Success of torsional correction surgery after failed surgeries for patellofemoral pain and instability

Abstract

Torsional deformities of the femur and/or tibia often go unrecognized in adolescents and adults who present with anterior knee pain, and patellar maltracking or instability. While open and arthroscopic surgical techniques have evolved to address these problems, unrecognized torsion may compromise the outcomes of these procedures. We collected a group of 16 consecutive patients (23 knees), with mean age of 17, who had undergone knee surgery before torsion was recognized and subsequently treated by means of rotational osteotomy of the tibia and/or femur. By follow-up questionnaire, we sought to determine the role of rotational correction at mean 59-month follow-up. We reasoned that, by correcting torsional alignment, we might be able to optimize long-term outcomes and avert repeated knee surgery. Knee pain was significantly improved after torsional treatment (mean 8.6 pre-op vs. 3.3 post-op, p < 0.001), while 70 % of patients did have some continued knee pain postoperatively. Only 43 % of patients had continued patellar instability, and 57 % could trust their knee after surgery. Activity level remained the same or increased in 78 % of patients after torsional treatment. Excluding planned rod removal, subsequent knee surgery for continued anterior knee pain was undertaken on only 3 knees in 2 patients. We believe that malrotation of the lower limb not only raises the propensity for anterior knee symptoms, but is also a under-recognized etiology in the failure of surgeries for anterior knee pain and patellar instability. Addressing rotational abnormalities in the index surgery yields better clinical outcomes than osteotomies performed after other prior knee surgeries.

Idiopathic Rotational Abnormalities of the Lower Extremities in Children and Adults

“…Meister and James reported similar findings at 10 years of follow-up 137 . Stevens et al evaluated 16 subjects and reported persistent patellar instability at 5 years after surgery in 43% of patients who had undergone torsional correction following previously failed procedures for the treatment of anterior knee pain and patellar maltracking 138 . Stotts and Stevens, in a study of 59 patients who were managed with tibial derotation osteotomy with intramedullary nail fixation, reported that 23.7% of the patients had persistent knee complaints 2 years postoperatively 129 .…”

Proximal femoral derotation osteotomy for idiopathic excessive femoral anteversion and intoeing gait

“…Stevens et al [11] published the success of femoral torsional correction in patients who had developed anterior knee pain and/or patellar instability before skeletal maturity and had failed to improve after one or more knee surgeries. Recent literature has also implicated increased femoral anteversion as a cause for femoroacetabular impingement and labral tear [8, 9, 15].…”

Etiopathogenic bases for patellofemoral arthritis development

“…Таким образом, наружная ротация боль-шеберцовой кости даже при минимальных движениях КС до 15° способствует механи-ческой деградации латеральной суставной поверхности надколенника (хондромаля-ции), компрессирует основную медиальную Обзоры и дополнительные фасетки [37,40], непо-средственно влияя на вращательные дви-жения надколенника, создаёт условия для ранней нестабильности КС и пателлофемо-рального синдрома.…”

“…Однако она обусловливает общее формирование биомеханики всей нижней конечности, опосредованно, и на КС [37,40]. В частности, были проанализированы эф-фекты как наружной, так и внутренней ро-тации бедра в пределах 0-20°, что влекло к минимальному увеличению нагрузки на фасетки надколенника.…”