Supracondylar femur osteotomies around the knee

Jm, Brinkman; Freiling, D.; Lobenhoffer, P.; Ae, Staubli; Rj, van Heerwaarden

doi:10.1007/s00132-014-3007-6

Cited by 44 publications

(27 citation statements)

References 52 publications

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“…Due to valgus of the femur and an inability to bring the feet together, an oblique joint line was also observed in type 5 valgus alignment, which is comparable to previously reported results [ 23 ]. Therefore, distal femur osteotomy is performed in patients with valgus osteoarthritis [ 28 ], and the joint line in these patients may also be corrected to be horizontal to the floor after the osteotomy. In patients with knee osteoarthritis with type 5 valgus alignment before osteoarthritis, perpendicular bony cut to the mechanical axis during TKA causes approximately 4.2° of extension gap tightness in the lateral side.…”

Section: Discussionmentioning

confidence: 99%

Mismatch between femur and tibia coronal alignment in the knee joint: classification of five lower limb types according to femoral and tibial mechanical alignment

Lin

Chang

Chen

et al. 2018

BMC Musculoskelet Disord

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BackgroundReasons for dissatisfaction with total knee arthroplasty (TKA) include unequal flexion or extension gap, soft tissue imbalance, and patella maltracking, which often occur with mismatch between femoral and tibial coronal bony alignment in the knee joint or extremely varus or valgus alignment. However, lower limb coronal alignment classification is based only on hip–knee–ankle angle (HKAA), leading to oversight regarding a mismatch between femoral and tibial coronal alignment. We aimed to classify alignment of the lower limbs according to the mechanical alignment of the femur and tibia in a healthy population.MethodsAll 214 normal triple films were reviewed retrospectively. HKAA, mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA), angle between the femoral anatomical axis and the mechanical axis (AA-MA), and knee alignment angle (KAA) were measured. Subjects were categorized into one of five types based on the mechanical alignment of femur and tibia.ResultsMean HKAA, mLDFA, and mMPTA of all subjects were 1.2°, 87.3°, and 85.8°, respectively. All subjects were classified into one of five types with significant differences (p < 0.001). About 61% of subjects showed neutral alignment, of which nearly 40% were type 2 (valgus of the femur and varus of the tibia with oblique joint line: mLDFA 85.0° ± 1.4°, mMPTA 85.1° ± 1.2°, TJLA 2.7° ± 2.4°) and 60% exhibited neutral alignment with a neutral femur and tibia (type 1). In varus and valgus types, mismatch between the mechanical angle of the femur and tibia was common. Varus alignment, including types 3 (varus of the tibia: mLDFA 88.0° ± 1.4°, mMPTA 83.5° ± 1.6°) and 4 (varus of both the tibia and femur: mLDFA 91.4° ± 1.4°, mMTPA 85.2° ± 2.0°), was found in 30% of subjects. Valgus alignment (type 5 valgus of femur: mLDFA 84.6° ± 1.6°, mMPTA 88.8° ± 2.0°) accounted for 8.9% of all subjects.ConclusionsMismatch between mechanical alignment of the femur and tibia was common in varus and valgus alignment types. Joint line obliquity was also observed in 40% of the neutral alignment population. This classification provides a quick, simple interpretation of femoral and tibial coronal alignment, and more detailed guidance for preoperative planning for TKA than the traditional varus–neutral–valgus classification.Electronic supplementary materialThe online version of this article (10.1186/s12891-018-2335-9) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Mismatch between femur and tibia coronal alignment in the knee joint: classification of five lower limb types according to femoral and tibial mechanical alignment

Lin

Chang

Chen

et al. 2018

BMC Musculoskelet Disord

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“…Distal femoral osteotomy (DFO), though most commonly advocated as a treatment option for lateral-compartment osteoarthritis,9 recently has been found to be effective for chronic patellar dislocation as well 10111213. DFO helps to correct excessive Q angle and genu valgum deformity, both of which are commonly associated with patellar instability 12.…”

Section: Introductionmentioning

confidence: 99%

“…DFO helps to correct excessive Q angle and genu valgum deformity, both of which are commonly associated with patellar instability 12. Furthermore, biplanar closing-wedge DFO (CWDFO) provides better stability and promotes bone healing, due to increased cancellous bone surface area at the osteotomy site 9101415. For these reasons, CWDFO could be a valuable procedure in a chronic patellar instability patient with excessive Q-angle stemming from significant genu valgum, Additional medial reefing with lateral release could be helpful when instability would be potentially intractable in the patient 1011121316…”

Section: Introductionmentioning

confidence: 99%

A Combined Closing Wedge Distal Femoral Osteotomy and Medial Reefing Procedure for Recurrent Patellar Dislocation with Genu Valgum

et al. 2017

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PurposeRecurrent patellar dislocation is often associated with genu valgum. The purpose of this study was to analyze the short-term results of single-incision, closing-wedge distal femoral osteotomy (CWDFO) combined with medial reefing and lateral release for recurrent patellar instability with genu valgum.Materials and MethodsCombined CWDFO/medial reefing/lateral release was performed on 10 knees. Clinical evaluation was based on pre- and postoperative Knee Society Score (KSS) and Kujala patellofemoral score. Radiographic evaluation was performed with reference to the weight-bearing line (WBL), the femorotibial angle (FTA), and the mechanical lateral distal femoral angles in the knee-standing view.ResultsAt a mean follow-up of 20±11.7 months (range, 12–42 months), KSS scores improved significantly, from 46.7±5.2 preoperatively to 87±4.4 postoperatively (p<0.001), as did the Kujala score, from 44±8 preoperatively to 86.6±6.8 postoperatively (p<0.001). The WBL decreased significantly, from 76±7% preoperatively to 41±11% postoperatively (p<0.001). The FTA was improved significantly, from 12.7±1.7° preoperatively to 4±4° postoperatively (p<0.001), as was the mLDFA, from 83±4° preoperatively to 91±1.3° postoperatively (p<0.001).ConclusionUse of single-incision CWDFO combined with medial reefing and lateral release prevents patellar dislocation, corrects deformity, and improves clinical outcomes.

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“…Increased femoral antetorsion is one important risk factor for patellofemoral instability and anterior knee pain syndrome in teenagers and young adults [ 1 – 4 ]. Correction osteotomy at the distal femur has been shown to be a reliable option for correction of torsional pathologies [ 4 – 8 ]. Increased lateral facet pressure and increased medial retinaculum strain was shown to be correlated with increased femoral antetorsion [ 9 – 11 ].…”

Section: Introductionmentioning

confidence: 99%

Single cut distal femoral osteotomy for correction of femoral torsion and valgus malformity in patellofemoral malalignment - proof of application of new trigonometrical calculations and 3D-printed cutting guides

Imhoff

Schnell

Magaña

et al. 2018

BMC Musculoskelet Disord

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BackgroundThe purpose of this study was to perform a derotational osteotomy at the distal femur, as is done in cases of patellofemoral instability, and demonstrate the predictability of three-dimensional (3D) changes on axes in a cadaveric model by the use of a new mathematical approach.MethodsTen human cadaveric femurs, with increased antetorsion, underwent a visually observed derotational osteotomy at the distal femur by 20°, as is commonly done in clinics. For surgery, a single cut osteotomy with a defined cutting angle was calculated and given using a simple 3D-printed cutting guide per specimen, based on a newly-created trigonometrical model. To simulate post-operative straight frontal alignment in a normal range, a goal for the mechanical lateral distal femur angle (mLDFA) was set to 87.0° for five specimens (87-goal group) and 90.0° for five specimens (90-goal group). Specimens underwent pre- and post-operative radiographic analysis with CT scan for torsion and frontal plane x-ray for alignment measurements of mLDFA and anatomical mechanical angle (AMA).ResultsPerformed derotation showed a mean of 19.69° ±1.08°SD (95% CI: 18.91° to 20.47°). Regarding frontal alignment, a mean mLDFA of 86.9° ±0.66°SD (87-goal-group) and 90.42° ±0.25° SD (90-goal group), was observed (p = 0.008). Overall, the mean difference between intended mLDFA-goal and post-operatively achieved mLDFA was 0.14° ±0.56° SD (95% CI: -0.26° to 0.54°).ConclusionA preoperative calculated angle for single cut derotational osteotomy at the distal femur leads to a clinically precise post-operative result on torsion and frontal alignment when using this approach.

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Supracondylar femur osteotomies around the knee

Cited by 44 publications

References 52 publications

Mismatch between femur and tibia coronal alignment in the knee joint: classification of five lower limb types according to femoral and tibial mechanical alignment

Mismatch between femur and tibia coronal alignment in the knee joint: classification of five lower limb types according to femoral and tibial mechanical alignment

A Combined Closing Wedge Distal Femoral Osteotomy and Medial Reefing Procedure for Recurrent Patellar Dislocation with Genu Valgum

Single cut distal femoral osteotomy for correction of femoral torsion and valgus malformity in patellofemoral malalignment - proof of application of new trigonometrical calculations and 3D-printed cutting guides

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