Closing-wedge Distal Femoral Osteotomy Combined with Medial Patellofemoral Ligament Reconstruction for Recurrent Patellar Dislocation with Genu Valgum

Abstract

Background: Medial patellofemoral ligament reconstruction (MPFLR) is a well-established procedure for addressing recurrent patellar dislocation (RPD) in young patients. However, for RPD with genu valgum, simultaneous MPFLR and closing-wedge distal femoral osteotomy (CWDFO) may be a promising procedure yet rarely reported. This study’s purpose was to observe and analyse the clinical and imaging findings of CWDFO combined with MPFLR for RPD with genu valgum.Methods: From May 2015 to Apirl 2018, 25 patients with RPD and genu valgum were surgically treated in our department. Anteroposterior long-leg, weight-bearing, lower-extremity radiographs, lateral radiographs and computed tomography (CT) scans of the patellofemoral joint were obtained, and the femorotibial angle (FTA), mechanical lateral distal femoral angle (mLDFA), weight-bearing line rate (WBLR), patellar height, patellar lateral shift (PLS) and tibial tubercle–trochlear groove (TT-TG) distance were analysed. Validated knee scores, such as the Kujala, Lysholm, visual analogue scale (VAS) scores and Tegner socres, were evaluated preoperatively and 2 years postoperatively.Results: 25 patients, with an average age of 19.8 years (14–27), were evaluated. All patients had been able to achieve a better sports level without any problems during the 2-year follow-up period. There has been no recurrence of patellar instability. Compared with preoperation, the FTA, mLDFA, WBLR and PLS showed statistically significant improvement following the procedure (p < 0.001). Meanwhile, no significant differences in the Insall index and TT-TG distance was found. The mean Kujala score, average Lysholm score, VAS score and Tegner socres showed significant improvement postoperatively.Conclusions: CWDFO combined with MPFLR is a suitable treatment for RPD with genu valgum, as it leads to significant improvement in the clinical and imaging findings of the knee in the short term.