Short-term effectiveness of derotational distal femoral osteotomy combined with medial patellofemoral ligament reconstruction for recurrent patellar dislocation_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LI Yuan ¹ , LIU Juncai ¹ , LEI Lei ² , ZHOU Peng ¹ , DENG Fuyuan ¹ ,  LI Zhong ¹

1. Department of Orthopaedics, the Affiliated Hospital of Southwest Medical University & Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou Sichuan, 646000, P.R.China;
2. Department of Rehabilitation Medicine, the Affiliated Hospital of Southwest Medical University, Luzhou Sichuan, 646000, P.R.China;

Corresponding?author：

LI Zhong, Email: 545890312@qq.com

Keywords：

Recurrent patellar dislocation; derotational distal femoral osteotomy; medial patellofemoral ligament; ligament reconstruction

DOI：

10.7507/1002-1892.202009111

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Objective To investigate the short-term effectiveness of derotational distal femoral osteotomy (DDFO) combined with medial patellofemoral ligament (MPFL) reconstruction in treatment of recurrent patellar dislocation with excessive femoral anteversion angle (FAA≥30°). Methods Between June 2017 and August 2019, 17 patients with recurrent patellar dislocation with FAA≥30° were treated with DDFO and MPFL reconstruction. There were 5 males and 12 females, aged 14-22 years, with an average of 17.7 years. The patella dislocated for 2 to 8 times (mean, 3.6 times). The disease duration was 2-7 years (mean, 4.6 years). The patellar apprehension tests were positive. Preoperative pain visual analogue scale (VAS) score, Lysholm score, Tegner score, and Kujala score were 4.2±1.1, 47.8±8.1, 3.6±1.1, and 56.8±5.7, respectively. FAA, mechanical lateral distal femoral angle (mLDFA), lateral patella displacement (LPD), tibial tuberosity-trochlear groove distance (TT-TG) were (34.9±3.4)°, (85.8±3.0)°, (13.7±3.8) mm, and (23.1±2.1) mm, respectively. Results All incisions healed by first intention, and there was no complications such as knee stiffness, infection, and re-dislocation of the patella. All patients were followed up 13-25 months, with an average of 17.7 months. The imaging review showed that 1 case of osteotomy did not union, and achieved satisfactory results after the secondary revision and strengthening fixation; the osteotomies of other patients healed completely after 3 to 4 months of operation. The patellar apprehension tests were negative. At last follow-up, the FAA, mLDFA, LPD, and TT-TG were (15.6±2.7)°, (83.0±2.1)°, (5.0±2.6) mm, and (20.5±2.5) mm, respectively; the VAS score, Lysholm score, Tegner score, and Kujala score were 2.4±1.4, 93.4±7.8, 6.8±1.5, and 89.0±8.0, respectively. There were significant differences in the above indicators between pre- and post-operation (P<0.05). Conclusion DDFO combined with MPFL reconstruction for the recurrent patellar dislocation with excessive FAA (≥30°) can achieve good short-term effectiveness, significantly reduce knee pain, and improve function.

Citation： LI Yuan, LIU Juncai, LEI Lei, ZHOU Peng, DENG Fuyuan, LI Zhong. Short-term effectiveness of derotational distal femoral osteotomy combined with medial patellofemoral ligament reconstruction for recurrent patellar dislocation. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(3): 343-348. doi: 10.7507/1002-1892.202009111 Copy

1.	Nelitz M, Dreyhaupt J, Williams SR, et al. 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): 2355-2362.
2.	Kaiser P, Schmoelz W, Schoettle P, et al. Increased internal femoral torsion can be regarded as a risk factor for patellar instability-A biomechanical study. Clin Biomech (Bristol, Avon), 2017, 47: 103-109.
3.	Diederichs G, K?hlitz T, Kornaropoulos E, et al. Magnetic resonance imaging analysis of rotational alignment in patients with patellar dislocations. Am J Sports Med, 2013, 41(1): 51-57.
4.	Zhang Z, Zhang H, Song G, et al. Increased femoral anteversion is associated with inferior clinical outcomes after MPFL reconstruction and combined tibial tubercle osteotomy for the treatment of recurrent patellar instability. Knee Surg Sports Traumatol Arthrosc, 2020, 28(7): 2261-2269.
5.	Zheng X, Hu Y, Xie P, et al. Surgical medial patellofemoral ligament reconstruction versus non-surgical treatment of acute primary patellar dislocation: a prospective controlled trial. Int Orthop, 2019, 43(6): 1495-1501.
6.	Imhoff FB, 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, 2019, 27(2): 652-658.
7.	Edmonds EW, Fuller CB, Jeffords ME, et al. Femoral derotational osteotomy level does not effect resulting torsion. J Exp Orthop, 2020, 7(1): 9.
8.	Takagi S, Sato T, Watanabe S, et al. Alignment in the transverse plane, but not sagittal or coronal plane, affects the risk of recurrent patella dislocation. Knee Surg Sports Traumatol Arthrosc, 2018, 26(10): 2891-2898.
9.	Yang G, Dai Y, Dong C, et al. Distal femoral morphological dysplasia is correlated with increased femoral torsion in patients with trochlear dysplasia and patellar instability. Bone Joint J, 2020, 102-B(7): 868-873.
10.	Neri T, Parker DA, Beach A, et al. Medial patellofemoral ligament reconstruction with or without tibial tubercle transfer is an effective treatment for patellofemoral instability. Knee Surg Sports Traumatol Arthrosc, 2019, 27(3): 805-813.
11.	Previtali D, Milev SR, Pagliazzi G, et al. Recurrent patellar dislocations without untreated predisposing factors: medial patellofemoral ligament reconstruction versus other medial soft-tissue surgical techniques-A meta-analysis. Arthroscopy, 2020, 36(6): 1725-1734.
12.	張志軍, 張輝, 宋關陽, 等. 股骨前傾角對復發性髕骨脫位術后髕骨穩定性的影響. 中國運動醫學雜志, 2018, 37(12): 989-993.
13.	Nelitz M. Femoral derotational osteotomies. Curr Rev Musculoskelet Med, 2018, 11(2): 272-279.
14.	Yang GM, Wang YY, Zuo LX, et al. Good outcomes of combined femoral derotation osteotomy and medial retinaculum plasty in patients with recurrent patellar dislocation. Orthop Surg, 2019, 11(4): 578-585.
15.	Zhang Z, Zhang H, Song G, et al. A high-grade J sign is more likely to yield higher postoperative patellar laxity and residual maltracking in patients with recurrent patellar dislocation treated with derotational distal femoral osteotomy. Am J Sports Med, 2020, 48(1): 117-127.
16.	Frings J, Krause M, Akoto R, et al. Clinical results after combined distal femoral osteotomy in patients with patellar maltracking and recurrent dislocations. J Knee Surg, 2019, 32(9): 924-933.
17.	程張靜, 薛喆, 張爽. 股骨遠端旋轉截骨術與傳統術式治療復發性髕骨脫位的術后早期臨床觀察. 中國運動醫學雜志, 2017, 36(12): 1097-1099.
18.	Hinterwimmer S, Minzlaff P, Saier T, et al. Biplanar supracondylar femoral derotation osteotomy for patellofemoral malalignment: the anterior closed-wedge technique. Knee Surg Sports Traumatol Arthrosc, 2014, 22(10): 2518-2521.
19.	Kraeutler MJ, Chadayammuri V, Garabekyan T, et al. Femoral version abnormalities significantly outweigh effect of cam impingement on hip internal rotation. J Bone Joint Surg (Am), 2018, 100(3): 205-210.
20.	Lee SY, Jeong J, Lee K, et al. Unexpected angular or rotational deformity after corrective osteotomy. BMC Musculoskeletal Disorders, 2014, 15(1): 175.
21.	Strecker W, Dickschas J. Torsional osteotomy: operative treatment of patellofemoral maltracking. Oper Orthop Traumatol, 2015, 27(6): 505-524.
22.	Liska F, von Deimling C, Otto A, et al. Distal femoral torsional osteotomy increases the contact pressure of the medial patellofemoral joint in biomechanical analysis. Knee Surg Sports Traumatol Arthrosc, 2019, 27(7): 2328-2333.
23.	Nelitz M, Wehner T, Steiner M, et al. The effects of femoral external derotational osteotomy on frontal plane alignment. Knee Surg Sports Traumatol Arthrosc, 2014, 22(11): 2740-2746.

1. Nelitz M, Dreyhaupt J, Williams SR, et al. 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): 2355-2362.
2. Kaiser P, Schmoelz W, Schoettle P, et al. Increased internal femoral torsion can be regarded as a risk factor for patellar instability-A biomechanical study. Clin Biomech (Bristol, Avon), 2017, 47: 103-109.
3. Diederichs G, K?hlitz T, Kornaropoulos E, et al. Magnetic resonance imaging analysis of rotational alignment in patients with patellar dislocations. Am J Sports Med, 2013, 41(1): 51-57.
4. Zhang Z, Zhang H, Song G, et al. Increased femoral anteversion is associated with inferior clinical outcomes after MPFL reconstruction and combined tibial tubercle osteotomy for the treatment of recurrent patellar instability. Knee Surg Sports Traumatol Arthrosc, 2020, 28(7): 2261-2269.
5. Zheng X, Hu Y, Xie P, et al. Surgical medial patellofemoral ligament reconstruction versus non-surgical treatment of acute primary patellar dislocation: a prospective controlled trial. Int Orthop, 2019, 43(6): 1495-1501.
6. Imhoff FB, 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, 2019, 27(2): 652-658.
7. Edmonds EW, Fuller CB, Jeffords ME, et al. Femoral derotational osteotomy level does not effect resulting torsion. J Exp Orthop, 2020, 7(1): 9.
8. Takagi S, Sato T, Watanabe S, et al. Alignment in the transverse plane, but not sagittal or coronal plane, affects the risk of recurrent patella dislocation. Knee Surg Sports Traumatol Arthrosc, 2018, 26(10): 2891-2898.
9. Yang G, Dai Y, Dong C, et al. Distal femoral morphological dysplasia is correlated with increased femoral torsion in patients with trochlear dysplasia and patellar instability. Bone Joint J, 2020, 102-B(7): 868-873.
10. Neri T, Parker DA, Beach A, et al. Medial patellofemoral ligament reconstruction with or without tibial tubercle transfer is an effective treatment for patellofemoral instability. Knee Surg Sports Traumatol Arthrosc, 2019, 27(3): 805-813.
11. Previtali D, Milev SR, Pagliazzi G, et al. Recurrent patellar dislocations without untreated predisposing factors: medial patellofemoral ligament reconstruction versus other medial soft-tissue surgical techniques-A meta-analysis. Arthroscopy, 2020, 36(6): 1725-1734.
12. 張志軍, 張輝, 宋關陽, 等. 股骨前傾角對復發性髕骨脫位術后髕骨穩定性的影響. 中國運動醫學雜志, 2018, 37(12): 989-993.
13. Nelitz M. Femoral derotational osteotomies. Curr Rev Musculoskelet Med, 2018, 11(2): 272-279.
14. Yang GM, Wang YY, Zuo LX, et al. Good outcomes of combined femoral derotation osteotomy and medial retinaculum plasty in patients with recurrent patellar dislocation. Orthop Surg, 2019, 11(4): 578-585.
15. Zhang Z, Zhang H, Song G, et al. A high-grade J sign is more likely to yield higher postoperative patellar laxity and residual maltracking in patients with recurrent patellar dislocation treated with derotational distal femoral osteotomy. Am J Sports Med, 2020, 48(1): 117-127.
16. Frings J, Krause M, Akoto R, et al. Clinical results after combined distal femoral osteotomy in patients with patellar maltracking and recurrent dislocations. J Knee Surg, 2019, 32(9): 924-933.
17. 程張靜, 薛喆, 張爽. 股骨遠端旋轉截骨術與傳統術式治療復發性髕骨脫位的術后早期臨床觀察. 中國運動醫學雜志, 2017, 36(12): 1097-1099.
18. Hinterwimmer S, Minzlaff P, Saier T, et al. Biplanar supracondylar femoral derotation osteotomy for patellofemoral malalignment: the anterior closed-wedge technique. Knee Surg Sports Traumatol Arthrosc, 2014, 22(10): 2518-2521.
19. Kraeutler MJ, Chadayammuri V, Garabekyan T, et al. Femoral version abnormalities significantly outweigh effect of cam impingement on hip internal rotation. J Bone Joint Surg (Am), 2018, 100(3): 205-210.
20. Lee SY, Jeong J, Lee K, et al. Unexpected angular or rotational deformity after corrective osteotomy. BMC Musculoskeletal Disorders, 2014, 15(1): 175.
21. Strecker W, Dickschas J. Torsional osteotomy: operative treatment of patellofemoral maltracking. Oper Orthop Traumatol, 2015, 27(6): 505-524.
22. Liska F, von Deimling C, Otto A, et al. Distal femoral torsional osteotomy increases the contact pressure of the medial patellofemoral joint in biomechanical analysis. Knee Surg Sports Traumatol Arthrosc, 2019, 27(7): 2328-2333.
23. Nelitz M, Wehner T, Steiner M, et al. The effects of femoral external derotational osteotomy on frontal plane alignment. Knee Surg Sports Traumatol Arthrosc, 2014, 22(11): 2740-2746.

Chinese Journal of Reparative and Reconstructive Surgery

Short-term effectiveness of derotational distal femoral osteotomy combined with medial patellofemoral ligament reconstruction for recurrent patellar dislocation

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