Surgical Treatment With Closing-Wedge Distal Femoral Osteotomy for Recurrent Patellar Dislocation With Genu Valgum

Nha, Kyung Wook; Ha, Yoonwon; Oh, Seung-Min; Nikumbha, Vivek P; Kwon, Sae Kwang; Shin, Woo Jin; Lee, Byung‐Hoon; Hong, Keun Bae

doi:10.1177/0363546518765479

Cited by 46 publications

(101 citation statements)

References 35 publications

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“…This is because the valgus moment to the patella is reduced by decreasing the Q angle, and the congruity of the patella is thus Table 4 Results of patellofemoral joint congruity improved. However, these results deviate from our study, which showed that there is no effect on the patellar tilt or shift because combined procedures were proactively performed with DFO for patellar instability to improve patellar tracking, including tibial tuberosity osteotomy [23,26], medial reefing [23,25,26] and lateral release [23,26,27]. In our study, the mean preoperative tilt and shift were small at 5.1°and 6.8%, respectively, and there were no cases with patellar instability.…”

Section: Discussioncontrasting

confidence: 88%

“…In terms of DFO performed to correct valgus deformity in knees with patellar instability, several studies have examined the postoperative change in patellar height; however, the results have been inconsistent between studies. Nha et al [23] reported that there was no significant postoperative change in patellar height as assessed by the Caton-Deschamps index in knees that underwent medial closed DFO for patellar dislocation associated with valgus knee deformity. On the other hand, Wilson et al [24] reported a significant reduction in the Caton-Deschamps index following lateral open DFO performed for recurrent patellar instability.…”

Section: Discussionmentioning

confidence: 99%

“…In terms of the tilt and shift of the patella, there are some reports that suggest that DFO for patellar instability with valgus deformity of the knee may lead to significant improvement [23,[25][26][27]. This is because the valgus moment to the patella is reduced by decreasing the Q angle, and the congruity of the patella is thus Table 4 Results of patellofemoral joint congruity improved.…”

Section: Discussionmentioning

confidence: 99%

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Postoperative change in patellofemoral alignment following closing-wedge distal femoral osteotomy performed for valgus osteoarthritic knees

Akaoka

Nakayama

Iseki

et al. 2020

Knee Surg & Relat Res

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Purpose: To evaluate the postoperative change in patellar position after medial closed distal femoral osteotomy (DFO) performed for valgus osteoarthritic knees. Methods: The study included 21 consecutive knees in 20 patients undergoing DFO. A minimum of 2-year followup data was obtained for all subjects with a mean follow-up period of 42 months (range 31-59 months). The patellar position was evaluated on plain radiographs preoperatively, 1-year postoperatively, and 2-year postoperatively. For patellar height, the modified Insall-Salvati Index (mISI), modified Caton-Deschamps Index (mCDI) and modified Blackburne-Peel Index (mBPI) were measured on the standing lateral radiographs. Patellofemoral alignment on the axial plane was assessed on skyline views with 30°flexion based on the measurements for lateral patellar tilt (LPT) and lateral patellar shift (LPS). Measured values at pre-and postoperative phases were statistically compared using a two-way analysis of variance. Results: All indices including mISI, mCDI, mBPI, LPT and LPS showed no statistically significant postoperative changes. Conclusion: Medial closed-wedge DFO performed for valgus osteoarthritic knees did not significantly influence patellofemoral alignment either on the sagittal or axial plane. Therefore, to highlight the clinical relevance of our findings, medial closed-wedge DFO for the valgus knee does not adversely affect the patellofemoral joint. Level of evidence: Level IV, case series.

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Section: Discussioncontrasting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Postoperative change in patellofemoral alignment following closing-wedge distal femoral osteotomy performed for valgus osteoarthritic knees

Akaoka

Nakayama

Iseki

et al. 2020

Knee Surg & Relat Res

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“…The patellar height was measured using the method applied by Insall [12]. The patellar lateral shift (PLS) was calculated by CT at 30 degrees of knee exion, as described by Nha et al [11], and was de ned as the shortest distance from the cortex of the lateral trochlea to the lateral edge of the patella. The pro le information of these patients are presented in Table 1.…”

Section: Clinical and Radiological Evaluationmentioning

confidence: 99%

“…In terms of patellar instability, the popularly accepted opinion is the MPFLR [10]. However, patellar maltracking could be restored by DFO in the patients with genu valgum [11]. So, CWDFO combined MPFLR could be justi ed in these patients with genu valgum.…”

Section: Introductionmentioning

confidence: 99%

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

Jing¹,

Wang²,

Liu³

et al. 2020

Preprint

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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.

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Patellofemoral Instability

Charalambous

2021

The Knee Made Easy

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Surgical Treatment With Closing-Wedge Distal Femoral Osteotomy for Recurrent Patellar Dislocation With Genu Valgum

Abstract: CWDFO combined with medial reefing and lateral release successfully treated RPD with genu valgum for a minimum follow-up of 2 years, with improved patellar alignment and stability.

Cited by 46 publications

References 35 publications

Postoperative change in patellofemoral alignment following closing-wedge distal femoral osteotomy performed for valgus osteoarthritic knees

Postoperative change in patellofemoral alignment following closing-wedge distal femoral osteotomy performed for valgus osteoarthritic knees

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

Patellofemoral Instability

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