Erschienen in:
21.12.2016 | Orthopaedic Surgery
Torsional osteotomies of the tibia in patellofemoral dysbalance
verfasst von:
Jörg Dickschas, Aliki Tassika, Christoph Lutter, Jörg Harrer, Wolf Strecker
Erschienen in:
Archives of Orthopaedic and Trauma Surgery
|
Ausgabe 2/2017
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Abstract
Background and purpose
Anterior knee pain or patellofemoral instability is common symptom of patellofemoral dysbalance or maltracking. Tibial torsional deformities can be the reason of this pathology. After appropriate diagnostic investigation, the treatment of choice is a torsional osteotomy. This study addresses the diagnostic investigation, treatment, and the outcome of torsional osteotomies of the tibia. Does this treatment result in patellofemoral stability and provide pain relief?
Methods
Forty-nine tibial torsional osteotomies were included. The major symptoms were patellofemoral instability in 19 cases and anterior knee pain in 42 cases. In addition to clinical and radiographic analysis, a torsional angle CT scan was performed pre-operatively. A visual analog scale (VAS), the Japanese Knee Society score, the Tegner activity score, and the Lysholm score were assessed pre-operatively and at the 42-month follow-up.
Results
Mean tibial external torsion was 47.4° (SD 5.41; range 37°–66°; standard value 34°). Surgical treatment consisted of an acute supratuberositary tibial internal torsional osteotomy (mean 10.8°; SD 3.01°; range 5°–18°). At the follow-up investigation, the Tegner activity score was increased 0.4 points (p value 0.014) from 3.9 (SD 1.33; range 2–7) to 4.3 (SD 1.25; range 0–7). The Lysholm score increased 26 points (SD 16.32; p value 0.001) from 66 (SD 14.94; range 32–94) to 92 (SD 9.29; range 70–100) and the Japanese Knee Society score increased 18 points (SD 14.70; p value 0.001) from 72 (SD 13.72, range 49–100) to 90 (SD 9.85, range 60–100). VAS was reduced 3.4 points (SD 2.89; p value 0.001) from 5.7 (SD 2.78; range 0–10) to 2.3 (SD 1.83; range 0–7). As regards patellofemoral instability, no redislocation occurred in the follow-up period.
Interpretation
The results of this study show that in cases of tibial maltorsion, a torsional osteotomy can lead to patellofemoral stability and pain relief, and should be considered as a treatment option. The improved clinical scores in the present investigation show the value of the procedure.
Level of evidence Level IV.