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Derotational osteotomy at the distal femur is effective to treat patients with patellar instability

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Increased femoral antetorsion influences patellofemoral joint kinematics. The aim of this study was to retrospectively evaluate the clinical outcome after derotational osteotomies and combined procedures in patients with patellofemoral instability.

Methods

All patients with derotational osteotomies and combined procedures in patients with patellofemoral instability and increased femoral antetorsion performed between 2007 and 2016 were retrospectively analyzed. Exclusion criteria were open growth plates, posttraumatic deformities, and a follow-up period less than 12 months. Simple radiography and magnetic resonance imaging to evaluate cartilage lesions, trochlear dysplasia, tubercle distance, and osseous malalignment as frontal axis and torsion were performed on every patient. Patients were evaluated pre- and postoperatively using the visual analog scale (VAS) for pain, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, the subjective IKDC evaluation form, the Lysholm score, and the Tegner activity score.

Results

Out of 222 femoral osteotomies, a total of 42 patients (44 knees) met the inclusion criteria. Mean preoperative femoral antetorsion of 31° (SD ± 9°) and mean valgus malalignment of 1° (SD ± 3°) were observed. An intended derotation of 12° (SD ± 5°) was set overall. The additional procedures included correction of valgus in 50% (n = 22), MPFL reconstruction in 64% (n = 28), patellofemoral arthroplasty in 18% (n = 8), trochleoplasty in 14% (n = 6), tibial tubercle transfer in 14% (n = 6). During the mean follow-up period of 44 months (SD ± 27, range 12–88), a total of five patients were lost to follow-up, resulting in a follow-up rate of 89% (n = 39). A significant pain relief from VAS 4 (SD ± 3) to VAS 2 (SD ± 2) (p = 0.006) as well as improved scores, WOMAC: from 80 (SD ± 14) to 88 (SD ± 16) (p = 0.007), Lysholm: from 46 (SD ± 21) to 71 (SD ± 24) (p < 0.001), IKDC: from 54 (SD ± 13) to 65 (SD ± 17) (p < 0.001), were observed postoperatively. During the follow-up period, no patellar re-dislocation was observed.

Conclusion

Combined derotational osteotomy is a suitable treatment for patellar instability due to torsional malformity, as it leads to a significant reduction of pain, and a significant increase of knee function with good-to- excellent results in the short-term follow-up.

Level of evidence

IV.

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Funding

There was no financial conflict of interest with regards to this study.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Sports Medicine, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany

    Florian B. Imhoff, Matthias Cotic, Franz Liska, Felix G. E. Dyrna, Knut Beitzel, Andreas B. Imhoff & Elmar Herbst

Authors
  1. Florian B. Imhoff
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  2. Matthias Cotic
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  3. Franz Liska
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  4. Felix G. E. Dyrna
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  5. Knut Beitzel
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  6. Andreas B. Imhoff
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  7. Elmar Herbst
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Contributions

FI had done several surgeries within the study group, carried out the study design and drafted the manuscript. MC helped with study design, patient acquisition, data processing and statistical analysis. FL helped with data collection and interpretation of the data, and performed surgeries. FD carried out coordination of the patient’s follow-up, participated in surgeries and helped to draft the manuscript. KB performed the surgeries, assessed the radiological analysis and served as internal reviewer of the manuscript. AI performed the surgeries, assessed the radiological analysis and served as internal reviewer of the manuscript. EH made substantial contribution to the study design, defined study variables and drafted the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Andreas B. Imhoff.

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Conflict of interest

FI, MC, FL, FD report none. KB is a consultant of Arthrex GmbH. AI is a consultant for Arthrex and receives grants and royalties from Arthrex.

Ethical approval

Ethical approval was obtained from the Ethics Committee of the Technical University Munich. All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Imhoff, F.B., Cotic, M., Liska, F. et al. Derotational osteotomy at the distal femur is effective to treat patients with patellar instability. Knee Surg Sports Traumatol Arthrosc 27, 652–658 (2019). https://doi.org/10.1007/s00167-018-5212-z

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  • DOI: https://doi.org/10.1007/s00167-018-5212-z

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