Derotational distal femoral osteotomy improves subjective function and patellar tracking after medial patellofemoral ligament reconstruction in recurrent patellar dislocation patients with increased femoral anteversion: A systematic review and meta‐analysis

Wang, Daofeng; Zheng, Tong; Cao, Yanwei; Zhang, Zhijun; Di, Menglinqian; Fu, Qizhen; Sun, Jianzhong; Zhang, Hui

doi:10.1002/ksa.12021

Cited by 5 publications

(4 citation statements)

References 38 publications

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“…Another, more recent systematic review of six studies investigating outcomes and satisfaction found very similar results but concluded that there is no consensus on when to perform a DeDFO [ 55 ]. A very recent meta‐analysis of 11 studies found a redislocation rate of 1.1% and overall excellent results, including better results when compared to isolated MPFL [ 49 ]. In the present study, which included 12 studies, the minimum cut‐off was 20° of anteversion, but some studies reported it as high as 30° [ 6 , 57 ].…”

Section: Discussionmentioning

confidence: 99%

Promising results following derotational femoral osteotomy in patellofemoral instability with increased femoral anteversion: A systematic review on current indications, outcomes and complication rate

Klasan,

Compagnoni,

Grassi

et al. 2024

J. exp. orthop.

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PurposePatellofemoral joint instability (PFJI) can surgically be treated with a multitude of approaches, depending on the underlying pathology. In the presence of increased femoral anteversion, some authors have reported good results with a derotational distal femoral osteotomy (DeDFO). The purpose of the study was to investigate the indications, outcomes and complication rate of DeDFO for PFJI.MethodsA systematic review was performed according to the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta‐analyses) by searching Medline, Embase, Web of Science and Cochrane Library databases through 1 December 2023. Included were levels 1–4 clinical studies of skeletally mature patients undergoing a DeDFO for PFJI irrespective of concomitant procedures. Study characteristics, indications, radiological and clinical outcomes, surgical technique and concomitant procedures, re‐dislocation and complication rate were all analysed, as was methodological quality.ResultsA total of 12 studies including 310 patients (325 knees) were included. Three studies were cohort studies, all others were case series. The mean patient age across the studies was 22 years, and the mean follow‐up was 29.4 months. Femoral anteversion cut‐off was between 20° and 30°. Every study included at least one concurrent soft tissue, bony or combined procedure. Across all studies, one case of re‐dislocation was reported (0.3%) and four implant or osteotomy‐related complications (1.2%) were reported. All studies reported a statistically significant increase in clinical scores.ConclusionThis systematic review of DeDFO for patellofemoral instability in the presence of increased femoral anteversion demonstrates promising clinical results and an extremely low dislocation and complication rate. The heterogeneity of the cut‐off in anteversion and concomitant procedures, especially tibial tubercle osteotomy with seemingly identical results, indicates the need for high‐quality evidence for treating patellofemoral instability. Based upon this systematic review, we strongly recommend that DeDFO be added to the ‘menu à la carte’ of PFJI.Level of EvidenceLevel III Systematic Review.

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Section: Discussionmentioning

confidence: 99%

Promising results following derotational femoral osteotomy in patellofemoral instability with increased femoral anteversion: A systematic review on current indications, outcomes and complication rate

Klasan,

Compagnoni,

Grassi

et al. 2024

J. exp. orthop.

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“…These knees typically exhibit high-grade patellar mal-tracking, which may persist even after soft tissue reconstruction, resulting in the persistence of residual J-sign and an inability to define a favourable clinical outcome. Correction of these bony risk factors through osteotomy is deemed necessary [8,12,13,20,24,33]. Based on relatively large samples, this study describes the epidemiological characteristics of various bony structural abnormalities in knees with high-grade J-sign, aiming to facilitate precise preoperative assessment and guide intraoperative decision-making.…”

Section: Patellar J-sign and Bony Abnormalitiesmentioning

confidence: 99%

Recurrent patellar dislocation patients with high‐grade J‐sign have multiple structural bone abnormalities in the lower limbs

Wang,

Zhang,

Cao

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeTo explore the relationship between preoperative J‐sign grading and structural bone abnormalities in patients with recurrent patellar dislocation (RPD).MethodsA retrospective study was conducted on RPD patients over 5 years. Patients were categorised based on J‐sign grade into low (J‐ and J1+), moderate (J2+) and high groups (J3+). Trochlear dysplasia (TD) and osseous structures (femoral anteversion angle [FAA], knee torsion, tibial tuberosity‐trochlear groove [TT‐TG] distance, Caton–Deschamps index) were assessed and grouped according to risk factor thresholds. The χ2 test was used to compare composition ratio differences of structural bone abnormalities among the groups.ResultsA total of 256 patients were included, with 206 (80.5%) females. The distribution of J‐sign grade was as follows: 89 knees (34.8%) of low grade, 86 moderate (33.6%) and 81 high (31.6%). Among the five structural bone abnormalities, TD was the most common with a prevalence of 78.5%, followed by increased TT‐TG at 47.4%. Excessive tibiofemoral rotation had the lowest occurrence at 28.9%. There were 173 (67.6%) patients who had two or more abnormalities, while 45 (17.6%) had four to five bony abnormalities. Among patients with any bony abnormality, the proportion of high‐grade J‐sign surpassed 40%. Patients with moderate and high‐grade J‐sign had more increased FAA and more pronounced patella alta (all p < 0.001). The proportion of excessive knee torsion and TD increased with increasing each J‐sign grade, with the more notable tendency in knee torsion (high vs. moderate vs. low‐grade: 61% vs. 22% vs 7%, p < 0.001). Furthermore, the higher J‐sign grade was also associated with more combined bony abnormalities (p < 0.001). In the high‐grade J‐sign group, 90.2% of the knees had two or more bony risk factors and 40.7% had four or more, which were significantly higher than the moderate and low‐grade J‐sign groups (40.7% vs. 11.6% vs. 2.2%, p < 0.001).ConclusionIn patients with a high‐grade J‐sign, over 90% of the lower limbs had two or more structural bone risk factors, and more than 40% had four or more. These proportions were significantly higher compared to knees with low‐grade and moderate J‐sign. In clinical practice, when treating high‐grade patellar mal‐tracking, it is important to focus on and correct these strongly correlated abnormal bone structures.Level of EvidenceLevel III.

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“…This leads to heightened medial patellofemoral ligament (MPFL) tension, increased stress on the lateral patella facet, and reduced stress on the medial patella facet [6,20]. Derotational distal femur osteotomy (DDFO) is the main surgical procedure for correcting enlarged femoral torsion in patients with patellar dislocation [12,13,23].…”

Section: Introductionmentioning

confidence: 99%

“…The FAA can guide the angle of rotational osteotomy. However, there is no consensus on the indications of DDFO in the treatment of recurrent patellar dislocation [10,23]. Kaiser et al [14], for example, believe that DDFO should be performed when the FAA exceeds 20°, whereas Zhang et al [27] believed that DDFO has good clinical results when the FAA exceeds 30°.…”

Section: Introductionmentioning

confidence: 99%

Decreased femoral trochlea axial orientation corrected by derotational distal femur osteotomy in patients with patellar dislocation yields satisfactory outcomes

Li,

Chen,

Huo

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeThe femoral trochlea axial orientation has been shown to be a better predictor of patellar dislocation than the femoral anteversion angle. However, no study has investigated the importance of the femoral trochlea axial orientation in the surgical treatment of patellar dislocation. It is aimed to explore the pathological threshold of the femoral trochlea axial orientation and its guiding implications for surgical interventions in the study.MethodsSixty‐four patients with patellar dislocation and 64 controls were included for measurement of the femoral trochlea axial orientation. The ability to predict the patellar dislocation and the pathologic threshold of the femoral trochlea axial orientation were evaluated using the receiver operating characteristic curve. One hundred patients with medial patellofemoral ligament reconstruction and 25 patients with derotational distal femur osteotomy were divided into two groups based on the femoral trochlea axial orientation cut‐off value and their postoperative knee functions, and patellar tilt angles were compared.ResultsThere were significant differences in the femoral trochlea axial orientation (60.8 ± 7.9 vs. 67.8 ± 4.6, p < 0.05) between patients with patellar dislocation and the normal population. The sensitivity and specificity of the femoral trochlea axial orientation were 0.641 and 0.813, respectively, at the femoral trochlea axial orientation smaller than 63.8°. Amongst patients having had isolated medial patellofemoral ligament reconstruction with decreased femoral trochlea axial orientation, knee function was poorer after surgery. The prognosis of patients with the femoral trochlea axial orientation correction in derotational distal femur osteotomy was better than that for patients without correction.ConclusionsThe femoral trochlea axial orientation had good predictive efficiency for patellar dislocation. Isolated medial patellofemoral ligament reconstruction is not sufficiently effective for patients with patellar dislocation and decreased femoral trochlea axial orientation. Patients with a decreased femoral trochlea axial orientation can have better surgical outcomes after correction by derotational distal femur osteotomy.Level of EvidenceLevel III.

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Derotational distal femoral osteotomy improves subjective function and patellar tracking after medial patellofemoral ligament reconstruction in recurrent patellar dislocation patients with increased femoral anteversion: A systematic review and meta‐analysis

Cited by 5 publications

References 38 publications

Promising results following derotational femoral osteotomy in patellofemoral instability with increased femoral anteversion: A systematic review on current indications, outcomes and complication rate

Promising results following derotational femoral osteotomy in patellofemoral instability with increased femoral anteversion: A systematic review on current indications, outcomes and complication rate

Recurrent patellar dislocation patients with high‐grade J‐sign have multiple structural bone abnormalities in the lower limbs

Decreased femoral trochlea axial orientation corrected by derotational distal femur osteotomy in patients with patellar dislocation yields satisfactory outcomes

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