Derotational Osteotomy at the Distal Femur is Effective to Treat Patients with Patellar Instability

Overview

Journal Knee Surg Sports Traumatol Arthrosc

Publisher Wiley

Specialties Emergency Medicine
General Surgery
Orthopedics

Date 2018 Oct 14

PMID 30315327

Citations 42

Authors

Florian B Imhoff

Matthias Cotic

Franz Liska

Felix G E Dyrna

Knut Beitzel

Andreas B Imhoff

Elmar Herbst

Affiliations

Soon will be listed here.

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.

Citing Articles

Distal femoral osteotomy for the treatment of chronic patellofemoral instability improves gait patterns.

Rab P, Vieider R, Fritsch L, Cotic M, Imhoff F, Siebenlist S Arch Orthop Trauma Surg. 2025; 145(1):176.

PMID: 40056196 PMC: 11890233. DOI: 10.1007/s00402-025-05788-x.

Derotational osteotomy is a relevant procedure in the management of lateral patellar dislocation: An expert survey of the International Patellofemoral Study Group.

Wierer G, Milinkovic D, Seitlinger G, Liebensteiner M, Post W, Winkler P J Exp Orthop. 2025; 12(1):e70116.

PMID: 39949711 PMC: 11821726. DOI: 10.1002/jeo2.70116.

The efficacy of medial patellofemoral ligament reconstruction combined with distal femoral varus osteotomy in recurrent patellar dislocation and genu valgum.

Arias Perez R, Jaramillo Quiceno G, Sarmiento Riveros P Musculoskelet Surg. 2025; .

PMID: 39890771 DOI: 10.1007/s12306-024-00878-2.

Small changes of femoral torsion in varus or valgus distal femoral osteotomy using patient-specific instruments.

Jud L, Neopoulos G, Hodel S, Vlachopoulos L, Fucentese S Int Orthop. 2025; 49(3):621-627.

PMID: 39875640 PMC: 11889048. DOI: 10.1007/s00264-025-06415-5.

Derotational distal femoral osteotomy yields better outcomes in patellar subluxation with proximal femoral torsion compared with distal femoral torsion: A retrospective comparative study.

Jia Y, Bao H, Hou J, Sun R, Wang Z, Jiang J J Orthop Surg Res. 2024; 19(1):640.

PMID: 39380005 PMC: 11462965. DOI: 10.1186/s13018-024-05123-x.

References

Gould D, Kelly D, Goldstone L, Gammon J . Examining the validity of pressure ulcer risk assessment scales: developing and using illustrated patient simulations to collect the data. J Clin Nurs. 2002; 10(5):697-706. DOI: 10.1046/j.1365-2702.2001.00525.x. View

Post W, Teitge R, Amis A . Patellofemoral malalignment: looking beyond the viewbox. Clin Sports Med. 2002; 21(3):521-46, x. DOI: 10.1016/s0278-5919(02)00011-x. View

Fucentese S, von Roll A, Koch P, Epari D, Fuchs B, Schottle P . The patella morphology in trochlear dysplasia--a comparative MRI study. Knee. 2006; 13(2):145-50. DOI: 10.1016/j.knee.2005.12.005. View

Schottle P, Romero J, Schmeling A, Weiler A . Technical note: anatomical reconstruction of the medial patellofemoral ligament using a free gracilis autograft. Arch Orthop Trauma Surg. 2007; 128(5):479-84. DOI: 10.1007/s00402-007-0300-4. View

Schottle P, Hensler D, Imhoff A . Anatomical double-bundle MPFL reconstruction with an aperture fixation. Knee Surg Sports Traumatol Arthrosc. 2009; 18(2):147-51. DOI: 10.1007/s00167-009-0868-z. View

Buckens C, Saris D . Reconstruction of the medial patellofemoral ligament for treatment of patellofemoral instability: a systematic review. Am J Sports Med. 2009; 38(1):181-8. DOI: 10.1177/0363546509353132. View

Dickschas J, Harrer J, Pfefferkorn R, Strecker W . Operative treatment of patellofemoral maltracking with torsional osteotomy. Arch Orthop Trauma Surg. 2011; 132(3):289-98. DOI: 10.1007/s00402-011-1303-8. View

Beitzel K, Schottle P, Cotic M, Dharmesh V, Imhoff A . Prospective clinical and radiological two-year results after patellofemoral arthroplasty using an implant with an asymmetric trochlea design. Knee Surg Sports Traumatol Arthrosc. 2012; 21(2):332-9. DOI: 10.1007/s00167-012-2022-6. View

Howells N, Barnett A, Ahearn N, Ansari A, Eldridge J . Medial patellofemoral ligament reconstruction: a prospective outcome assessment of a large single centre series. J Bone Joint Surg Br. 2012; 94(9):1202-8. DOI: 10.1302/0301-620X.94B9.28738. View

10.

Diederichs G, Kohlitz T, Kornaropoulos E, Heller M, Vollnberg B, Scheffler S . Magnetic resonance imaging analysis of rotational alignment in patients with patellar dislocations. Am J Sports Med. 2012; 41(1):51-7. DOI: 10.1177/0363546512464691. View

11.

de Carvalho Jr L, Temponi E, Soares L, Goncalves M, Costa L . Physical activity after distal femur osteotomy for the treatment of lateral compartment knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc. 2012; 22(7):1607-11. DOI: 10.1007/s00167-012-2316-8. View

12.

Banke I, Kohn L, Meidinger G, Otto A, Hensler D, Beitzel K . Combined trochleoplasty and MPFL reconstruction for treatment of chronic patellofemoral instability: a prospective minimum 2-year follow-up study. Knee Surg Sports Traumatol Arthrosc. 2013; 22(11):2591-8. DOI: 10.1007/s00167-013-2603-z. View

13.

Ateschrang A, Freude T, Grunwald L, Schaffler A, Stockle U, Schroter S . [Patella dislocation: an algorithm for diagnostic and treatment considering the rotation]. Z Orthop Unfall. 2014; 152(1):59-67. DOI: 10.1055/s-0033-1360303. View

14.

Nelitz M, Williams R, Lippacher S, Reichel H, Dornacher D . Analysis of failure and clinical outcome after unsuccessful medial patellofemoral ligament reconstruction in young patients. Int Orthop. 2014; 38(11):2265-72. DOI: 10.1007/s00264-014-2437-4. View

15.

Mulliez A, Lambrecht D, Verbruggen D, Van Der Straeten C, Verdonk P, Victor J . Clinical outcome in MPFL reconstruction with and without tuberositas transposition. Knee Surg Sports Traumatol Arthrosc. 2015; 25(9):2708-2714. DOI: 10.1007/s00167-015-3654-0. View

16.

Nelitz M, Dreyhaupt J, Williams S, Dornacher D . Combined supracondylar femoral derotation osteotomy and patellofemoral ligament reconstruction for recurrent patellar dislocation and severe femoral anteversion syndrome: surgical technique and clinical outcome. Int Orthop. 2015; 39(12):2355-62. DOI: 10.1007/s00264-015-2859-7. View

17.

Feucht M, Cotic M, Beitzel K, Baldini J, Meidinger G, Schottle P . A matched-pair comparison of inlay and onlay trochlear designs for patellofemoral arthroplasty: no differences in clinical outcome but less progression of osteoarthritis with inlay designs. Knee Surg Sports Traumatol Arthrosc. 2015; 25(9):2784-2791. DOI: 10.1007/s00167-015-3733-2. View

18.

Strecker W, Dickschas J . [Torsional osteotomy : Operative treatment of patellofemoral maltracking]. Oper Orthop Traumatol. 2015; 27(6):505-24. DOI: 10.1007/s00064-015-0430-8. View

19.

Weber A, Nathani A, Dines J, Allen A, Shubin-Stein B, Arendt E . An Algorithmic Approach to the Management of Recurrent Lateral Patellar Dislocation. J Bone Joint Surg Am. 2016; 98(5):417-27. DOI: 10.2106/JBJS.O.00354. View

20.

OMalley M, Pareek A, Reardon P, Stuart M, Krych A . Distal Femoral Osteotomy: Lateral Opening Wedge Technique. Arthrosc Tech. 2016; 5(4):e725-e730. PMC: 5039957. DOI: 10.1016/j.eats.2016.02.037. View