Department of Sports Orthopaedics, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany.
Arch Orthop Trauma Surg. 2024 Apr;144(4):1667-1673. doi: 10.1007/s00402-024-05212-w. Epub 2024 Feb 22.
The purpose of the study was to report the clinical, functional and radiological outcome following varus osteotomy as a salvage procedure in young to middle-aged patients with patellofemoral arthritis (PFA) and associated valgus malalignment. It was hypothesized that a significant improvement in knee function and reduction in pain would be achieved. Moreover, no conversion to patellofemoral joint arthroplasty could be observed.
Patients (< 50 years of age) that underwent varus osteotomy between 08/2012 and 01/2020 for the treatment of symptomatic PFA and associated valgus malalignment were consecutively included (minimum follow-up: 24 months). Patient-reported outcome measures (PROM; International Knee Documentation Committee subjective knee form [IKDC]), Visual Analog Scale [VAS] for pain, Tegner Activity Scale [TAS], and satisfaction with the postoperative results (1-10-scale, 10 = highest satisfaction) and weight-bearing whole-leg anteroposterior radiographs were conducted pre- and postoperatively. The change in PROM and femorotibial angle (FTA) were tested for statistical significance.
In total, 12 patients (14 knees) were included (66.7% female; mean age: 33.8 ± SD 6.6 years). In ten cases, lateral opening-wedge distal femoral osteotomies (DFO) were performed, of which three cases included a concomitant femoral derotation. Three medial closing-wedge DFO and one medial closing-wedge high tibial osteotomy were performed. At follow-up (55.3 ± 29.3 months), a significant improvement in knee function (IKDC: 56.4 ± 14.4 to 69.1 ± 11.2, p = 0.015) and reduction in pain (VAS for pain: 3.5 [interquartile range 2.3-5.8] to 0.5 [0-2.0], p = 0.018) were observed. Patients were able to reach their preoperative sporting activity level (TAS: 3.0 [3.0-4.0] to 3.5 [3.0-4.0], p = 0.854) and were highly satisfied with the postoperative result (9.0 [6.5-10]). Additionally, a significant correction of valgus malalignment was observed (5.0° ± 2.9° valgus to 0.7° ± 3.2° varus, p < 0.001). Regarding complications, two re-osteosyntheses were performed due to loss of correction and delayed union. No conversion to patellofemoral arthroplasty occurred.
In patients with symptomatic PFA and associated valgus malalignment, varus osteotomy as a salvage procedure achieved a significant improvement in knee function and reduction in pain. No conversion to patellofemoral joint arthroplasty occurred at short- to mid-term follow-up.
Retrospective case series, Level IV.
本研究旨在报告在年轻至中年髌股关节炎（PFA）伴内翻畸形的患者中，作为挽救性手术行内翻截骨术后的临床、功能和影像学结果。假设可以实现膝关节功能的显著改善和疼痛的减轻。此外，未观察到向髌股关节置换术的转化。
2012 年 8 月至 2020 年 1 月，连续纳入（最短随访：24 个月）因症状性 PFA 伴内翻畸形而行内翻截骨术治疗的患者（<50 岁）。进行患者报告的结局测量（PROM；国际膝关节文献委员会主观膝关节评分 [IKDC]）、疼痛的视觉模拟评分 [VAS]、Tegner 活动量表 [TAS] 和对术后结果的满意度（1-10 分制，10 分为最高满意度），以及负重全长前后位 X 线片。对 PROM 和股胫角（FTA）的变化进行统计学显著性检验。
共纳入 12 名患者（14 膝）（66.7%为女性；平均年龄：33.8±6.6 岁）。在 10 例中，行外侧撑开楔形股骨远端截骨术（DFO），其中 3 例包括股骨旋转移位。3 例行内侧闭合楔形 DFO，1 例行内侧闭合楔形胫骨高位截骨术。随访时（55.3±29.3 个月），膝关节功能显著改善（IKDC：56.4±14.4 至 69.1±11.2，p=0.015），疼痛减轻（VAS 疼痛评分：3.5 [四分位间距 2.3-5.8] 至 0.5 [0-2.0]，p=0.018）。患者能够达到术前的运动活动水平（TAS：3.0 [3.0-4.0] 至 3.5 [3.0-4.0]，p=0.854），对术后结果非常满意（9.0 [6.5-10]）。此外，观察到明显的内翻畸形矫正（5.0°±2.9°外翻至 0.7°±3.2°内翻，p<0.001）。关于并发症，有 2 例因矫正丢失和延迟愈合而再次进行骨愈合。未发生向髌股关节置换术的转化。
在有症状的 PFA 伴内翻畸形的患者中，作为挽救性手术的内翻截骨术可显著改善膝关节功能和减轻疼痛。在短至中期随访中，未发生向髌股关节置换术的转化。
回顾性病例系列，IV 级。
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