Derotational distal femoral osteotomy for patellar dislocation yielded favorable outcomes
Medial patellofemoral reconstruction with derotational distal femoral osteotomy yielded favorable subjective and objective outcomes among patients with recurrent patellar dislocation and increased femoral anteversion, according to results.
Researchers categorized 126 patients (135 knees) with recurrent patellar dislocation and increased femoral anteversion angle into groups based on whether they underwent MPFL reconstruction with (n=66) or without (n=69) derotational distal femoral osteotomy. Researchers measured preoperative and postoperative patellar stability with stress radiography and compared patellar maltracking and patient-reported outcomes between the groups. Researchers performed subgroup analysis by stratifying the results in terms of severity of preoperative patellar maltracking.
Results showed patients who underwent derotational distal femoral osteotomy had significantly lower rates of postoperative MPFL residual graft laxity and residual J-sign compared with the control group. Researchers also found significantly higher Kujala and Lysholm scores in the derotational distal femoral osteotomy group. Patients with a preoperative high-grade J-sign had a significantly lower rate of MPFL residual graft laxity when they underwent derotational distal femoral osteotomy, according to subgroup analysis.
“Bearing in mind the concepts of femoral torsional deformity and patellar maltracking, we believe that cases with concurrent excessive [femoral anteversion angle] FAA and a high-grade J-sign pose a challenged scenario in the [recurrent patellar dislocation] RPD spectrum, as described previously and also observed in the present study,” the authors wrote. “On the basis of our findings, we believe that FAA and patellar tracking should be identified and that their severity should be surgically corrected using more extensive procedures, such as [derotational distal femoral osteotomy] DDFO, rather than using MPFL [reconstruction] alone or with tibial tubercle transfer.”