North France Lille University, 59000 Lille, France.
Orthop Traumatol Surg Res. 2010 Nov;96(7):785-92. doi: 10.1016/j.otsr.2010.04.008. Epub 2010 Sep 28.
Torsional abnormalities of the leg may cause instability and pain in the patellofemoral joint. Although derotation osteotomies seem logical to address these conditions, there are very few surgical results reported in the literature.
Isolated tibial derotation osteotomies relieve patellofemoral pain and instability even in the event of combined femoral and tibial torsion abnormalities.
Test this hypothesis in a retrospective and continuous series of thirty-six tibial derotation osteotomies and define the factors of success and failure.
Thirty-six derotation osteotomies of the proximal tibial metaphysis were performed between 1995 and 2006 in 29 patients (five men and 24 women, an average of 26.5 years old±7.4 (18-44)) followed-up for a mean 4.7 years. There was confirmed patellar instability in five knees, and patellofemoral pain without instability in 31. A proximal metaphyseal osteotomy was performed to correct excessive external tibial rotation as well as to recenter the tibial tubercle after anterior tibial cortex elevation. All patients were followed-up and the clinical data were analysed according to criteria from the Lille score [specifically designed for patellofemoral joints (100 point score)] and the IKS score. All patients had a preoperative radiological evaluation [(including measurement of torsion abnormalities in 32 cases by computed tomodensitometry (CT scan))]. The mean preoperative external tibial torsion measured on CT scan was 36.2°±9.48 (26-51°) and the mean femoral anteversion was 19.4°±9.5 (8-36°).
Twenty-seven patients (94%) were satisfied or very satisfied. The Lille score increased from 54.8±16.9 (30-92) preoperatively to 85.2±14.2 (36-100) at follow-up. The mean IKS knee scores and function increased from 56±14.8 (45-94) to 94±12.1 (60-100) and from 71±18.4 (30-100)-96±11.9 (50-100). Patellofemoral dislocations did not occur in any of the five cases with instability. Mean derotation was 25° measured with a mean tibial torsion measured clinically at follow-up 8.6°±7.2 (0-30). Two reoperations were necessary, (one knee manipulation under general anesthesia, and in another the fibular fibrous arch had to be released). One case of regressive palsy of the common fibular nerve was observed. Union of the osteotomy was obtained in all patients.
This series is one of the largest series published to date. Isolated medialization of the anterior tibial tubercle only partially corrects these morphological abnormalities. In cases of associated excessive femoral anteversion we recommend surgery to the tibia alone because results were comparable in groups with and without excessive anteversion of the femoral neck.
level IV. Retrospective study.
腿部扭转异常可能导致髌股关节不稳定和疼痛。虽然扭转截骨术似乎是解决这些问题的合理方法，但文献中很少有手术结果的报道。
单纯胫骨旋转移位截骨术可缓解髌股疼痛和不稳定，即使存在股骨和胫骨扭转异常。
通过回顾性和连续的 36 例胫骨旋转移位截骨术系列研究来检验这一假设，并确定成功和失败的因素。
1995 年至 2006 年期间，对 29 例患者（5 名男性，24 名女性，平均年龄 26.5 岁±7.4（18-44 岁））进行了 36 例胫骨近端干骺端旋转移位截骨术，平均随访 4.7 年。5 例膝关节存在明确的髌骨不稳定，31 例存在髌股疼痛但无不稳定。进行胫骨近端干骺端截骨术以纠正胫骨过度外旋，并在前侧胫骨皮质抬高后重新定位胫骨结节。所有患者均进行随访，并根据 Lille 评分（专为髌股关节设计[100 分评分]）和 IKS 评分的标准对临床数据进行分析。所有患者均进行术前放射学评估[（包括 32 例通过计算机断层扫描（CT 扫描）测量扭转异常）]。术前 CT 扫描测量的胫骨外旋平均为 36.2°±9.48（26-51°），股骨前倾角平均为 19.4°±9.5（8-36°）。
27 例患者（94%）满意或非常满意。Lille 评分从术前的 54.8±16.9（30-92）增加到随访时的 85.2±14.2（36-100）。平均 IKS 膝关节评分和功能从术前的 56±14.8（45-94）分别增加到随访时的 94±12.1（60-100）和 71±18.4（30-100）-96±11.9（50-100）。5 例不稳定患者中均未发生髌股脱位。术后平均旋转移位 25°，临床随访时胫骨扭转平均 8.6°±7.2（0-30）。需要进行 2 次翻修手术（一次是在全身麻醉下进行膝关节手法复位，另一次是腓骨纤维弓需要松解）。观察到一例腓总神经退行性瘫痪。所有患者均获得了骨愈合。
本系列是目前已发表的最大系列之一。单纯胫骨内侧化仅部分纠正这些形态异常。对于伴有股骨前倾角过大的病例，我们建议仅对胫骨进行手术，因为在伴有和不伴有股骨颈过度前倾角的组中，结果是可比的。
IV 级。回顾性研究。
