Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 May;143(5):2557-2563.
doi: 10.1007/s00402-022-04541-y. Epub 2022 Jul 21.

Combined distal femoral osteotomy and tibial tuberosity distalization is effective in patients presenting with patellar instability and patellofemoral pain due to patella alta and femoral malalignment

Julian Fluegel  1 , Felix Zimmermann  2 , Sebastian Gebhardt  3 , Danko Dan Milinkovic  4 , Peter Balcarek  5   6
Affiliations

Combined distal femoral osteotomy and tibial tuberosity distalization is effective in patients presenting with patellar instability and patellofemoral pain due to patella alta and femoral malalignment

Julian Fluegel et al. Arch Orthop Trauma Surg. 2023 May.

Abstract

Introduction: Patellar malalignment has been considered one of the major pathomechanical causes of patellofemoral instability and pain. The results have been reported after femoral varization/torsional osteotomy and tibial tuberosity distalization osteotomy (TTD-O). However, the combination of a femoral deformity (genu valgum/increased femur antetorsion) and patella alta remains underreported. Therefore, the aim of this study was to investigate the clinical outcomes of patients simultaneously treated by distal femoral osteotomy and TTD-O. The hypothesis was that restoration of patellofemoral (PF) alignment via the abovementioned osteotomies would achieve good patient-reported outcome measures.

Materials and methods: Between 2016 and 2019, a series of 25 knees in 20 patients were treated by a distal femoral osteotomy combined with a TTD-O aiming to correct patellofemoral malalignment consisting of genu valgum and/or increased femur antetorsion and patella alta. Six patients were lost to follow-up, and one patient refused to participate. Thus, 17 knees in 13 patients (male/female 1/12; age 27.4 ± 5.4 years) were included and comprised the study group for this investigation. Patients were evaluated after a mean of 3.1 ± 0.9 years postoperatively. The Kujala anterior knee pain scale and the PF-subscale of the Knee Osteoarthritis and Outcome score (KOOS-PF) were used to assess patients' reported outcome measures from pre- to postoperatively.

Results: The mean amount of torsional correction, valgus correction, and tibial tuberosity distalization averaged 14° (10°-18°), 5.2° (3.8°-8°), and 9 mm (6°-15 mm), respectively. The Kujala score increased by an average of 24.18 points from a mean of 66.6 ± 18.3 points (34-93 points) preoperatively to 90.8 ± 14.2 points (44-100 points) postoperatively (95% CI - 33.0 to - 15.3; p < 0.0001). The KOOS-PF score increased by an average of 33.7 points from a mean of 49.5 ± 24.5 points (9.1-88.6 points) preoperatively to 83.2 ± 21.6 points (15.9 -100 points) postoperatively (95% CI - 47.5 to - 19.9; p < 0.0001).

Conclusion: The findings of this study indicate that the combination of a distal femoral osteotomy and a tibial tuberosity distalization osteotomy is effective in patients presenting with patellar instability and patellofemoral pain due to patella alta and femoral malalignment.

Keywords: Femur antetorsion; Genu valgum; Patella alta; Patellar instability; Patellofemoral pain; Tibial tuberosity distalization.

PubMed Disclaimer

References

    1. Dejour H, Walch G, Nove-Josserand L, Guier C (1994) Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc 2(1):19–26. https://doi.org/10.1007/BF01552649 - DOI - PubMed
    1. Milinkovic DD, Jovandic I, Zimmermann F, Balcarek P (2021) The J-sign and body mass index determine the disease-specific quality of life in patients with lateral patellar instability. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-021-06705-6.Advanceonlinepublication.10.1... - DOI - PubMed
    1. Zhang ZJ, Zhang H, Song GY, Zheng T, Feng H (2020) A preoperative grade 3 J-sign adversely affects short-term clinical outcome and is more likely to yield MPFL residual graft laxity in recurrent patellar dislocation. Knee Surg Sports Traumatol Arthrosc 28(7):2147–2156 - DOI - PubMed
    1. Tanaka MJ, Elias JJ, Williams AA, Demehri S, Cosgarea AJ (2016) Characterization of patellar maltracking using dynamic kinematic CT imaging in patients with patellar instability. Knee Surg Sports Traumatol Arthrosc 24(11):3634–3641 - DOI - PubMed
    1. Van Haver A, De Roo K, De Beule M, Labey L, De Baets P, Dejour D, Claessens T, Verdonk P (2015) The effect of trochlear dysplasia on patellofemoral biomechanics: a cadaveric study with simulated trochlear deformities. Am J Sports Med 43(6):1354–1361. https://doi.org/10.1177/0363546515572143 - DOI - PubMed

LinkOut - more resources