Patellofemoral dysbalance and genua valga: outcome after femoral varisation osteotomies

Abstract

Introduction: Patellofemoral dysbalance may be caused by trochlear dysplasia, an elevated TTTG distance, femoral or tibial torsional deformities, patella alta, or a genu valgum. The surgical procedure for the treatment of a genu valgum is varisation osteotomy, usually in the femoral aspect. Several authors believe that a genu valgum is one cause of patellofemoral dysbalance, but studies about the outcome of the treatment with a varisation osteotomy are rare.

Materials and methods: Nineteen knees in 18 patients, aged on average 28 (16-52) years were investigated in a retrospective study. The patients had symptoms of patellofemoral instability or anterior knee pain due to a genu valgum, without symptoms of a lateral femorotibial compartment. All patients underwent a femoral varisation osteotomy. The diagnostic investigation prior to surgery included full-leg radiographs and torsional angle CT scans. The pre-surgery and follow-up investigation included the visual analog scale (VAS), the Kujala score, the Japanese Knee Society score, the Lysholm score.

Results: The mean duration of follow-up was 44(10-132) months. The mean preoperative mechanical valgus was 5.6° (range 4-10°). Twelve patients mentioned patellar instability as the main symptom while 14 mentioned anterior knee pain. No redislocation occurred in the follow-up period. Anterior knee pain on the VAS (p value < 0.001) was significantly reduced (5.6-2.1). The Japanese Knee Society score improved from 87 to 93 (p value 0.013) points, the Kujala score improved significantly from 72 to 87 (p value 0.009), and the Lysholm score significantly from 76 to 92 (p value < 0.001).

Conclusion: Genua valga can lead to patellofemoral dysbalance, treatment of this condition is femoral varisation osteotomy. In this study, patellofemoral stability was achieved and anterior knee pain was significantly reduced. Significant improvements in clinical scores proved the success of the treatment.

Level of evidence: IV, case series.

Keywords: Anterior knee pain; Genua valga; Patellar dislocations; Patellofemoral dysbalance; Varisation osteotomy.