Department of Orthopedic Surgery, Inje University Ilsan Paik Hospital, Ilsanseo-gu, Goyang, Republic of Korea.
Department of Orthopedic Surgery, Mumbai Port Trust Hospital, Mumbai, India.
Am J Sports Med. 2018 Jun;46(7):1632-1640. doi: 10.1177/0363546518765479. Epub 2018 Apr 24.
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.
To evaluate the clinical and radiologic outcomes of surgical treatment with CWDFO for treatment of RPD with genu valgum.
Case series; Level of evidence, 4.
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.
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.
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.
闭合楔形股骨远端截骨术（CWDFO）结合内侧倒“V”形切开和外侧松解术，已被用于治疗伴发胫骨内翻的复发性髌骨脱位（RPD）。
评估 CWDFO 治疗伴发胫骨内翻的复发性髌骨脱位的临床和影像学结果。
病例系列；证据等级，4 级。
对 14 例（23 膝）伴发胫骨内翻的 RPD 患者进行 CWDFO 治疗。符合本研究条件的患者需要至少随访 2 年。既往手术失败的患者也符合条件。采用机械性股胫角和外侧远端股骨角进行影像学评估。评估与 RPD 相关的髌骨位置和病理异常的影像学参数。对再次关节镜检查中的软骨病变变化进行检查，并在至少 2 年的时间内评估术前和术后的临床结果（如再次脱位、活动范围和临床评分）。
平均随访 30.7 个月（范围，25-62 个月），机械性股胫角和机械性外侧远端股骨角分别从 5°（范围，2°-11°）的外翻显著改善至 3°（2°-11°；P<.001）和从 83°（范围，78°-86°）改善至 89°（84°-92°；P<.001）。髌骨吻合角从 40°外侧（范围，20°-53°外侧）改善至 4°内侧（23°内侧至 21°外侧；P<.001），外侧髌股角从 26°（范围，8°-62°）改善至 9°（0°-15°；P<.001）。CT 扫描显示，髌骨外侧移位的平均距离从 13.5mm（范围，4-22mm）减少至 2.0mm（-4 至 5mm；P<.001）。胫骨结节至滑车沟的平均距离显著从 20.4mm 减少至 13.5mm（P<.001），而术后 Caton-Deschamps 比值无显著变化（P=.984）。髌骨和滑车沟的软骨病变显著改善或保持不变。术后无患者发生半脱位或再脱位。髌骨不稳定症状也得到改善，影像学和其他临床结果均得到证实。
CWDFO 联合内侧倒“V”形切开和外侧松解术治疗伴发胫骨内翻的复发性髌骨脱位，至少随访 2 年，可改善髌骨对线和稳定性。
