Successful Return to Sport Following Distal Femoral Varus Osteotomy

Abstract

Objectives: Distal femoral varus osteotomy is an effective treatment for unloading valgus knee malalignment; however, there is limited evidence on the ability for patients to return to athletics following this procedure. The purpose of this study is to report the functional outcomes and return to sport for athletic patients that underwent distal femoral varus osteotomy. Methods: A consecutive series of athletic patients that had undergone distal femoral varus osteotomy for symptomatic lateral compartment overload and valgus knee malalignment were prospectively reviewed. All patients had a minimum of 2-year follow-up. Radiographs were assessed to determine pre-operative and post-operative alignment. Details regarding sport of interest, ability to return to sport, and timing of return were obtained from the patients. Prospective institutional registries were utilized to collect pre-operative and post-operative Marx Activity Scale and International Knee Documentation Committee Subjective Knee Evaluation Form (IKDC) scores; these values were compared using paired t-tests with p < 0.05 as the threshold for significance. Results: A total of 13 patients with a mean age of 24 years (range: 17-35) and a mean follow-up of 43 months (range: 24-74) were included in the study. Six patients underwent medial closing wedge osteotomy, and seven patients underwent lateral opening wedge osteotomy. The mean alignment correction was 8 degrees (range: 5-13). Nine patients underwent one or more concomitant procedures at the time of the osteotomy: 6 lateral femoral condyle osteochondral allografts, 2 partial lateral meniscectomies, 1 lateral meniscus allograft transplantation, and 1 revision anterior cruciate ligament reconstruction. All patients were able to successfully return to their sport of choice (4 soccer, 2 softball, 2 running, 1 football, 1 basketball, 1 ice hockey, 1 volleyball, 1 rowing) at a mean of 11 months (range: 9-13). Furthermore, all 13 patients demonstrated an improvement in both Marx Activity Scale and IKDC scores after surgery. The mean improvement in Marx Activity Scale was 7 (mean pre-op: 4, mean post-op: 11, p < 0.01), and the mean improvement in IKDC score was 36 (mean pre-op: 53, mean post-op: 89, p < 0.01). Conclusion: Valgus knee malalignment results in overload of the lateral compartment and can severely limit one's ability to participate in athletic activities. Correction of valgus knee malalignment through distal femoral varus osteotomy-either medial closing wedge or lateral opening wedge-can reliably result in improvement in function and return to sport, provided that concomitant chondral, meniscal, and ligamentous pathology is addressed. Therefore, distal femoral varus osteotomy should be considered in the athletic population for correction of symptomatic valgus knee malalignment.

Factors Associated With Distal Femoral Osteotomy Survivorship: Data From the California Office of Statewide Health Planning and Development (OSHPD) Registry

“…In that group, the rate of return to physical activity was 57.7% at a mean follow-up time of 48 months. More recently, Voleti et al 15 reported a 100% rate of return to sport at a mean time of 11 months in 13 patients who underwent DFO for unloading valgus knee malalignment. Of those patients, 9 (69.2%) had concomitant chondral, meniscal, or ligamentous procedures performed on the ipsilateral knee joint.…”

“…More research is necessary to determine whether DFO should be routinely performed in athletes with lower extremity malalignment who wish to return to physical activity, but these past 2 studies showed promising outcomes. 4 , 15 …”

“…The mean age of that patient group was 24 years (range, 15-35 years), and the mean time to return to sport was 11 months (range, 9-13 months). 15 The survivorship rate after DFO in a recent systematic review ranged from 64% to 87% at 10 years, with similar rates between open and closed DFO. 9 …”

“…A systematic review 3 included 14 studies representing 236 patients (248 knees); however, 2 of the studies that provided the largest patient contributions originated from the same institution and therefore likely represented much of the same patient cohort. 1,14 Recently, Voleti et al 15 reported a 100% (13/13) return-to-sport rate in a group of athletic patients who underwent DFO. The mean age of that patient group was 24 years (range, 15-35 years), and the mean time to return to sport was 11 months (range, 9-13 months).…”

Osteotomi sonrası rehabilitasyon ve spora yeniden dönme

“…'nın distal femoral osteotomi ameliyatı geçiren 13 atlet hastada yaptıkları çalışmada, sporcuların ameliyat sonrası ortalama 11. ayda yaptıkları spora sorunsuz şekilde döndükleri bildirilmiştir. [27] Başka bir çalışmada ise Beyzadeoğlu ve ark., 21 hastanın 24 dizine yaptıkları osteotomi ile kombine yaptıkları yüzey kaplama artroplastisi ameliyatları sonrası, tüm hastalarında aynı düzeyde spora dönüş bildirmişlerdir. [28] Spora dönüşe katkıda bulunan en önemli faktörlerden biri de hasta motivasyonudur.…”