Return to sport following distal femur osteotomy: a systematic review

Abstract

Introduction Distal femur osteotomies (DFOs) are well-accepted procedures in treating unicompartmental knee osteoarthritis associated with valgus malalignment. This study aims to investigate the Return to sport (RTS) after DFO. Materials and methods We conducted a systematic review of the literature according to the PRISMA guidelines, including all articles published in English, with no time limit, excluding double-level knee osteotomies. Results Five articles were included for an overall cohort of 76 patients. The mean follow-up was 45.53 months. The mean age of the patients at the time of surgery was 33.87 years, and the mean malalignment was 5.59° in valgus. In 70 cases, patients received a lateral DFO, while in 6 cases, a medial closing-wedge DFO. An RTS of 86.1% was observed after DFO and a mean time to RTS of 12.3 months. 76.8% of patients recovered to a level equal to or higher than that practiced before the onset of symptoms. No statistically significant differences were observed in the RTS rate between those who performed lateral or medial DFO. Conclusions RTS after DFO is ubiquitous and occurs around one year after surgery. In most cases, patients report improved performance compared to what they experienced before the onset of symptoms. Unfortunately, while athletes often have RTS at a similar or better level, other patients often see a return to lower impact sports.

Return to Sport in Middle-aged and Older Athletes After Unicompartmental Knee Arthroplasty at a Mean 10-Year Follow-up: Radiographic and Clinical Outcomes

“…Return to sport after these procedures is not predictable, and many patients alter their activities to lower-impact activities. 8,20,24,37 In a meta-analysis by Krych et al, 20 only 76% of patients (mean age, 35 years) returned to sport at 1 to 2 years; however, sports and levels of return were not specified. Rupp et al 37 reported that, after double-level osteotomy, patients returned to sports but at a lower frequency and reduced number of sports and with a shift to low-impact sports.…”

“…Athletes often report that they are unable to return to sporting activities for a minimum of 1 to 2 years after surgery, and many fail to return to the same level of sport. 1,4,8,24,37 Recent data demonstrate that athletes shift toward lower-impact sporting activities after osteotomy and cartilage repair procedures. 37 It is projected that 1 of every 4 adults in the United States will have arthritis by the year 2030.…”

“…18,19 Treatment options have historically included nonoperative treatment, followed by femoral and tibial osteotomies and complex cartilage restoration procedures. 1,4,5,8,24,26,27,30,37 These surgical treatments require a lengthy period of nonweightbearing and a conservative rehabilitation regimen. Athletes often report that they are unable to return to sporting activities for a minimum of 1 to 2 years after surgery, and many fail to return to the same level of sport.…”

In closed wedge distal femur osteotomies for correction of valgus malalignment overcorrection of mLDFA should be avoided

“…There is no existing evidence whether the lateral opening wedge or the medial closing wedge technique leads to better clinical outcome [25, 30, 50]. Although there are several publications which reported on comparable results after DFO and lateral unicompartimental knee arthroplasty [34] and encouraging results regarding sports activities [7], no reports of the influence of joint angles are available. In case of varus knees, the influence of oblique joint line after high tibial osteotomy on the shear forces is published [29].…”

Assessment of return to sport and functional outcomes following distal femoral, double level and high tibial osteotomies for active patients with symptomatic varus malalignment

“…The demand for the return to sports (RTS) after KO is increasing with 71% of patients undergoing HTO motivated to return to their original sport activity [31]. Reviews show that 86–87% of patients after DFO [1, 10], 92% after DLO [29], and 76–94% after HTO [18, 21, 31] can return to sports at their pre‐surgery level. However, there are evidence and also systematic reviews evaluating RTS after KO [1, 10, 18, 21, 29, 31], and no evidence comparing outcomes among DFO, DLO and HTO.…”