A Combined Closing Wedge Distal Femoral Osteotomy and Medial Reefing Procedure for Recurrent Patellar Dislocation with Genu Valgum
4
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Purpose: Recurrent patellar dislocation is often associated with genu valgum. The purpose of this study was to analyze the short-term results of single-incision, closing-wedge distal femoral osteotomy (CWDFO) combined with medial reefing and lateral releasefor recurrent patellar instability with genu valgum. Materials and Methods: Combined CWDFO/medial reefing/lateral release was performed on 10 knees. Clinical evaluation was based on pre- and postoperative Knee Society Score (KSS) and Kujala patellofemoral score. Radiographic evaluation was performedwith reference to the weight-bearing line (WBL), the femorotibial angle (FTA), and the mechanical lateral distal femoral angles in the knee-standing view. Results: At a mean follow-up of 20±11.7 months (range, 12–42 months), KSS scores improved significantly, from 46.7±5.2 preoperativelyto 87±4.4 postoperatively (p<0.001), as did the Kujala score, from 44±8 preoperatively to 86.6±6.8 postoperatively (p<0.001). The WBL decreased significantly, from 76±7% preoperatively to 41±11% postoperatively (p<0.001). The FTA was improved significantly,from 12.7±1.7° preoperatively to 4±4° postoperatively (p<0.001), as was the mLDFA, from 83±4° preoperatively to 91±1.3° postoperatively (p<0.001). Conclusion: Use of single-incision CWDFO combined with medial reefing and lateral release prevents patellar dislocation, correctsdeformity, and improves clinical outcomes.
Abstract
Purpose: Recurrent patellar dislocation is often associated with genu valgum. The purpose of this study was to analyze the short-term results of single-incision, closing-wedge distal femoral osteotomy (CWDFO) combined with medial reefing and lateral releasefor recurrent patellar instability with genu valgum. Materials and Methods: Combined CWDFO/medial reefing/lateral release was performed on 10 knees. Clinical evaluation was based on pre- and postoperative Knee Society Score (KSS) and Kujala patellofemoral score. Radiographic evaluation was performedwith reference to the weight-bearing line (WBL), the femorotibial angle (FTA), and the mechanical lateral distal femoral angles in the knee-standing view. Results: At a mean follow-up of 20±11.7 months (range, 12–42 months), KSS scores improved significantly, from 46.7±5.2 preoperativelyto 87±4.4 postoperatively (p<0.001), as did the Kujala score, from 44±8 preoperatively to 86.6±6.8 postoperatively (p<0.001). The WBL decreased significantly, from 76±7% preoperatively to 41±11% postoperatively (p<0.001). The FTA was improved significantly,from 12.7±1.7° preoperatively to 4±4° postoperatively (p<0.001), as was the mLDFA, from 83±4° preoperatively to 91±1.3° postoperatively (p<0.001). Conclusion: Use of single-incision CWDFO combined with medial reefing and lateral release prevents patellar dislocation, correctsdeformity, and improves clinical outcomes.
참고문헌 (22)
- Ries Z, "Patellofemoral instability in active adolescents", J Knee Surg, 28, pp.265~277 (2015)
- Waterman BR, "Patellar dislocation in the United States: role of sex, age, race, and athletic participation", J Knee Surg, 25, pp.51~57 (2012)
- Smith TO, "Operative versus non-operative management of patellar dislocation. A meta-analysis", Knee Surg Sports Traumatol Arthrosc, 19, pp.988~998 (2011)
- Lee JJ, "Lateral release and medial plication for recurrent patella dislocation", Knee Surg Sports Traumatol Arthrosc, 20, pp.2438~2444 (2012)
- Ricchetti ET, "Comparison of lateral release versus lateral release with medial soft-tissue realignment for the treatment of recurrent patellar instability: a systematic review", Arthroscopy, 23, pp.463~468 (2007)
- Drexler M, "Tibial rotational osteotomy and distal tuberosity transfer for patella subluxation secondary to excessive external tibial torsion: surgical technique and clinical outcome", Knee Surg Sports Traumatol Arthrosc, 22, pp.2682~2689 (2014)
- Hall MJ, "Tibial tubercle osteotomy for patello-femoral joint disorders", Knee Surg Sports Traumatol Arthrosc, 24, pp.855~861 (2016)
- Shen HC, "Combined proximal and distal realignment procedures to treat the habitual dislocation of the patella in adults", Am J Sports Med, 35, pp.2101~2108 (2007)
- Brinkman JM, "Supracondylar femur osteotomies around the knee:patient selection, planning, operative techniques, stability of fixation, and bone healing", Orthopade, 43(Suppl 1), pp.S1~S1 (2014)
- Hinterwimmer S, "Biplanar supracondylar femoral derotation osteotomy for patellofemoral malalignment: the anterior closed-wedge technique", Knee Surg Sports Traumatol Arthrosc, 22, pp.2518~2521 (2014)
- 곽지훈, "Surgical Treatment of Habitual Patella Dislocation with Genu Valgum", Knee Surgery and Related Research, 23(3), pp.177~179 (2011), 대한슬관절학회
- Kwon JH, "Patellar dislocation with genu valgum treated by DFO", Orthopedics, 36, pp.840~843 (2013)
- Purushothaman B, "Posttraumatic chronic patellar dislocation treated by distal femoral osteotomy and medial patellofemoral ligament reconstruction", Orthopedics, 35, pp.e1668~e1672 (2012)
- Brinkman JM, "Axial and torsional stability of an improved single-plane and a new biplane osteotomy technique for supracondylar femur osteotomies", Knee Surg Sports Traumatol Arthrosc, 19, pp.1090~1098 (2011)
- van Heerwaarden R, "Wedge volume and osteotomy surface depend on surgical technique for distal femoral osteotomy", Knee Surg Sports Traumatol Arthrosc, 21, pp.206~212 (2013)
- Iliadis AD, "The operative management of patella malalignment", Open Orthop J, 6, pp.327~339 (2012)
- Forkel P, "Midterm results following medial closed wedge distal femoral osteotomy stabilized with a locking internal fixation device", Knee Surg Sports Traumatol Arthrosc, 23, pp.2061~2067 (2015)
- Haviv B, "The results of corrective osteotomy for valgus arthritic knees", Knee Surg Sports Traumatol Arthrosc, 21, pp.49~56 (2013)
- Insall JN, "Rationale of the Knee Society clinical rating system", Clin Orthop Relat Res, (248), pp.13~14 (1989)
- Kujala UM, "Scoring of patellofemoral disorders", Arthroscopy, 9, pp.159~163 (1993)
- Eilert RE, "Congenital dislocation of the patella", Clin Orthop Relat Res, (389), pp.22~29 (2001)
- Sherman SL, "Tibial tuberosity osteotomy: indications, techniques, and outcomes", Am J Sports Med, 42, pp.2006~2017 (2014)