcomes included physical examinations, functional outcomes (Kujala, Lysholm, International Knee Documentation Committee (IKDC), and Banff Patella Instability Instrument (BPII) scores), activity level (Tegner activity score and return to sports), complications, and patellar re‐dislocation rate. Radiological outcomes included patella tilt angle, patellar congruence angle, and patella–trochlear groove distance. ResultsAll clinical outcomes improved significantly in both groups, but the DDFO group had significantly better postoperative scores than the MPFLR group (Kujala: 85.1 ± 7.7 vs. 80.5 ± 8.4, P = 0.023; Lysholm: 86.8 ± 8.2 vs. 81.9 ± 9.1, P = 0.026; IKDC: 86.2 ± 10.0 vs. 81.7 ± 8.1, P = 0.045; and BPII: 68.0 ± 12.5 vs. 62.3 ± 10.0, P = 0.039). Both groups achieved successful return to sports (90.3% vs. 91.7%). No re‐dislocation or major complications occurred. Radiological outcomes improved significantly in both groups, but the DDFO group had better outcomes (P < 0.05). The tibial tubercle–trochlear groove distance was only improved after DDFO from 17.0 ± 2.3 mm to 15.1 ± 2.0 mm (P = 0.001). ConclusionBoth isolated MPFLR and MPFLR combined with DDFO yielded satisfactory clinical and radiological outcomes in the treatment of patellar dislocation with increased FA. However, combined DDFO had better outcomes and should be considered a priority. Level of evidenceLevel III.

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Section: Discussionmentioning

confidence: 99%

Medial patellofemoral ligament reconstruction combined with derotational distal femoral osteotomy yields better outcomes than isolated procedures in patellar dislocation with increased femoral anteversion

Hao

Niu

Kong

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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“… 7 , 12 , 22 , 24 , 25 In addition, previous studies failed to offer a suitable femoral level for osteotomies. 2 , 5 , 20 , 26 In the present study, we compared the differences in femoral torsion between patients with patellar dislocation and healthy individuals. The results of our study showed that excessive femoral torsion most frequently presented in the total, mid, and distal femoral segments in patients with patellar dislocation ( P < .01).…”

Section: Discussionmentioning

confidence: 99%

Pathological Thresholds of Segmental Femoral Torsion in Patients With Patellar Dislocation: Influence on Patellofemoral Malalignment

Song

Deng

et al. 2022

Orthopaedic Journal of Sports Medicine

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Background Femoral torsion can be evaluated from different femoral segments. The pathological thresholds for femoral torsion of different segments and the influence of segmental femoral torsion on patellofemoral alignment remain unknown. Purpose To compare femoral torsion between patients with recurrent patellar dislocation and healthy individuals, to determine the statistical physiological range and pathological thresholds of femoral torsion in different segments, and to investigate the influence of femoral torsion on patellofemoral malalignment. Study Design Cross-sectional study; Level of evidence, 3. Methods We retrospectively reviewed the records of patients with patellar dislocation who received surgical treatment in our department between 2019 and 2020. Healthy participants were recruited as the control group. The control patients were asymptomatic and had no history of lower extremity disorders. The differences in femoral torsion between the study and control groups were compared. The diagnostic capacity of femoral torsion in different segments and their correlation with patellar tilt were investigated. The mean value and 95% CI of femoral torsion in different segments were established using data from healthy volunteers. Results A total of 60 patients with patellar dislocation and 100 healthy volunteers were included in this study. The total, mid, and distal femoral torsion values differed significantly between the study and control groups ( P < .01). Total femoral torsion had the highest diagnostic value (area under the receiver operating curve = 0.733). Total torsion ( r = 0.432; P < .001), mid torsion ( r = 0.242; P = .002), and distal torsion ( r = 0.324; P < .001) showed significant correlations with patellar tilt. The pathological thresholds of excessive femoral torsion of the total, proximal, mid, and distal femoral segments were 24.73°, 46.68°, –6.55°, and 14.92°, respectively. Conclusion Patients with patellar dislocation had greater femoral torsion than healthy individuals in multiple femoral segments. Excessive mid, distal, and total torsion was associated with more significant patellar tilt.

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“…For this reason, derotational femoral osteotomy has been proposed as an alternative therapy for RPD with increased femoral anteversion to eliminate the adverse influences of torsional deformity on the patellofemoral joint, and this outcome has been demonstrated in recent clinical studies. 2,3,7,8,10,13,23 In a recent systematic review, Zhang et al 33 investigated the role of derotational distal femoral osteotomy (DDFO) in treating RPD with increased femoral anteversion and found that DDFO led to favorable clinical outcomes with a low redislocation rate.…”

mentioning

confidence: 99%

Clinical and Second-look Arthroscopic Results for Derotational Distal Femoral Osteotomy With Medial Patellofemoral Ligament Reconstruction for Recurrent Patellar Dislocation With Increased Femoral Anteversion: A Series of 102 Cases With a Minimum Clinical Follow-up of 2 Years

Zhang

Song

et al. 2023

Am J Sports Med

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Background: Derotational distal femoral osteotomy (DDFO) has been used to treat patients with recurrent patellar dislocation (RPD) with increased femoral anteversion. However, no study has reported second-look arthroscopic findings in the patellofemoral joint after DDFO. Purpose: To report clinical and second-look arthroscopic outcomes for DDFO with combined medial patellofemoral ligament reconstruction (MPFL-R) in treating RPD with increased femoral anteversion. Study Design: Case series; Level of evidence, 4. Methods: From 2015 to 2019, 131 consecutive patients (144 knees) with RPD were treated with combined MPFL-R and DDFO. Patients with a femoral anteversion angle >30° and a minimum 2-year clinical follow-up period were included in the study. Three-dimensional computed tomography was performed to evaluate rotational deformities of the lower leg. Radiographic parameters presenting bony abnormalities associated with RPD were measured. Second-look arthroscopic evaluations were available for 86 knees to assess patellar tracking and chondral lesion changes. Moreover, clinical and radiologic outcomes were assessed pre- and postoperatively at a minimum 2 years. Results: A total of 102 knees in 92 patients were included in the present study with a mean clinical follow-up of 4.1 years (range, 2.0-5.6 years). Mean ± SD femoral anteversion changed significantly from 34.7°± 7.5° preoperatively to 11.3°± 0.2° postoperatively ( P < .001), and mean tibial tubercle–trochlear groove distance decreased significantly from 19.6 ± 3.5 mm preoperatively to 17.4 ± 3.2 mm postoperatively ( P < .001). In the majority of knees, at the time of second-look arthroscopic assessment, chondral lesion status remained unchanged at the lateral patellar facet (96%) and trochlear groove (95%); in contrast, chondral damage at the medial patellar facet was aggravated in 9 cases (10%). All functional scores (Tegner, Lysholm, visual analog scale, and Kujala scores) improved significantly at final follow-up. None of the patients experienced redislocation or subluxation after surgery. Conclusion: Chondral lesions in the patellofemoral joint remained unchanged in the majority of cases in second-look arthroscopy after combined MPFL-R and DDFO. Moreover, high-grade trochlear dysplasia and arthroscopic residual patellar maltracking might be associated with cartilaginous deterioration at the medial patellar facet after surgery.

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Reflections on Rotational Osteotomies around the Patellofemoral Joint

Cited by 6 publications

References 22 publications

Medial patellofemoral ligament reconstruction combined with derotational distal femoral osteotomy yields better outcomes than isolated procedures in patellar dislocation with increased femoral anteversion

Medial patellofemoral ligament reconstruction combined with derotational distal femoral osteotomy yields better outcomes than isolated procedures in patellar dislocation with increased femoral anteversion

Pathological Thresholds of Segmental Femoral Torsion in Patients With Patellar Dislocation: Influence on Patellofemoral Malalignment

Clinical and Second-look Arthroscopic Results for Derotational Distal Femoral Osteotomy With Medial Patellofemoral Ligament Reconstruction for Recurrent Patellar Dislocation With Increased Femoral Anteversion: A Series of 102 Cases With a Minimum Clinical Follow-up of 2 Years

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