Tan Si Heng Sharon, Hui Si Jian, Doshi Chintan, Wong Keng Lin, Lim Andrew Kean Seng, Hui James Hoipo
Department of Orthopaedic Surgery, University Orthopaedic, Hand and Reconstructive Microsurgery Cluster, National University Health System (NUHS), Singapore, Singapore.
J Knee Surg. 2020 May;33(5):504-512. doi: 10.1055/s-0039-1681043. Epub 2019 Mar 1.
Distal femoral varus osteotomies have been novelly described in the recent years to be successful in the management of patellofemoral instability with genu valgum. However, these publications are limited to case reports and small case series and no published literature have attempted to analyze them in totality. The current review aims to pool together these small case series to evaluate the outcomes and complications of distal varus femoral osteotomies when performed for patellofemoral instability. The review was conducted using the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. All studies that reported the outcomes of distal femoral varus osteotomy for patellofemoral instability were included. A total of five publications were included in the review, which included a total of 73 patients. All of the studies reported improvement in the radiological outcomes for genu valgum correction and patellofemoral instability. One study using opening wedge osteotomy reported a decrease in Caton-Deschamps index postoperatively, while another study using closing wedge osteotomy reported maintenance of the Caton-Deschamps index postoperatively. Second look arthroscopy showed an improvement in the status of the chondral lesions of the medial facet of the patellar undersurface, the lateral facet of the patellar undersurface and the trochlear groove 2 years postoperatively. All studies also reported a decrease in the risk of recurrence of patellofemoral instability, reduction in pain, and an improvement in all the clinical outcomes knee scores. Distal femoral varus osteotomy is promising and useful in the management of patellofemoral instability with genu valgum. The procedure can allow for radiological correction of the genu valgum and patellofemoral instability, reduction in the risk of recurrence of patellofemoral instability, reduction in pain, improvement in clinical knee outcome scores, and improvement in the status of the chondral lesions in the patellofemoral joint. It is highly versatile and could accommodate varying degrees of correction. These improvements in radiological and clinical outcomes can be seen in studies for both closing wedge and opening wedge distal femoral osteotomies. However, opening wedge osteotomies appear to decrease the patellar height as compared with closing wedge osteotomies which maintain the patellar height; therefore, the patellar height should be assessed preoperatively prior to deciding whether to perform an opening wedge or closing wedge distal femoral varus osteotomy. The Level of Evidence for this study is IV.
近年来，股骨远端内翻截骨术被创新性地描述为在治疗伴有膝外翻的髌股关节不稳方面取得了成功。然而，这些报道仅限于病例报告和小病例系列，尚无已发表的文献试图对其进行全面分析。本综述旨在汇总这些小病例系列，以评估股骨远端内翻截骨术治疗髌股关节不稳的疗效和并发症。本综述按照系统评价和Meta分析的首选报告项目（PRISMA）指南进行。纳入所有报道股骨远端内翻截骨术治疗髌股关节不稳疗效的研究。本综述共纳入5篇文献，共计73例患者。所有研究均报告膝外翻矫正和髌股关节不稳的影像学结果有所改善。一项采用开放楔形截骨术的研究报告术后Caton-Deschamps指数下降，而另一项采用闭合楔形截骨术的研究报告术后Caton-Deschamps指数维持不变。二次关节镜检查显示，术后2年髌骨关节面内侧、髌骨关节面外侧和滑车沟软骨损伤状况有所改善。所有研究还报告髌股关节不稳复发风险降低、疼痛减轻以及所有临床膝关节评分改善。股骨远端内翻截骨术在治疗伴有膝外翻的髌股关节不稳方面前景广阔且实用。该手术可实现膝外翻和髌股关节不稳的影像学矫正，降低髌股关节不稳复发风险，减轻疼痛，改善临床膝关节结局评分，并改善髌股关节软骨损伤状况。它具有高度的通用性，可适应不同程度的矫正。闭合楔形和开放楔形股骨远端截骨术的研究均显示影像学和临床结果有这些改善。然而，与维持髌骨高度的闭合楔形截骨术相比，开放楔形截骨术似乎会降低髌骨高度；因此，在决定是否进行开放楔形或闭合楔形股骨远端内翻截骨术前，应进行术前髌骨高度评估。本研究的证据等级为IV级。
