The incidence of complications after derotational femoral and/or tibial osteotomies in patellofemoral disorders in adolescents and active young patients: a systematic review with meta-analysis

Sanchis-Alfonso, Vicente; Doménech, Julio; Ferràs-Tarragó, Joan; Roselló-Añón, Alejandro; Teitge, Robert A.

doi:10.1007/s00167-022-06964-x

Cited by 11 publications

(5 citation statements)

References 46 publications

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“…A previous systematic review investigating complications after DeDFO concluded that the procedure is safe both for patellofemoral instability and for anterior knee pain [ 38 ], the former being observed in the present study as well. 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 ].…”

Section: Discussionsupporting

confidence: 79%

“…Previous systematic reviews demonstrated the safety of the procedure with very low complication rates but also included DeDFO for patellofemoral pain [ 38 ]. A more recent systematic review demonstrated favourable results and a low redislocation rate but only included six studies [ 55 ]; however, both reviews included less than 200 patients.…”

Section: Introductionmentioning

confidence: 99%

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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: Discussionsupporting

confidence: 79%

Section: Introductionmentioning

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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“…Patellofemoral instability (PFI), anterior knee pain due to patellofemoral maltracking and posttraumatic torsional deformities are the most common indication for torsional (= de‐rotational) corrections around the knee joint [8, 10, 25, 31]. In cases of PFI, a combination of bony deformities is common: dysplasia of the trochlea, lateralization of the tibial tubercle, patella alta or torsional deformity of the femur, the tibia or both [5, 7, 14, 26].…”

Section: Introductionmentioning

confidence: 99%

Intraoperative control by Schanz‐screws is inaccurate to achieve the exact amount of correction in de‐rotational osteotomies

Ferner

Klinder

Woerner

et al. 2023

Knee surg. sports traumatol. arthrosc.

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Purpose The accuracy of intraoperative control of correction commonly is achieved by K‐wires or Schanz‐screws in combination with goniometer in de‐rotational osteotomies. The purpose of this study is to investigate the accuracy of intraoperative torsional control in de‐rotational femoral and tibial osteotomies. It is hypothesized, that intraoperative control by Schanz‐screws and goniometer in de‐rotational osteotomies around the knee is a safe and well predictable method to control the surgical torsional correction intraoperatively. Methods 55 consecutive osteotomies around the knee joint were registered, 28 femoral and 27 tibial. The indication for osteotomy was femoral or tibial torsional deformity with the clinical occurrence of patellofemoral maltracking or PFI. Pre‐ and postoperative torsions were measured according to the method of Waidelich on computed tomography (CT) scan. The scheduled value of torsional correction was defined by the surgeon preoperatively. Intraoperative control of torsional correction was achieved by 5 mm‐Schanz‐screws and goniometer. The measured values of torsional CT scan were compared to the preoperative defined and intended values and deviation was calculated separately for femoral and tibial osteotomies. Results The surgeon’s intraoperative measured mean value of correction in all osteotomies was 15.2° (SD 4.6; range 10–27), whereas the postoperatively measured mean value on CT scan was 15.6 (6.8; 5.0–28.5). Intraoperatively the femoral mean value measured 17.9° (4.9; 10–27) and 12.4° (1.9; 10–15) for the tibia. Postoperatively the mean value for femoral correction was 19.8 (5.5; 9.0–28.5) and 11.3 (5.0; 5.0–26.0) for tibial correction. When considering a deviation of plus or minus 3° to be acceptable femorally 15 osteotomies (53.6%) and tibially 14 osteotomies (51.9%) fell within these limits. Nine femoral cases (32.1.%) were overcorrected, four cases undercorrected (14.3%). Four tibial cases of overcorrection (14.8%) and 9 tibial cases of undercorrection (33.3%) were observed. However, the observed difference between femur and tibia regarding the distribution of cases between the three groups did not reach significance. Moreover, there was no correlation between the extent of correction and the deviation from the intended result. Conclusion The use of Schanz‐screws and goniometer in de‐rotational osteotomies as an intraoperative control of correction is an inaccurate method. Every surgeon performing derotational osteotomies must consider this and include postoperative torsional measurement in his postoperative algorithm until new tools or devices are available to guarantee a better intraoperative accuracy of torsional correction. Study design Observational study. Level of evidence III.

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“…In the presence of femoral maltorsion as an underlying deformity for recurrent patellofemoral instability, rotational osteotomy in combination with patellofemoral stabilising techniques can be performed with a satisfactory outcome [7,12,30]. However, realignment procedures in combination with a trochleoplasty, as often required in high-grade dysplastic knees, are invasive, and associated complications have been reported in up to 40% of cases [18,23]. Therefore, careful selection of patients and comprehensive analysis of underlying concomitant deformities are indispensable for improving clinical outcomes [31].…”

Section: Introductionmentioning

confidence: 99%

Increased femoral curvature and trochlea flexion in high-grade patellofemoral dysplastic knees

Hodel

Torrez²,

Hoch³

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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PurposeHigh‐grade patellofemoral dysplasia is often associated with concomitant axial and frontal leg malalignment. However, curvature of the femur and sagittal flexion of the trochlea has not yet been studied in patellofemoral dysplastic knees. The aim of the study was to quantify the femoral curvature and sagittal flexion of the trochlea in both high‐grade patellofemoral dysplastic and healthy knees. MethodsA retrospective case–control study matched 19 high‐grade patellofemoral dysplastic knees (Dejour types C and D) with 19 healthy knees according to sex and body mass index. Three‐dimensional (3D) femoral curvature and sagittal trochlea flexion were analysed. To analyse femoral curvature, the specific 3D radius of curvature (ROC) was calculated. Trochlear flexion was quantified through the development of the trochlea flexion angle (TFA), which is a novel 3D measurement in relation to the anatomical and mechanical femur axis and is referred to as 3D TFAanatomic and 3D TFAmech. The influence of age, gender, height, weight and frontal and axial alignment on ROC and TFA was analysed in a multiple regression model. ResultsOverall ROC was significantly smaller in dysplastic knees, compared with the control group [898.4 ± 210.8 mm (range 452.9–1275.1 mm) vs 1308.4 ± 380.5 mm (range 878.3–2315.8 mm), p < 0.001]. TFA was significantly higher in dysplastic knees, compared with the control group, for 3D TFAmech [13.8 ± 7.2° (range 4.4–33.4°) vs 6.5 ± 2.3° (range 0.8–10.2°), p < 0.001] and 3D TFAanatomic [12.5 ± 7.2° (range 3.1–32.2°) vs 6.4 ± 1.9° (range 2.1–9.1°), p = 0.001]. A smaller ROC was associated with smaller height, female gender and higher femoral ante torsion. An increased TFA was associated with valgus malalignment. ConclusionHigh‐grade patellofemoral dysplastic knees demonstrated increased femoral curvature and sagittal flexion of the trochlea, compared with healthy knees. The ROC and newly described TFA allowed the quantification of the sagittal femoral deformity. TFA and ROC should be incorporated in future deformity analysis to investigate their potential as a target for surgical correction. Level of EvidenceLevel III.

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The incidence of complications after derotational femoral and/or tibial osteotomies in patellofemoral disorders in adolescents and active young patients: a systematic review with meta-analysis

Cited by 11 publications

References 46 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

Intraoperative control by Schanz‐screws is inaccurate to achieve the exact amount of correction in de‐rotational osteotomies

Increased femoral curvature and trochlea flexion in high-grade patellofemoral dysplastic knees

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