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. 2019 Jan;10(1):19-25.
doi: 10.1177/1947603517743545. Epub 2017 Dec 21.

Successful Return to Sport Following Distal Femoral Varus Osteotomy

Pramod B Voleti  1 , Isabella T Wu  2 , Ryan M Degen  1 , Danielle M Tetreault  1 , Aaron J Krych  2 , Riley J Williams 3rd  1
Affiliations

Successful Return to Sport Following Distal Femoral Varus Osteotomy

Pramod B Voleti et al. Cartilage. 2019 Jan.

Abstract

Objective: Distal femoral varus osteotomy (DFVO) is an effective treatment for unloading valgus knee malalignment; however, there is limited evidence on the ability for patients to return to athletics following this procedure. The purpose of this study is to report the functional outcomes and rate of return to sport for athletes that underwent DFVO.

Design: A consecutive series of athletes that had undergone DFVO were retrospectively reviewed. Radiographs were assessed to determine preoperative and postoperative alignment. Institutional registries were used to collect preoperative and postoperative Marx Activity Scale, International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form scores, and return to sport.

Results: Thirteen patients (8 males, 5 females) with a mean age of 24 years (range 17-35 years) and a mean follow-up of 43 months (range 24-74 months) were included in the study. Six patients underwent medial closing wedge DFVO versus 7 patients who underwent lateral opening wedge DFVO. Nine of 13 had concomitant chondral, meniscal, or ligamentous procedures performed. The mean alignment correction was 8° (range 5°-13°). All patients were able to successfully return to sport at a mean of 11 months (range 9-13 months). Furthermore, all 13 patients demonstrated an improvement in both Marx Activity Scale (4-11; P < 0.01) and IKDC scores (53-89; P < 0.01) after surgery.

Conclusions: Correction of valgus knee malalignment through DFVO-either medial closing wedge or lateral opening wedge-can reliably result in improvement in function and return to sport. Concomitant chondral, meniscal, and ligamentous pathology should be addressed.

Keywords: distal femoral varus osteotomy; lateral compartment overload; return to sport; valgus knee malalignment.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Riley J. Williams III: Arthrex, Inc.—IP royalties, paid consultant; Cymedica Inc.—stock or stock options; Histogenics Inc.—research support; JRF Ortho—paid consultant R2T2 Laboratories Inc.—stock or stock options; R2T2 Labs Inc.—unpaid consultant; RecoverX—stock or stock options; Springer—publishing royalties, financial or material support; Stryker—paid consultant. Aaron J. Krych: Aesculap/B.Braun—research support; American Journal of Sports Medicine—editorial or governing board; Arthrex, Inc.—IP royalties, paid consultant; Arthritis Foundation—research support; Ceterix—research support; Histogenics—research support; International Cartilage Repair Society—board or committee member; International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine—board or committee member; Minnesota Orthopedic Society—board or committee member; Musculoskeletal Transplantation Foundation—board or committee member; Vericel—paid consultant.

Figures

Figure 1.
Figure 1.
Kirschner wires are placed under direct imaging establishing the desired amount of medial bone wedge removed per the preoperative plan.
Figure 2.
Figure 2.
A nonlocking bicortical screw has been placed in compression mode to compress the osteotomy site.
Figure 3.
Figure 3.
(A) Final images of the plate construct are obtained. This shows an anteroposterior view of the distal femur with the implant in place. (B) A lateral view is also obtained to ensure appropriate plate placement on the medial cortex of the femur.
Figure 4.
Figure 4.
(A) Standing long-leg radiograph displaying valgus deformity of the left knee with a mechanical axis demonstrated by drawn line. (B) Standing long-leg radiograph displaying corrected deformity of the left knee with mechanical axis status post medial closing wedge distal femoral osteotomy.
See this image and copyright information in PMC

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