Yonsei Med J.  2017 Jul;58(4):878-883. 10.3349/ymj.2017.58.4.878.

A Combined Closing Wedge Distal Femoral Osteotomy and Medial Reefing Procedure for Recurrent Patellar Dislocation with Genu Valgum

• Chang CB
• Shetty GM
• Lee JS
• Kim YC
• Kwon JH
• Nha KW

• KMID: 2419098
• DOI: http://doi.org/10.3349/ymj.2017.58.4.878

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 release for 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 performed with 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 preoperatively to 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, corrects deformity, and improves clinical outcomes.

Keyword

Patellar instability; distal femoral osteotomy; genu valgum; medial reefing

MeSH Terms

Adult
Demography
Female
Femur/diagnostic imaging/pathology/*surgery
Follow-Up Studies
Genu Valgum/*complications/diagnostic imaging/*surgery
Humans
Male
Osteotomy/*methods
Patellar Dislocation/*complications/diagnostic imaging/*surgery
Preoperative Care
Treatment Outcome
Young Adult

Figure

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  Fig. 1 (A) Biplane distal femur osteotomy and medial reefing procedure arthroscopic superiorlateral view-subluxed patellar target point is above the lateral epicondyle of distal femur biplane osteotomy lateral release and medial reefing. (B) Biplane distal femur osteotomy and medial reefing procedure arthroscopic superiorlateral view-subluxed patellar target point is above the lateral epicondyle of distal femur biplane osteotomy lateral release and medial reefing. (C) Biplane distal femur osteotomy and medial reefing procedure arthroscopic superiorlateral view-subluxed patellar target point is above the lateral epicondyle of distal femur biplane osteotomy lateral release and medial reefing. (D) Biplane distal femur osteotomy and medial reefing procedure arthroscopic superiorlateral view-subluxed patellar target point is above the lateral epicondyle of distal femur biplane osteotomy lateral release and medial reefing.

• 

  Fig. 2 (A-a) Preoperative standing, full length, hip-to-ankle radiograph of a 21-year-old male patient showing bilateral genu valgus deformity as shown by the weight bearing lines (green line) and subluxation of patellar both. (A-b) Postoperative standing, full length, hip-to-ankle radiograph of the same patient at 1-year follow-up showing significant change in the weight bearing lines after a combined medial closed-wedge distal femoral osteotomy and lateral release with medial reefing and normal alignment of patellofemoral joint. (B-a) Preoperative standing, full length, hip-to-ankle radiograph of a 21-year-old male patient showing bilateral genu valgus deformity as shown by the weight bearing lines (green line) and subluxation of patellar both. (B-b) Postoperative standing, full length, hip-to-ankle radiograph of the same patient at 1-year follow-up showing significant change in the weight bearing lines after a combined medial closed-wedge distal femoral osteotomy and lateral release with medial reefing and normal alignment of patellofemoral joint.

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