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Clinical and Radiological Outcomes of Surgical Treatment Using Closing-wedge Distal Femoral Osteotomy for Recurrent Patellar Instability with Genu Valgum
Author(s):
Lee B. (South Korea (ROK))
,
Lee B. (South Korea (ROK))
Affiliations:
Nha K.
Nha K.
Affiliations:
ESSKA Academy. Lee B. 05/09/18; 209700; P12-536 Topic: Arthroscopic Surgery
Prof. Byung Hoon Lee
Prof. Byung Hoon Lee
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Abstract
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Objectives: Closing-wedge distal femoral osteotomy (CWDFO), combined with medial reefing and lateral re¬lease if necessary, has been used to treat recurrent patellar instability (RPI) with genu valgum. This study aimed to evaluate the clinical and radiological outcomes of surgical treatment using CWDFO for treatment of RPI with genu valgum.

Methods: Fourteen consecutive patients (23 knees) with RPI and genu valgum were treated using CWDFO. Patients with minimal 2-year follow-up period were eligible for this study. Radiographic evaluation was performed with mechanical femorotibial (MFTA) and lateral distal femoral angle (mLDFA). The radiographic parameters presenting patellar positions and pathologic abnormalities associated with RPI were evaluated. Chondral lesion changes in second-look arthroscopic examination were examined, and clinical outcomes, such as occurrence of re-dislocation, range of motion, and clinical scores were assessed at pre- and post-operatively at 2 years.

Results: At a mean follow-up period of 30.7 months (range, 25-62 months), The mean MFTA and mLDFA changed significantly from valgus 5.8° to varus 2.6° (p < 0.001) and from 83.2° to 88.8° (p < 0.001), respectively. The mean patella congruence angle (from 40.8° lateral to 4.0° medial, p < 0.001) and lateral patellofemoral angle (from 26.3° to 9.3°, p < 0.001) were improved. CT scan showed that the average distance of patellar lateral shift decreased from 13.5 to 2.0 mm (p < 0.001). The average tibial tubercle to trochlear groove distance significantly decreased from 20.4 to 13.5 mm (p < 0.001), while the Caton-Deschamps ratio did not change significantly after operation (p = 0.984). Chondral lesions of the patella and trochlear groove were significantly improved or maintained. None of the patients experienced subluxation or re-dislocation following surgery. Patellar instability symptoms were improved as validated by the radiographic outcomes as well as other clinical outcomes.

Conclusions: Alignment correction using CWDFO for treatment of RPI with genu valgum could correct other anatomic predisposing factors as abnormal TT-TG distance with no risk of patellar alta, and could relieve anterior knee pain by depressurization of cartilage on PF joint. Surgical treatment using CWDFO was proved to be effective and safe for a minimum follow-up of 2 years, and it could be considered as a viable surgical option for RPI patients with genu valgum.

Keywords:
Closing-wedge Distal Femoral Osteotomy, Recurrent Patellar Instability, Genu Valgum
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