gms | German Medical Science

Objectives: Anterior knee pain and patellar dislocation or subluxation are the major symptoms of patellofemoral maltracking and -malalignment. In cases of a combined torsional deformity with increased femoral internal and tibial external torsion we are talking about the 'inwardly pointing knee' syndrome. After clinical and radiological verification of the torsional deformity and a frustrating conservative therapy approach a combined (double-level) torsional osteotomy of femur and tibia is the appropriate treatment. Topic of this study are the diagnostic algorithms, the treatment and the outcome of combined torsional osteotomies of femur and tibia.

Do the patients achieve patellofemoral stability and does the procedure provide pain relief or reduction?

Methods: 20 torsional osteotomies performed on 18 patients were included. 9 patients had experienced patellar dislocation in 11 joints. The symptoms leading to consultation were anterior knee pain or patellar dislocation. For assessment patients were clinically examined and radiographic analysis was done. In patients with a suspected torsional deformity a torsion angle CT scan completed diagnostic. Pre- and post-operatively multiple commonly approved scores were acquired: Lysholm Score, Tegner Activity score, Kujala Score, VAS and Japanese Knee Society score.

Results and Conclusion: The mean femoral torsion was -40.85° (SD 6.25°) and the mean tibial torsion was 49.15° (SD 3.71°) evaluated before surgery. In 18 patients we performed 20 double-level torsional osteotomies.

9 patients suffered from patellar dislocations in 11 knee joints prior to surgery. Of these patients 7 achieved a stable joint after surgery without further patellar dislocations. In two cases an additional medial patellar retinaculum plasty was necessary.

The mean VAS was reduced by 3.75 points (SD 2.09) from 5.50 points (SD 2.73) before surgery to 1.75 points (SD 1.67) after surgery. The Lysholm score increased by mean of 27.6 (SD 17.55) from mean 62.45 (SD 22.71) before to mean 90.05 (SD 10.18) after surgery. The Kujala Score did improve in average by 25.20 points (SD 13.61) from mean 62.9 (SD 16.24) to mean 93.2 (SD 9.20). The Tegner activity score did increase by 1.2 points (SD 1.47) in average from mean 2.65 (SD 1.11) to mean 3.85 (SD 1.42).

This is the first publication reporting about simultaneous bilevel torsional osteotomies in a comparatively high number of patients. In addition, this is the first publication assessing the patient collective afterwards with objectifying clinical outcome scores. The results show that double-level torsional osteotomy is the treatment of choice for patients with patellar dislocation or subluxation associated to torsional deformities of femur and tibia. Except one case all patients achieved joint stability through the procedure, in most cases without combination with other surgeries.