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Ferner F, Lutter C, Perl M, Harrer J. [Double-Level De-Rotational Osteotomy of the Knee]. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2024; 162:530-531. [PMID: 38242149 DOI: 10.1055/a-2232-3506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Abstract
Derotational osteotomies of the proximal tibia and distal femur are a common surgical treatment option in patients with a congenital or posttraumatic torsional deformity. Clinically, these patients present with isolated anterior knee pain alone or in in combination with patellofemoral instability. Since the combination of femoral and tibial deformity is common (quotation Cooke), a combined surgical treatment is needed for these cases. This includes high tibial derotational and a distal femoral osteotomy, stabilised by a plate respectively. The current video shows the technique of this combined osteotomy assisted by external fixateur and the tibial approach with tibialis anterior fasciectomy and neurolysis of the peroneal nerve.
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Affiliation(s)
- Felix Ferner
- Klinik für Orthopädie und Unfallchirurgie, REGIOMED Klinikum Lichtenfels, Lichtenfels, Deutschland
- Orthopädische Klinik und Poliklinik, Universität Rostock, Medizinische Fakultät, Rostock, Deutschland
| | - Christoph Lutter
- Orthopädische Klinik und Poliklinik, Universität Rostock, Medizinische Fakultät, Rostock, Deutschland
| | - Mario Perl
- Unfallchirurgische und Orthopädische Klinik, Universität Erlangen, Erlangen, Deutschland
| | - Jörg Harrer
- Klinik für Orthopädie und Unfallchirurgie, REGIOMED Klinikum Lichtenfels, Lichtenfels, Deutschland
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Zhang Z, Wang D, Di M, Zheng T, Zhang H. Surgical treatment for recurrent patellar dislocation with severe torsional deformities: Double-level derotational osteotomy may not have a clear advantage over single-level derotational osteotomy in improving clinical and radiological outcomes. Knee Surg Sports Traumatol Arthrosc 2024; 32:2248-2257. [PMID: 38751078 DOI: 10.1002/ksa.12246] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 04/19/2024] [Accepted: 04/26/2024] [Indexed: 09/03/2024]
Abstract
PURPOSE The purpose of this study was to investigate whether double-level (femur + tibia) derotational osteotomy is superior to single-level femoral derotational osteotomy for recurrent patellar dislocation with severe femoral and tibial rotational deformities (femoral anteversion >30° and external tibial torsion >30°). METHODS Between January 2015 and June 2020, a total of 115 knees with recurrent patellar dislocation treated with combined medial patellofemoral ligament reconstruction (MPFL-R) and derotational osteotomies were evaluated after a minimum follow-up of 2 years. Among these cases, 15 knees that underwent double-level derotational osteotomy were included in the double-level group, which was propensity-matched in a 1:2 ratio to a single-level group of patients who underwent single-level femoral derotational osteotomy (30 knees). The clinical and radiological outcomes were evaluated and compared between the groups. Furthermore, the foot progression angle was measured preoperatively and 2 years after surgery. RESULTS The patient-specific variables did not differ significantly between the double- and the single-level groups after propensity score matching. The postoperative mean foot progression angle was significantly lower in the double-level group than in the single-level group (9° ± 8° vs. 15° ± 11°; p = 0.014); however, there were no statistically significant differences between the groups in terms of any other clinical and radiological assessments. CONCLUSION For patients with severe femoral and tibial torsional deformities (femoral anteversion >30° and external tibial torsion >30°), the double-level derotational osteotomy is superior to single-level osteotomy in maintaining normal foot progression angle, but it does not show an advantage in terms of patient-reported outcomes, radiological results and redislocation rate at minimum 2 years of follow-up. Furthermore, concomitant excessive external tibial torsion (>30°) did not have an adverse effect on clinical outcomes in patients who underwent derotational distal femoral osteotomy with MPFL-R due to excessive femoral anteversion. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Zhijun Zhang
- Sports Medicine Service, Beijing Jishuitan Hospital, Capital Medical University, Beijing, Xi Cheng District, China
| | - Daofeng Wang
- Sports Medicine Service, Beijing Jishuitan Hospital, Capital Medical University, Beijing, Xi Cheng District, China
| | - Menglinqian Di
- Sports Medicine Service, Beijing Jishuitan Hospital, Capital Medical University, Beijing, Xi Cheng District, China
| | - Tong Zheng
- Sports Medicine Service, Beijing Jishuitan Hospital, Capital Medical University, Beijing, Xi Cheng District, China
| | - Hui Zhang
- Sports Medicine Service, Beijing Jishuitan Hospital, Capital Medical University, Beijing, Xi Cheng District, China
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Franciozi CE. Editorial Commentary: Surgical Treatment Algorithm for Patellofemoral Recurrent Instability. Arthroscopy 2024:S0749-8063(24)00491-2. [PMID: 38986850 DOI: 10.1016/j.arthro.2024.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 07/01/2024] [Accepted: 07/03/2024] [Indexed: 07/12/2024]
Abstract
As a frame of reference, the patella can be "out" of the trochlea owing to extensor mechanism malalignment, such as an increased tibial tuberosity (TT)-trochlear groove (TG) distance, or the trochlea can be "out" of the patella if the TG is misplaced owing to increased internal femoral torsion. Both lead to an increased Q angle and patellofemoral maltracking. Medial patellofemoral ligament reconstruction acts as a medial checkrein against instability, but it does not solve maltracking in every case. TT medialization is recommended for an increased TT-TG distance, and TT anteromedialization additionally diminishes patellofemoral contact pressure. TT distalization can address patella alta. Trochleoplasty is a direct treatment for trochlea dysplasia. Varus osteotomy in cases of valgus deformity, and derotational femoral osteotomy in cases of increased internal femoral torsion, can realigning the trochlea with the patella. Derotational osteotomy addresses the misplaced trochlea-and not the patella or extensor mechanism. Cases of increased external tibial torsion (ETT) and foot pronation both result in compensatory increased hip internal rotation leading to knee internal rotation and lateral shear forces on the patella. In such cases, derotational supra-TT osteotomy provides better results than medialization because medialization could increase ETT and exacerbate symptoms. Supra-TT osteotomy results in TT medialization, whereas infra-TT osteotomy does not, so patients with increased ETT and an increased TT-TG distance may require supra-TT derotational osteotomy whereas those with increased ETT and a regular TT-TG distance may require infra-TT derotational osteotomy-if tibial derotational osteotomy is to be performed. Indications for medial patellofemoral ligament reconstruction, various TT transfers, trochleoplasty, varus osteotomy, and derotational osteotomy (with rotational population means and thresholds for surgical treatment) are finally presented, in addition to alert signs such as a squinting pattella, a high grade J sign, a type 2 extended Q angle described by Manilov, and the inverted proximal humerus sign.
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Solaiman RH, Shih Y, Bakker C, Arendt EA, Tompkins MA. Tibial derotational osteotomy for idiopathic tibial torsion: A systematic review of surgical indications based on clinical presentation and measurement technique. Knee Surg Sports Traumatol Arthrosc 2024; 32:1798-1809. [PMID: 38713870 DOI: 10.1002/ksa.12231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 04/06/2024] [Accepted: 04/09/2024] [Indexed: 05/09/2024]
Abstract
PURPOSE The aim of this systematic review was to identify the surgical indications of tibial derotational osteotomy (TDO) in patients with idiopathic external tibial torsion (ETT) and identify common measurement thresholds for surgical correction. METHODS A systematic search of MEDLINE and Embase via Ovid, Cochrane Library via Wiley, Web of Science, Scopus, SPORTDiscus via EBSCOhost, ClinicalTrials.gov, WHO ICTRP and Global Index Medicus databases was performed with search terms reflecting the concepts of idiopathic tibial torsion, TDOs, and surgical indications. Studies reporting surgical indications and measurement methods of idiopathic tibial torsion in patients who underwent TDO were included. Two authors independently screened articles and extracted data that was characterized with descriptive statistics. RESULTS Seventeen studies were identified for inclusion, with 460 tibias and 351 patients. Nearly all patients who underwent surgery had either anterior knee pain or patellar instability, even if other indications were present. Of all included patients, the most common surgical indications for TDO were anterior knee pain (88%), patellar instability (59%), gait dysfunction (41%) and cosmetic deformity (12%). Twelve studies (71%) cited multiple of these indications as reasons for surgery. On physical exam, tibial torsion was measured most commonly by thigh-foot angle (59%) (TFA) and transmalleolar axis (24%) (TMA). In terms of TFA, the most frequently reported cut-off for ETT was >30° (35%). Computerized tomography (CT) was used by nine studies (53%). The most common CT axes used to measure ETT were the TMA with respect to the posterior tibia condylar axis or the bicondylar tibia axis. CONCLUSION Anterior knee pain and/or patellar instability are common indications for TDO in patients with idiopathic tibial torsion. Standardized TFA thresholds (>30°) and CT measurement methods (TMA and posterior tibia condylar or bicondylar tibial axis) may help further establish objective surgical indications. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Rafat H Solaiman
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Yushane Shih
- Department of Orthopedic Surgery, Texas Children's Hospital, Woodlands, Texas, USA
| | - Caitlin Bakker
- Archer Library, University of Regina, Regina, Saskatchewan, Canada
| | - Elizabeth A Arendt
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Marc A Tompkins
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA
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Ferreira B, Gomes E, Figueiredo I, Ribeiro R, Valente C, Delgado D, Sánchez M, Andrade R, Espregueira-Mendes J. Derotational high tibial osteotomy in cases of anterior knee pain and/or patellofemoral instability: a systematic review. J ISAKOS 2024; 9:401-409. [PMID: 38430984 DOI: 10.1016/j.jisako.2024.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/09/2024] [Accepted: 02/25/2024] [Indexed: 03/05/2024]
Abstract
IMPORTANCE Derotational high tibial osteotomy (HTO) is a surgical intervention for correcting rotational malalignments in the lower limb, which may contribute to anterior knee pain (AKP) and/or patellofemoral instability (PFI). This surgical technique is not yet widely implemented and requires a systematic evaluation of its outcomes. AIM To assess the effectiveness of derotational HTO in correcting rotational malalignments of the lower limb in patients with AKP and/or PFI through radiological, clinical, and patient-reported outcome measures. EVIDENCE REVIEW Searches were conducted in the PubMed, Embase, and Web of Science databases up to March 3, 2023, to identify studies utilizing derotational HTO in patients with AKP and/or PFI. The primary outcome measures of interest were measurements of lower limb angular correction. Other radiological, clinical, and patient-reported outcome measures were also analyzed. The risk of bias was judged with the RoBANS tool. FINDINGS A total of 8 studies were included, comprising 215 patients (27.0 ± 3.9 years) and 245 knees. The most reported angle was tibial torsion (k = 6 studies, n = 173 knees), with a mean difference between postoperative and preoperative values (postsurgical correction) ranging from -37.8° to -10.8°. Patient-reported outcome measures showed significant improvements in the postoperative moment, exceeding the minimal clinically important difference in almost all cases, and with high patient satisfaction (93.6%). CONCLUSIONS AND RELEVANCE Derotational HTO allows the correction of rotational malalignments of the lower limb (tibial torsion) and promotes patient satisfaction. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
| | - Eluana Gomes
- Clínica Espregueira-FIFA Medical Centre of Excellence, 4350-415, Porto, Portugal
| | - Inês Figueiredo
- School of Medicine, Minho University, 4710-057, Braga, Portugal
| | - Ricardo Ribeiro
- School of Medicine, Minho University, 4710-057, Braga, Portugal
| | - Cristina Valente
- Clínica Espregueira-FIFA Medical Centre of Excellence, 4350-415, Porto, Portugal; Dom Henrique Research Centre, 4350-415, Porto, Portugal
| | - Diego Delgado
- Advanced Biological Therapy Unit, Hospital Vithas Vitoria, 01008, Vitoria-Gasteiz, Spain
| | - Mikel Sánchez
- Advanced Biological Therapy Unit, Hospital Vithas Vitoria, 01008, Vitoria-Gasteiz, Spain; Arthroscopic Surgery Unit, Hospital Vithas Vitoria, 01008, Vitoria-Gasteiz, Spain
| | - Renato Andrade
- Clínica Espregueira-FIFA Medical Centre of Excellence, 4350-415, Porto, Portugal; Dom Henrique Research Centre, 4350-415, Porto, Portugal; Porto Biomechanics Laboratory (LABIOMEP), Faculty of Sports, University of Porto, 4200-450, Porto, Portugal
| | - João Espregueira-Mendes
- School of Medicine, Minho University, 4710-057, Braga, Portugal; Clínica Espregueira-FIFA Medical Centre of Excellence, 4350-415, Porto, Portugal; Dom Henrique Research Centre, 4350-415, Porto, Portugal; ICVS/3B's-PT Government Associate Laboratory, 4710-057, Braga/Guimarães, Portugal; 3B's Research Group-Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, 4806-909, Barco, Guimarães, Portugal.
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Qiao Y, Wu X, Wu J, Lu S, Zhao S, Zhao J. Double-Level Knee Derotational Osteotomy Yields Better Postoperative Outcomes Than Tibial Tubercle Transfer Combined With Medial Patellofemoral Ligament Reconstruction in Patients With Recurrent Patellar Instability and Severe Malrotation. Arthroscopy 2024:S0749-8063(24)00367-0. [PMID: 38777002 DOI: 10.1016/j.arthro.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 04/22/2024] [Accepted: 05/02/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE To assess the postoperative outcomes of double-level knee derotational osteotomy (KDRO) combined with medial patellofemoral ligament reconstruction (MPFLR) and to compare it with tibial tuber transfer (TTT) and MPFLR without derotational osteotomy in patients with recurrent patellar instability and a marked torsional deformity. METHODS From March 2020 to December 2021, patients with torsion deformity (combined femoral torsion [FT] and tibial torsion [TTn] ≥30°) were retrospectively included. The minimum follow-up time was 18 months. Patients who received KDRO and MPFLR were categorized as the KDRO group and patients who received a combined TTT and MPFLR were categorized as the control group. Preoperative and postoperative clinical symptoms, patient-reported outcomes (Kujala, visual analog scale, Lysholm, International Knee Documentation Committee, Tegner, and Knee Injury and Osteoarthritis Outcome scores), and imaging parameters (FT, TTn, patellar height, femoral trochlear dysplasia, congruence angle, patellar tilt angle, lateral patellar angle, lateral patellar translation, and tibial tubercle-trochlear groove distance) were analyzed. RESULTS In all, 36 patients were included with 18 in KDRO group and 18 in control group. The mean follow-up time was 30 (range 21-39) months. At the latest follow-up, no patient experienced redislocation in either group. Except for the FT and TTn in the control group, postoperative imaging parameters were significantly reduced to the normal range. KDRO group had a lower patellar tilt angle (P = .043, effect size 0.64). All clinical scores in both groups significantly improved postoperatively. The KDRO group had better functional scores than control group except the KOOS daily living activities subscore and the KOOS sports and recreation subscore. More patients in the KDRO group met the minimal clinically important difference for most patient-reported outcomes than the control group. Eight patients (44%) in the control group complained of postoperative anterior knee pain, compared with 1 patient (6%) in the KDRO group (P = .018). CONCLUSIONS KDRO combined with MPFLR was associated with better postoperative outcomes than TTT combined with MPFLR in patients with recurrent patellar instability and a torsion deformity. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Yi Qiao
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiulin Wu
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinlong Wu
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Simin Lu
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Song Zhao
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinzhong Zhao
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Hinz M, Weyer M, Brunner M, Fritsch L, Otto A, Siebenlist S, Achtnich A. Varus osteotomy as a salvage procedure for young patients with symptomatic patellofemoral arthritis and valgus malalignment at short- to mid-term follow-up: a case series. Arch Orthop Trauma Surg 2024; 144:1667-1673. [PMID: 38386061 PMCID: PMC10965738 DOI: 10.1007/s00402-024-05212-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 01/24/2024] [Indexed: 02/23/2024]
Abstract
PURPOSE The purpose of the study was to report the clinical, functional and radiological outcome following varus osteotomy as a salvage procedure in young to middle-aged patients with patellofemoral arthritis (PFA) and associated valgus malalignment. It was hypothesized that a significant improvement in knee function and reduction in pain would be achieved. Moreover, no conversion to patellofemoral joint arthroplasty could be observed. MATERIAL AND METHODS Patients (< 50 years of age) that underwent varus osteotomy between 08/2012 and 01/2020 for the treatment of symptomatic PFA and associated valgus malalignment were consecutively included (minimum follow-up: 24 months). Patient-reported outcome measures (PROM; International Knee Documentation Committee subjective knee form [IKDC]), Visual Analog Scale [VAS] for pain, Tegner Activity Scale [TAS], and satisfaction with the postoperative results (1-10-scale, 10 = highest satisfaction) and weight-bearing whole-leg anteroposterior radiographs were conducted pre- and postoperatively. The change in PROM and femorotibial angle (FTA) were tested for statistical significance. RESULTS In total, 12 patients (14 knees) were included (66.7% female; mean age: 33.8 ± SD 6.6 years). In ten cases, lateral opening-wedge distal femoral osteotomies (DFO) were performed, of which three cases included a concomitant femoral derotation. Three medial closing-wedge DFO and one medial closing-wedge high tibial osteotomy were performed. At follow-up (55.3 ± 29.3 months), a significant improvement in knee function (IKDC: 56.4 ± 14.4 to 69.1 ± 11.2, p = 0.015) and reduction in pain (VAS for pain: 3.5 [interquartile range 2.3-5.8] to 0.5 [0-2.0], p = 0.018) were observed. Patients were able to reach their preoperative sporting activity level (TAS: 3.0 [3.0-4.0] to 3.5 [3.0-4.0], p = 0.854) and were highly satisfied with the postoperative result (9.0 [6.5-10]). Additionally, a significant correction of valgus malalignment was observed (5.0° ± 2.9° valgus to 0.7° ± 3.2° varus, p < 0.001). Regarding complications, two re-osteosyntheses were performed due to loss of correction and delayed union. No conversion to patellofemoral arthroplasty occurred. CONCLUSION In patients with symptomatic PFA and associated valgus malalignment, varus osteotomy as a salvage procedure achieved a significant improvement in knee function and reduction in pain. No conversion to patellofemoral joint arthroplasty occurred at short- to mid-term follow-up. LEVEL OF EVIDENCE Retrospective case series, Level IV.
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Affiliation(s)
- Maximilian Hinz
- Department of Sports Orthopaedics, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany.
| | - Maximilian Weyer
- Department of Sports Orthopaedics, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Moritz Brunner
- Department of Sports Orthopaedics, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Lorenz Fritsch
- Department of Sports Orthopaedics, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Alexander Otto
- Department of Sports Orthopaedics, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Sebastian Siebenlist
- Department of Sports Orthopaedics, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Andrea Achtnich
- Department of Sports Orthopaedics, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
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Sanchis-Alfonso V, Ramírez-Fuentes C, Beser-Robles M, Roselló-Añón A, Chiappe C, Martí-Bonmatí L, Doménech-Fernández J. Increased femoral anteversion in females with anterior knee pain relates to both the neck and the shaft of the femur. Arch Orthop Trauma Surg 2024; 144:51-57. [PMID: 37610697 DOI: 10.1007/s00402-023-05036-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 08/13/2023] [Indexed: 08/24/2023]
Abstract
INTRODUCTION Increased femoral anteversion (FAV) can have many clinical manifestations, including anterior knee pain (AKP). To our knowledge, no studies have measured the location of FAV in a cohort of female AKP patients. The objective of this research is to determine whether the increased FAV in AKP females originates above the lesser trochanter, below the lesser trochanter or at both levels. MATERIALS AND METHODS Thrity-seven consecutive AKP female patients (n = 66 femurs) were recruited prospectively. There were 17 patients (n = 26 femurs; mean age of 28 years) in whom the suspicion for the increased FAV of the femur was based on the clinical examination (pathological group-PG). The control group (CG) consisted of 20 patients (n = 40 femurs; mean age of 29 years) in whom there was no increased FAV from the clinical standpoint. All of them underwent a torsional computed tomography of the lower limbs. FAV was measured according to Murphy´s method. A segmental analysis of FAV was performed using the lesser trochanter as a landmark. RESULTS Significant differences in the total FAV (18.7 ± 5.52 vs. 42.46 ± 6.33; p < 0.001), the neck version (54.88 ± 9.64 vs. 64.27 ± 11.25; p = 0.0006) and the diaphysis version (- 36.17 ± 8.93 vs. - 21.81 ± 11.73; p < 0.001) were observed between the CG and the PG. The difference in the diaphyseal angle between CG and PG accounts for 60% of the total difference between healthy and pathological groups, while the difference between both groups in the angle of the neck accounts for 40%. CONCLUSION In chronic AKP female patients with increased FAV, the two segments of the femur contribute to the total FAV, with a different pattern among patients and controls, being the compensation mechanism of the diaphysis much lower in the pathological femurs than in the controls.
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Affiliation(s)
- Vicente Sanchis-Alfonso
- Department of Orthopedic Surgery, Hospital Arnau de Vilanova, C/ San Clemente 12, 46015, Valencia, Spain.
| | | | - María Beser-Robles
- GIBI230 Research Group on Biomedical Imaging, Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Alejandro Roselló-Añón
- Department of Orthopedic Surgery, Hospital Arnau de Vilanova, C/ San Clemente 12, 46015, Valencia, Spain
| | - Caterina Chiappe
- Department of Orthopedic Surgery, Hospital Arnau de Vilanova, C/ San Clemente 12, 46015, Valencia, Spain
| | - Luis Martí-Bonmatí
- Department of Radiology, Hospital Universitario y Politécnico de La Fe, Valencia, Spain
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Ferner F, Klinder A, Woerner M, Morris P, Harrer J, Dickschas J, Lutter C. Intraoperative control by Schanz-screws is inaccurate to achieve the exact amount of correction in de-rotational osteotomies. Knee Surg Sports Traumatol Arthrosc 2023; 31:4319-4326. [PMID: 37329368 DOI: 10.1007/s00167-023-07485-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 06/06/2023] [Indexed: 06/19/2023]
Abstract
PURPOSE The accuracy of intraoperative control of correction commonly is achieved by K-wires or Schanz-screws in combination with goniometer in de-rotational osteotomies. The purpose of this study is to investigate the accuracy of intraoperative torsional control in de-rotational femoral and tibial osteotomies. It is hypothesized, that intraoperative control by Schanz-screws and goniometer in de-rotational osteotomies around the knee is a safe and well predictable method to control the surgical torsional correction intraoperatively. METHODS 55 consecutive osteotomies around the knee joint were registered, 28 femoral and 27 tibial. The indication for osteotomy was femoral or tibial torsional deformity with the clinical occurrence of patellofemoral maltracking or PFI. Pre- and postoperative torsions were measured according to the method of Waidelich on computed tomography (CT) scan. The scheduled value of torsional correction was defined by the surgeon preoperatively. Intraoperative control of torsional correction was achieved by 5 mm-Schanz-screws and goniometer. The measured values of torsional CT scan were compared to the preoperative defined and intended values and deviation was calculated separately for femoral and tibial osteotomies. RESULTS The surgeon's intraoperative measured mean value of correction in all osteotomies was 15.2° (SD 4.6; range 10-27), whereas the postoperatively measured mean value on CT scan was 15.6 (6.8; 5.0-28.5). Intraoperatively the femoral mean value measured 17.9° (4.9; 10-27) and 12.4° (1.9; 10-15) for the tibia. Postoperatively the mean value for femoral correction was 19.8 (5.5; 9.0-28.5) and 11.3 (5.0; 5.0-26.0) for tibial correction. When considering a deviation of plus or minus 3° to be acceptable femorally 15 osteotomies (53.6%) and tibially 14 osteotomies (51.9%) fell within these limits. Nine femoral cases (32.1.%) were overcorrected, four cases undercorrected (14.3%). Four tibial cases of overcorrection (14.8%) and 9 tibial cases of undercorrection (33.3%) were observed. However, the observed difference between femur and tibia regarding the distribution of cases between the three groups did not reach significance. Moreover, there was no correlation between the extent of correction and the deviation from the intended result. CONCLUSION The use of Schanz-screws and goniometer in de-rotational osteotomies as an intraoperative control of correction is an inaccurate method. Every surgeon performing derotational osteotomies must consider this and include postoperative torsional measurement in his postoperative algorithm until new tools or devices are available to guarantee a better intraoperative accuracy of torsional correction. STUDY DESIGN Observational study. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Felix Ferner
- Klinik für Orthopädie, Unfallchirurgie, Handchirurgie, Regiomed Klinik Lichtenfels, Prof. Arneth Str. 2B, 96125, Lichtenfels, Germany.
- Orthopädische Klinik und Poliklinik, Universität Rostock, Rostock, Germany.
- Osteotomie Komitee, Deutsche Kniegesellschaft, Lichtenfels, Germany.
| | - Annett Klinder
- Orthopädische Klinik und Poliklinik, Universität Rostock, Rostock, Germany
| | - Michael Woerner
- Klinik für Orthopädie und Unfallchirurgie, Sozialstiftung Bamberg, Bamberg, Germany
| | - Patrick Morris
- Klinik für Orthopädie und Unfallchirurgie, Sozialstiftung Bamberg, Bamberg, Germany
| | - Joerg Harrer
- Klinik für Orthopädie, Unfallchirurgie, Handchirurgie, Regiomed Klinik Lichtenfels, Prof. Arneth Str. 2B, 96125, Lichtenfels, Germany
- Osteotomie Komitee, Deutsche Kniegesellschaft, Lichtenfels, Germany
| | - Joerg Dickschas
- Klinik für Orthopädie und Unfallchirurgie, Sozialstiftung Bamberg, Bamberg, Germany
| | - Christoph Lutter
- Orthopädische Klinik und Poliklinik, Universität Rostock, Rostock, Germany
- Osteotomie Komitee, Deutsche Kniegesellschaft, Lichtenfels, Germany
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陈 佳, 马 剑, 马 信. [Advances in peripatellar osteotomy for treating recurrent patellar dislocation]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2023; 37:1156-1161. [PMID: 37718431 PMCID: PMC10505621 DOI: 10.7507/1002-1892.202304055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/28/2023] [Indexed: 09/19/2023]
Abstract
Objective To summarize the progress of research related to the surgical treatment of recurrent patellar dislocation by peripatellar osteotomy in clinical practice, in order to provide reference for clinical treatment. Methods The recent literature on peripatellar osteotomy for recurrent patellar dislocation at home and abroad was reviewed, and the bony structural abnormalities, imaging diagnosis, and treatment status were summarized. Results Abnormalities in the bony anatomy of the lower limb and poor alignment lead to patellofemoral joint instability through the quadriceps pulling force line and play an important role in the pathogenesis of recurrent patellar dislocation. Identifying the source of the deformity and intervening with peripatellar osteotomy to restore the biomechanical structure of the patellofemoral joint can reduce the risk of soft tissue surgical failure, delay joint degeneration, and achieve the target of treatment. Conclusion In the clinical diagnosis and treatment of recurrent patellar dislocation, the factors causing patellofemoral joint instability should be comprehensively evaluated to guide the selection of surgery and personalized treatment.
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Affiliation(s)
- 佳晖 陈
- 天津市天津医院(天津 300211)Tianjin Hospital, Tianjin, 300211, P. R. China
| | - 剑雄 马
- 天津市天津医院(天津 300211)Tianjin Hospital, Tianjin, 300211, P. R. China
| | - 信龙 马
- 天津市天津医院(天津 300211)Tianjin Hospital, Tianjin, 300211, P. R. China
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11
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Chen J, Ma J, Wang Y, Bai H, Lu B, Zhao X, Wu Y, Dai J, Ma X. Computer-aided design combined with 3D-printed osteotomy guide-assisted derotational distal femoral osteotomy for treating recurrent patellar dislocation with increased femoral anteversion angle: a retrospective study. INTERNATIONAL ORTHOPAEDICS 2023; 47:2197-2205. [PMID: 37067550 DOI: 10.1007/s00264-023-05798-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 03/26/2023] [Indexed: 04/18/2023]
Abstract
PURPOSE Derotational distal femoral osteotomy (DDFO) has good clinical outcomes for the treatment of the recurrent patellar dislocation combined with increased femoral anteversion angle (FAA). Currently, there is no uniform surgical technique. The purpose of this study was to evaluate the safety and efficacy of computer-aided design (CAD) combined 3D-printed osteotomy guide-assisted DDFO for treating these patients. METHODS In a retrospective study of 36 patients with recurrent patellar dislocation (RPD) from December 2017 to December 2020, all patients had increased FAA and underwent DDFO assisted by CAD combined with a 3D-printed osteotomy guide. Patients' radiological parameters were used to assess the correction of increased femoral torsion and preoperative and postoperative subjective scores were recorded to evaluate the knee function. Complications were recorded to determine the safety of the surgery. RESULT A total of 36 knees were included in this study, with a mean follow-up time of 32.6 ± 8.1 months. The mean age of the patients was 24.9±4.4 years and all patients experienced patellar dislocation preoperatively with a mean of 5.7±3.2 times. The patients' femoral anteversion angle decreased from 35.03±3.05° preoperatively to 14.80±0.87°, and the TT-TG distance decreased from 20.03±1.27 mm preoperatively to 19.22±1.22 mm. The hip-knee-ankle (HKA) angle and Insall-Salvatti index were not significantly different postoperatively compared to preoperatively. The knee function scores and visual analogue scale at the last follow-up were significantly improved compared to the preoperative scores. No major complications such as redislocation, nonunion, fixation or graft failure, or infection were observed in any patients. CONCLUSION Computer-aided design combined with 3D-printed osteotomy guide-assisted derotational distal femoral osteotomy could correct the increased anterior femoral torsion and demonstrate good results. There were no patients experienced re-dislocation during follow-up period and the overall complication rate is low.
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Affiliation(s)
- Jiahui Chen
- Clinical College of Orthopedics, Tianjin Medical University, Tianjin, 300070, People's Republic of China
- Tianjin Hospital, Tianjin, 300211, People's Republic of China
| | - Jianxiong Ma
- Tianjin Hospital, Tianjin, 300211, People's Republic of China
- Tianjin Key Laboratory of Orthopaedic Biomechanics and Medical Engineering, Tianjin, 300050, People's Republic of China
| | - Ying Wang
- Tianjin Hospital, Tianjin, 300211, People's Republic of China
- Tianjin Key Laboratory of Orthopaedic Biomechanics and Medical Engineering, Tianjin, 300050, People's Republic of China
| | - Haohao Bai
- Tianjin Hospital, Tianjin, 300211, People's Republic of China
- Tianjin Key Laboratory of Orthopaedic Biomechanics and Medical Engineering, Tianjin, 300050, People's Republic of China
| | - Bin Lu
- Tianjin Hospital, Tianjin, 300211, People's Republic of China
- Tianjin Key Laboratory of Orthopaedic Biomechanics and Medical Engineering, Tianjin, 300050, People's Republic of China
| | - Xingwen Zhao
- Clinical College of Orthopedics, Tianjin Medical University, Tianjin, 300070, People's Republic of China
- Tianjin Hospital, Tianjin, 300211, People's Republic of China
| | - Yanfei Wu
- Clinical College of Orthopedics, Tianjin Medical University, Tianjin, 300070, People's Republic of China
- Tianjin Hospital, Tianjin, 300211, People's Republic of China
| | - Jing Dai
- Clinical College of Orthopedics, Tianjin Medical University, Tianjin, 300070, People's Republic of China
- Tianjin Hospital, Tianjin, 300211, People's Republic of China
| | - Xinlong Ma
- Clinical College of Orthopedics, Tianjin Medical University, Tianjin, 300070, People's Republic of China.
- Tianjin Hospital, Tianjin, 300211, People's Republic of China.
- Tianjin Key Laboratory of Orthopaedic Biomechanics and Medical Engineering, Tianjin, 300050, People's Republic of China.
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12
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Hogg J, Hampton M, Madan S. Supra tubercular tibial osteotomy and gradual correction with Taylor spatial frame for the management of Torsional malalignment syndrome - surgical technique and outcomes. Knee 2023; 40:8-15. [PMID: 36410254 DOI: 10.1016/j.knee.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 09/28/2022] [Accepted: 11/03/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Surgical management of Torsional Malalignment Syndrome (TMS) traditionally consists of simultaneous correction of both femoral anteversion and external tibial torsion. We hypothesise that a single supra tubercular osteotomy followed by tibial derotation with Taylor Spatial Frame (TSF) is sufficient to provide significant improvement in both appearance and function. METHOD This is a retrospective single surgeon case series performed at a tertiary referral centre in the UK. Data collected included patient demographics, clinical findings and CT rotational profile measurements. All patients completed pre and post-operative Oxford Knee Score (OKS) and Kujala Anterior Knee Pain Scale (AKPS) functional outcome scores for analysis. RESULTS There were 16 osteotomies in 11 patients with complete data sets for analysis performed between 2006 and 2017. Mean age of 16.7 ± 0.8 years. The results show significant improvements in post-operative functional assessment scores, with mean OKS increasing by 18.3 and mean AKPS increasing by 31.4. Average pre-operative thigh-foot angle (TFA) was 44.7°, this was reduced to 12.8° post-operatively, representing an average correction of 31.9°. CONCLUSION The results show that supra tubercular osteotomy, followed by gradual correction with TSF, can be used to provide a significant improvement in both appearance and function for patients suffering from TMS.
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Affiliation(s)
- Jack Hogg
- The University of Sheffield Medical School, Beech Hill Road, Broomhall, Sheffield S10 2RX, United Kingdom.
| | - Matthew Hampton
- Sheffield Children's Hospital, Western Bank, Sheffield S10 2TH, United Kingdom.
| | - Sanjeev Madan
- Sheffield Teaching Hospitals, Glossop Road, Broomhall, Sheffield S10 2JF, United Kingdom.
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