Success of torsional correction surgery after failed surgeries for patellofemoral pain and instability

Strategies in Trauma and Limb Reconstruction 12/2013; 9(1). DOI: 10.1007/s11751-013-0181-8
Source: PubMed


Torsional deformities of the femur and/or tibia often go unrecognized in adolescents and adults who present with anterior knee pain, and patellar maltracking or instability. While open and arthroscopic surgical techniques have evolved to address these problems, unrecognized torsion may compromise the outcomes of these procedures. We collected a group of 16 consecutive patients (23 knees), with mean age of 17, who had undergone knee surgery before torsion was recognized and subsequently treated by means of rotational osteotomy of the tibia and/or femur. By follow-up questionnaire, we sought to determine the role of rotational correction at mean 59-month follow-up. We reasoned that, by correcting torsional alignment, we might be able to optimize long-term outcomes and avert repeated knee surgery. Knee pain was significantly improved after torsional treatment (mean 8.6 pre-op vs. 3.3 post-op, p < 0.001), while 70 % of patients did have some continued knee pain postoperatively. Only 43 % of patients had continued patellar instability, and 57 % could trust their knee after surgery. Activity level remained the same or increased in 78 % of patients after torsional treatment. Excluding planned rod removal, subsequent knee surgery for continued anterior knee pain was undertaken on only 3 knees in 2 patients. We believe that malrotation of the lower limb not only raises the propensity for anterior knee symptoms, but is also a under-recognized etiology in the failure of surgeries for anterior knee pain and patellar instability. Addressing rotational abnormalities in the index surgery yields better clinical outcomes than osteotomies performed after other prior knee surgeries.

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Available from: Jeremy M Gililland, Mar 05, 2014

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    ABSTRACT: Anterior knee pain is a common musculoskeletal condition amongst young adult population. Lower extremity structural factors, such as increased femoral anteversion and lateral tibial torsion, may contribute to patellofemoral malalignment and anterior knee pain. The aim of this study was to evaluate the lower extremity structural factors and related patellofemoral alignment parameters that play a role in the aetiology of anterior knee pain. This study involved three groups: patients with unilateral symptomatic knees (n = 35), asymptomatic contralateral knees in the same patients and a control group (n = 40). All subjects were physically examined, and Q-angles were measured. The lower extremities of all subjects were imaged by a very low-dose CT scan, and the symptomatic knees of patients were compared with their asymptomatic contralateral knees and with the healthy knees of controls regarding femoral anteversion, tibial torsion, sulcus angle, patellar tilt angle and lateral patellar displacement. Regarding the Q-angle, femoral anteversion and lateral tibial torsion, no significant differences were found between the symptomatic and asymptomatic knees, whereas significant differences were found between the symptomatic knees and controls. The symptomatic group demonstrated significantly greater sulcus angle only in 30° of knee flexion than did the controls. Patients with unilateral anterior knee pain may have similar morphology at their contralateral asymptomatic lower extremity, and different morphology compared with healthy controls. Lower extremity rotational deformities may increase the risk of anterior knee pain; however, these deformities alone are not sufficient to cause knee pain, and may be predisposing factor rather than a direct aetiology. Diagnostic study, Level III.
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