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Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy 7/2019

29.09.2018 | KNEE

Distal femoral torsional osteotomy increases the contact pressure of the medial patellofemoral joint in biomechanical analysis

verfasst von: Franz Liska, Constantin von Deimling, Alexander Otto, Lukas Willinger, Ralf Kellner, Andreas B. Imhoff, Rainer Burgkart, Andreas Voss

Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy | Ausgabe 7/2019

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Abstract

Purpose

Torsional osteotomy of the distal femur allows anatomic treatment of patellofemoral instability and patellofemoral pain syndrome in cases of increased femoral antetorsion. The purpose of this study was to investigate the effects of distal femoral torsional osteotomy on pressure distribution of the medial and lateral patellar facet.

Methods

Nine fresh frozen human knee specimens were embedded in custom-made 3D-printed casts and tested with a robotic arm. Torsional osteotomy could be simulated ranging from increased femoral antetorsion of 25° with a corresponding lateralization of the patella to an overcorrected value of 5° of femoral antetorsion. The peak and mean lateral and medial compartment pressure was measured in 0°, 15°, 30°, 45°, 60° and 90° flexion beginning with neutral anatomic muscle rotation.

Results

The medial aspect of the patella showed a significant influence of femoral torsion with an increase of mean and peak pressure in all flexion angles with progressive derotation from 15° external rotation to 5° internal rotation (p = 0.004). The overall pressure difference was highest in near extension and stayed on a constant level with further flexion. On the lateral facet, the derotation resulted in decrease of pressure in near extension; however, it had no significant influence on the mean and peak pressure through the different torsion angles (n.s.). Unlike on the medial facet, a significant consistent increase of peak pressure from 0° to 90° flexion could be shown (p = 0.022) on the lateral patella aspect.

Conclusion

Distal femoral torsional osteotomy to correct pathological femoral antetorsion leads to a redistribution of retropatellar pressure. External derotation leads to an increased peak pressure on the medial patellar facet and can impair simultaneous cartilage repair. However, as the lateral patellofemoral load decreases, it has a potential in preventing patellofemoral osteoarthritis.
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Metadaten
Titel
Distal femoral torsional osteotomy increases the contact pressure of the medial patellofemoral joint in biomechanical analysis
verfasst von
Franz Liska
Constantin von Deimling
Alexander Otto
Lukas Willinger
Ralf Kellner
Andreas B. Imhoff
Rainer Burgkart
Andreas Voss
Publikationsdatum
29.09.2018
Verlag
Springer Berlin Heidelberg
Erschienen in
Knee Surgery, Sports Traumatology, Arthroscopy / Ausgabe 7/2019
Print ISSN: 0942-2056
Elektronische ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-018-5165-2

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