Case 12: Bilateral Distal Femoral Osteotomy, Opening Wedge with Plate, for Genu Valgum

Purpose. The aims of this study were to (1) examine the timeline of return to sport (RTS) following isolated lateral opening wedge distal femoral osteotomy (DFO), (2) evaluate the degree of participation on RTS, and (3) identify risk factors for failure to RTS. Methods. Nineteen consecutive patients undergoing isolated lateral opening wedge DFO were reviewed retrospectively at a minimum of 2 years postoperatively. Patients completed a sports questionnaire, visual analogue scale for pain (VAS-Pain), Single Assessment Numerical Evaluation (SANE), and a satisfaction questionnaire. Results. Seventeen patents (89.5%; age 32.1 ± 10.1 years; gender 9 males, 52.9%) were contacted at 7.3 ± 4.4 years (range 2.0-13.8 years). Twelve patients (70.6%) resumed playing ≥1 sport at an average time of 9.5 ± 3.3 months (range 3-12 months). Of these 12 patients, 6 returned to a lower level of participation (50.0%). Seven patients (41.2%) had returned to the operating room for further surgery, which included removal of hardware (5.9%) and total knee arthroplasty (5.9%). The average VAS-Pain, SANE, and Marx scores were 3.4 ± 2.6 (range 0-8), 56.2 ± 18.7 (range 20-85), and 5.0 ± 5.3 (range 0-16), respectively. Fourteen patients (82.4%) were at least somewhat satisfied with their procedure. Conclusion. In patients with isolated lateral compartment osteoarthritis and valgus deformity, lateral opening wedge DFO allows 70.6% of patients to RTS by 9.5 ± 3.3 months. However, most patients may be unable to return to their presymptomatic level of function. Patient expectations regarding RTS can be appropriately managed with adequate preoperative patient education. Level of Evidence. IV, case series.

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

10.21203/rs.3.rs-38833/v1 ◽

2020 ◽

Author(s):

Lizhong Jing ◽

Xiaole Wang ◽

Kun Liu ◽

Xiaotan Wang ◽

Lu Jiang ◽

...

Keyword(s):

Patellar Dislocation ◽

Ligament Reconstruction ◽

Medial Patellofemoral Ligament ◽

Weight Bearing ◽

Femoral Osteotomy ◽

Genu Valgum ◽

Imaging Findings ◽

Medial Patellofemoral Ligament Reconstruction ◽

Recurrent Patellar Dislocation ◽

Distal Femoral Osteotomy

Abstract 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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Closing-wedge distal femoral osteotomy combined with medial patellofemoral ligament reconstruction for recurrent patellar dislocation with genu valgum

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04554-5 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Lizhong Jing ◽

Xiaole Wang ◽

Xiaoliang Qu ◽

Kun Liu ◽

Xiaotan Wang ◽

...

Keyword(s):

Patellar Dislocation ◽

Ligament Reconstruction ◽

Medial Patellofemoral Ligament ◽

Weight Bearing ◽

Femoral Osteotomy ◽

Genu Valgum ◽

Imaging Findings ◽

Medial Patellofemoral Ligament Reconstruction ◽

Recurrent Patellar Dislocation ◽

Distal Femoral Osteotomy

Abstract Background Medial patellofemoral ligament reconstruction (MPFLR) is a well-established procedure for addressing recurrent patellar dislocation (RPD) in young patients. However, despite being a promising procedure for RPD with genu valgum, there is a scarcity of reports on simultaneous MPFLR and closing-wedge distal femoral osteotomy (CWDFO). The purpose of the present study 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 April 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 anatomical femorotibial angle (aFTA), 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. During the 2-year follow-up period, all patients were able to achieve a better sports level without any problems, with no recurrence of patellar instability. Compared with preoperation, the aFTA, 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 were found. The mean Kujala score, average Lysholm score, VAS score and Tegner socres showed significant postoperative improvement. Conclusions CWDFO combined with MPFLR is a suitable treatment for RPD with genu valgum, and can lead to significant improvement in the clinical and imaging findings of the knee in the short term.

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Technique for Biplanar Lateral Opening Wedge Distal Femoral Osteotomy in the Valgus Knee

Arthroscopy Techniques ◽

10.1016/j.eats.2020.05.013 ◽

2020 ◽

Vol 9 (9) ◽

pp. e1323-e1333

Author(s):

Robert A. Duerr ◽

Sarah Harangody ◽

Robert A. Magnussen ◽

Christopher C. Kaeding ◽

David C. Flanigan

Keyword(s):

Femoral Osteotomy ◽

Valgus Knee ◽

Opening Wedge ◽

Distal Femoral Osteotomy ◽

Lateral Opening Wedge

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

The American Journal of Sports Medicine ◽

10.1177/0363546518765479 ◽

2018 ◽

Vol 46 (7) ◽

pp. 1632-1640 ◽

Cited By ~ 9

Author(s):

Kyung Wook Nha ◽

Yoonwon Ha ◽

Seungmin Oh ◽

Vivek P. Nikumbha ◽

Sae Kwang Kwon ◽

...

Keyword(s):

Surgical Treatment ◽

Patellar Dislocation ◽

Femoral Osteotomy ◽

Genu Valgum ◽

Lateral Release ◽

Trochlear Groove ◽

Recurrent Patellar Dislocation ◽

Distal Femoral Osteotomy ◽

The Mean

Background: Closing-wedge distal femoral osteotomy (CWDFO)—combined with medial reefing and lateral release, if necessary— has been used to treat recurrent patellar dislocation (RPD) with genu valgum. Purpose: To evaluate the clinical and radiologic outcomes of surgical treatment with CWDFO for treatment of RPD with genu valgum. Study Design: Case series; Level of evidence, 4. Methods: Fourteen consecutive patients (23 knees) with RPD and genu valgum were treated with CWDFO. Patients with a minimum 2-year follow-up period were eligible for this study. Patients with prior failed surgery were also eligible. Radiographic evaluation was performed with mechanical femorotibial and lateral distal femoral angle. The radiographic parameters presenting patellar positions and pathologic abnormalities associated with RPD were evaluated. Chondral lesion changes in second-look arthroscopic examination were examined, and clinical outcomes (eg, occurrence of redislocation, range of motion, and clinical scores) were assessed pre- and postoperatively at a minimum of 2 years. Results: At a mean follow-up of 30.7 months (range, 25-62 months), the mean mechanical femorotibial and mechanical lateral distal femoral angles changed significantly from valgus 5° (range, 2°-11°) to varus 3° (2°-11°; P < .001) and from 83° (range, 78°-86°) to 89° (84°-92°; P < .001), respectively. The mean patellar congruence angle improved from 40° lateral (range, 20°-53° lateral) to 4° medial (23° medial to 21° lateral; P < .001), as did the lateral patellofemoral angle from 26° (range, 8°-62°) to 9° (0°-15°; P < .001). Computed tomography scans showed that the mean distance of patellar lateral shift decreased from 13.5 mm (range, 4-22 mm) to 2.0 mm (–4 to 5 mm; P < .001). The mean tibial tubercle to trochlear groove distance significantly decreased from 20.4 to 13.5 mm ( P < .001), while the Caton-Deschamps ratio did not change significantly after surgery ( P = .984). Chondral lesions of the patella and trochlear groove significantly improved or were maintained. None of the patients experienced subluxation or redislocation after surgery. Patellar instability symptoms also improved, as validated by radiographic and other clinical outcomes. Conclusion: 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.

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The effect of lateral opening wedge distal femoral osteotomy on leg length

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-014-3387-5 ◽

2014 ◽

Vol 24 (3) ◽

pp. 847-854 ◽

Cited By ~ 12

Author(s):

A. Madelaine ◽

T. Lording ◽

V. Villa ◽

S. Lustig ◽

E. Servien ◽

...

Keyword(s):

Femoral Osteotomy ◽

Leg Length ◽

Opening Wedge ◽

Distal Femoral Osteotomy ◽

Lateral Opening Wedge

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Long term outcomes of computer navigated lateral opening wedge distal femoral osteotomy for lateral compartment knee arthrosis

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00527 ◽

2020 ◽

Vol 8 (9_suppl7) ◽

pp. 2325967120S0052

Author(s):

Vikram Kandhari Darshan Angadi ◽

Darli Myat ◽

Brett Fritsch ◽

David Parker ◽

Myles Coolican

Keyword(s):

Computer Navigation ◽

Lateral Compartment ◽

Femoral Osteotomy ◽

Long Term Outcomes ◽

Opening Wedge ◽

Distal Femoral Osteotomy ◽

Long Term Follow Up ◽

Lateral Opening Wedge

Introduction: Osteotomy of the distal femur (DFO) to address symptomatic degeneration in the knee is a well-established procedure with good results reported in the literature . Broadly the osteotomy is based on either an opening or a closing wedge alignment technique. Several patient related parameters including age, gender, body mass index (BMI) and surgical factors such as osteotomy site, gap, and fixation technique amongst others have been demonstrated to influence the outcome of DFO. Preoperative planning based on imaging is vital to assess the type and extent of deformity correction to be undertaken in order to achieve optimal alignment. Computer-assisted surgery (CAS) has been extensively used as dynamic intraoperative alignment aid in knee arthroplasty providing good outcomes. Several investigators in the current literature have utilised computer navigation in proximal tibial osteotomy and reported improved accuracy in realising the planned alignment. However there is paucity of studies reporting the long-term outcomes of distal femur lateral opening-wedge (DFLOWO) using computer navigation. Through our study we aim to report on the long-term outcomes and survivorship of computer navigated DFLOWO. Hypotheses: We hypothesize that use of computer navigation will improve the survivorship of distal femoral osteotomy. Methods: Ethics committee approval was obtained for this study. Due consent was taken for the use of data from all the patients for this study. A retrospective analysis of prospectively collected data for patients with lateral compartment arthritis who underwent navigated lateral opening wedge distal femoral osteotomy from December 2006 to November 2012 was performed. Consecutive patients of lateral compartment knee arthrosis aged less than 55 years who failed to respond to conservative management were included in the study. Patients who had end stage arthritis with fixed flexion deformity of > 15 degrees, < 90 degrees of knee flexion or who did not consent for the procedure were excluded. Included patients were operated by one of the three senior surgeons attached to our research institute. The included patients were followed up with clinical and radiological evaluation at regular intervals (6 weeks / 6 months / 1 year / 5years). The final follow-up for the included patients was done using email questionnaire of the patient reported outcomes measures. Conversion to either UKA or TKA during the follow-up was the end point. Additionally, this information was verified from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) database Results: 19 DFLOWO with mean age of 46.6 ± 6.5 years formed the study cohort. The coronal alignment was corrected from a mean of 7.1º (2-11º) valgus to mean 2.1º (0.5º - 3º) varus. IKDC scores improved from mean of 39 pre-op to 53 at the mean long-term follow-up of 9.1 years. KOOS scores at the long-term follow-up were pain-71, symptoms-56, activities of daily living-82, sports and recreation-59, quality of life-43. Survivorship of DFLOWO was 78.9% at a follow-up of 9.1 years. Presence of ≥ grade 2 ICRS cartilage degeneration in the medial compartment of knee and >7⁰ pre-operative valgus deformity strongly correlated with conversion to TKA at the long-term follow-up (r - 0.66). Conclusion: Computer navigated DFLOWO has satisfactory clinical outcomes and 79% survivorship in long-term follow-up. Presence of more than ICRS ≥ grade 2 degenerative changes in the medial compartment of knee with > 7 degrees pre-operative valgus deformity negatively affects the survivorship of DFLOWO in the long-term follow-up.

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