Advances in peripatellar osteotomy for treating recurrent patellar dislocation_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CHEN Jiahui , MA Jianxiong ,  MA Xinlong

Tianjin Hospital, Tianjin, 300211, P. R. China;

Corresponding?author：

MA Xinlong, Email: maxinlong8686@sina.com

Keywords：

Peripatellar osteotomy; recurrent patellar dislocation; lower limb aligment

DOI：

10.7507/1002-1892.202304055

Video：

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Objective To summarize the progress of research related to the surgical treatment of recurrent patellar dislocation by peripatellar osteotomy in clinical practice, in order to provide reference for clinical treatment. Methods The recent literature on peripatellar osteotomy for recurrent patellar dislocation at home and abroad was reviewed, and the bony structural abnormalities, imaging diagnosis, and treatment status were summarized. Results Abnormalities in the bony anatomy of the lower limb and poor alignment lead to patellofemoral joint instability through the quadriceps pulling force line and play an important role in the pathogenesis of recurrent patellar dislocation. Identifying the source of the deformity and intervening with peripatellar osteotomy to restore the biomechanical structure of the patellofemoral joint can reduce the risk of soft tissue surgical failure, delay joint degeneration, and achieve the target of treatment. Conclusion In the clinical diagnosis and treatment of recurrent patellar dislocation, the factors causing patellofemoral joint instability should be comprehensively evaluated to guide the selection of surgery and personalized treatment.

Citation： CHEN Jiahui, MA Jianxiong, MA Xinlong. Advances in peripatellar osteotomy for treating recurrent patellar dislocation. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(9): 1156-1161. doi: 10.7507/1002-1892.202304055 Copy

1.	Wolfe S, Varacallo M, Thomas J D, et al. Patellar Instability//StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing, 2023: 1-11.Wolfe S, Varacallo M, Thomas J D, et al. Patellar Instability//StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing, 2023: 1-11.
2.	Watts JC, Farrow LD, Elias JJ. Anatomical characteristics contributing to patellar dislocations following mpfl reconstruction: A dynamic simulation study. J Biomech Eng, 2023, 145(4): 041003.
3.	Fan C, Niu Y, Wang F. Local torsion of distal femur is a risk factor for patellar dislocation. J Orthop Surg Res, 2023, 18(1): 163.
4.	Danielsen O, Poulsen TA, Eysturoy NH, et al. Trochlea dysplasia, increased TT-TG distance and patella alta are risk factors for developing first-time and recurrent patella dislocation: a systematic review. Knee Surg Sports Traumatol Arthrosc, 2023. doi: 10.1007/s00167-022-07255-1.
5.	Migliorini F, Maffulli N, Vaishya R. Patellofemoral instability: Current status and future perspectives. J Orthop, 2022, 36: 49-50.
6.	孫玖陽, 楊久山. 嚴重膝外翻致復發性髕骨脫位1例并文獻復習. 中國骨與關節損傷雜志, 2022, 37(12): 1334-1336.
7.	陳志偉, 冉訊, 崔俊成, 等. 3D打印輔助難復性髕骨脫位外翻膝關節表面置換病例報告. 中南醫學科學雜志, 2022, 50(2): 290-292.
8.	Rupp MC, Lindner F, Winkler PW, et al. Clinical effect of isolated lateral closing wedge distal femoral osteotomy compared to medial opening wedge high tibial osteotomy for the correction of varus malalignment: A propensity score-matched analysis. Am J Sports Med, 2023, 51(2): 437-445.
9.	Diaz CC, Lavoie-Gagne OZ, Knapik DM, et al. Outcomes of distal femoral osteotomy for valgus malalignment: A systematic review and meta-analysis of closing wedge versus opening wedge techniques. Am J Sports Med, 2023, 51(3): 798-811.
10.	Liska F, Voss A, Imhoff FB, et al. Nonunion and delayed union in lateral open wedge distal femoral osteotomies-a legitimate concern? Int Orthop, 2018, 42(1): 9-15.
11.	Rupp MC, Themessl A, Merkle M, et al. Favorable rates of return to activity and work following lateral closing wedge distal femoral osteotomy for femoral-based symptomatic varus malalignment: an analysis at a mean 6-year follow-up. Knee Surg Sports Traumatol Arthrosc, 2023. doi: 10.1007/s00167-022-07303-w.
12.	Kandhari V, Angadi D, Myat D, et al. Long term outcomes of computer-navigated lateral opening wedge distal femoral osteotomy for lateral compartment knee arthrosis. Rev Bras Ortop (Sao Paulo), 2020, 57(1): 96-102.
13.	Agarwalla A, Liu JN, Garcia GH, et al. Return to sport following isolated lateral opening wedge distal femoral osteotomy. Cartilage, 2021, 13(1_suppl): 846S-852S.
14.	Pietsch M, Hochegger M, Winkler M, et al. Opening-wedge osteotomies of the distal femur: minor advantages for a biplanar compared to a uniplanar technique. Knee Surg Sports Traumatol Arthrosc, 2019, 27(7): 2375-2384.
15.	Sternheim A, Garbedian S, Backstein D. Distal femoral varus osteotomy: unloading the lateral compartment: long-term follow-up of 45 medial closing wedge osteotomies. Orthopedics, 2011, 34(9): e488-e490.
16.	Forkel P, Achtnich A, Metzlaff S, et al. Midterm results following medial closed wedge distal femoral osteotomy stabilized with a locking internal fixation device. Knee Surg Sports Traumatol Arthrosc, 2015, 23(7): 2061-2067.
17.	Kolb A, Isak V, Hobusch GM, et al. Distal femoral varus osteotomy: results of the lateral open-wedge technique without bone grafting. Int Orthop, 2019, 43(10): 2315-2322.
18.	Ekeland A, Nerhus TK, Dimmen S, et al. Good functional results of distal femoral opening-wedge osteotomy of knees with lateral osteoarthritis. Knee Surg Sports Traumatol Arthrosc, 2016, 24(5): 1702-1709.
19.	Nelitz M, Dreyhaupt J, Williams SR, et al. Combined supracondylar femoral derotation osteotomy and patellofemoral ligament reconstruction for recurrent patellar dislocation and severe femoral anteversion syndrome: surgical technique and clinical outcome. Int Orthop, 2015, 39(12): 2355-2362.
20.	Zheng X, Hu Y, Xie P, et al. Surgical medial patellofemoral ligament reconstruction versus non-surgical treatment of acute primary patellar dislocation: a prospective controlled trial. Int Orthop, 2019, 43(6): 1495-1501.
21.	Biedert RM. Combined deepening trochleoplasty and supracondylar external rotation osteotomy for recurrent patellar instability in patients with trochlear dysplasia and increased femoral antetorsion. Knee, 2020, 27(4): 1158-1166.
22.	李遠, 劉俊才, 雷蕾, 等. 股骨遠端去旋轉截骨聯合內側髕股韌帶重建術治療復發性髕骨脫位的早期療效. 中國修復重建外科雜志, 2021, 35(3): 343-348.
23.	Yang GM, Wang YY, Zuo LX, et al. Good outcomes of combined femoral derotation osteotomy and medial retinaculum plasty in patients with recurrent patellar dislocation. Orthop Surg, 2019, 11(4): 578-585.
24.	Hinz M, Cotic M, Diermeier T, et al. Derotational distal femoral osteotomy for patients with recurrent patellar instability and increased femoral antetorsion improves knee function and adequately treats both torsional and valgus malalignment. Knee Surg Sports Traumatol Arthrosc, 2022. doi: 10.1007/s00167-022-07150-9.
25.	Tian G, Yang G, Zuo L, et al. Femoral derotation osteotomy for recurrent patellar dislocation. Arch Orthop Trauma Surg, 2020, 140(12): 2077-2084.
26.	Imhoff FB, Beitzel K, Zakko P, et al. Derotational osteotomy of the distal femur for the treatment of patellofemoral instability simultaneously leads to the correction of frontal alignment: A laboratory cadaveric study. Orthop J Sports Med, 2018, 6(6): 2325967118775664. doi: 10.1177/2325967118775664.
27.	Zhang Z, Song G, Li Y, et al. Medial patellofemoral ligament reconstruction with or without derotational distal femoral osteotomy in treating recurrent patellar dislocation with increased femoral anteversion: A retrospective comparative study. Am J Sports Med, 2021, 49(1): 200-206.
28.	周元博, 王晉東. 股骨滑車發育不良的病因及治療: 是先天基因還是后天髕骨應力刺激. 中國組織工程研究, 2021, 25(24): 3908-3913.
29.	Rush J, Diduch D. When is trochleoplasty a rational addition? Sports Med Arthrosc Rev, 2019, 27(4): 161-168.
30.	Dejour H, Walch G, Nove-Josserand L, et al. Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc, 1994, 2(1): 19-26.
31.	Tigchelaar S, van Sambeeck J, Koeter S, et al. A stand-alone lateral condyle-elevating trochlear osteotomy leads to high residual instability but no excessive increase in patellofemoral osteoarthritis at 12-year follow-up. Knee Surg Sports Traumatol Arthrosc, 2018, 26(4): 1216-1222.
32.	Thaunat M, Bessiere C, Pujol N, et al. Recession wedge trochleoplasty as an additional procedure in the surgical treatment of patellar instability with major trochlear dysplasia: early results. Orthop Traumatol Surg Res, 2011, 97(8): 833-845.
33.	Longo UG, Vincenzo C, Mannering N, et al. Trochleoplasty techniques provide good clinical results in patients with trochlear dysplasia. Knee Surg Sports Traumatol Arthrosc, 2018, 26(9): 2640-2658.
34.	Coakley A, McNicholas M, Biant L, et al. A systematic review of outcomes of high tibial osteotomy for the valgus knee. Knee, 2023, 40: 97-110.
35.	van Lieshout WAM, van Ginneken BJT, Kerkhoffs GMMJ, et al. Medial closing wedge high tibial osteotomy for valgus tibial deformities: good clinical results and survival with a mean 4.5 years of follow-up in 113 patients. Knee Surg Sports Traumatol Arthrosc, 2020, 28(9): 2798-2807.
36.	Collins B, Getgood A, Alomar AZ, et al. Correction to: A case series of lateral opening wedge high tibial osteotomy for valgus malalignment. Knee Surg Sports Traumatol Arthrosc, 2018, 26(7): 2215.
37.	Mitani G, Serigano K, Takagaki T, et al. MPFL reconstruction combined with a modified elmslie-trillat procedure for recurrent patellofemoral instability. J Knee Surg, 2023. doi: 10.1055/a-2001-6565.
38.	Mitani G, Maeda T, Takagaki T, et al. Modified elmslie-trillat procedure for recurrent dislocation of the patella. J Knee Surg, 2017, 30(5): 493-500.
39.	熊炎, 包家鵬, 陳煒平, 等. 內側髕股韌帶重建聯合Fulkerson脛骨結節截骨術治療復發性髕骨脫位的適應癥及療效. 2018年浙江省骨科學學術年會論文匯編, 2018.
40.	王嘯, 王培召, 韓旭, 等. 關節鏡下內側髕股韌帶重建聯合半脛骨結節內移術治療復發性髕骨脫位. 中國修復重建外科雜志, 2020, 34(7): 836-842.
41.	孫振杰, 袁一, 劉瑞波. 髕股關節紊亂與脛骨扭轉畸形的相關性分析. 中國骨傷, 2015, 28(3): 222-225.
42.	Huettner F, Lutter C, Zuehlke C, et al. Determination of standard values for knee version in a healthy population. Am J Sports Med, 2023, 51(4): 949-956.
43.	Balcarek P, Radebold T, Schulz X, et al. Geometry of torsional malalignment syndrome: trochlear dysplasia but not torsion predicts lateral patellar instability. Orthop J Sports Med, 2019, 7(3): 2325967119829790. doi: 10.1177/2325967119829790.
44.	Hogg J, Hampton M, Madan S. Supra tubercular tibial osteotomy and gradual correction with Taylor spatial frame for the management of Torsional malalignment syndrome-surgical technique and outcomes. Knee, 2023, 40: 8-15.
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1. Wolfe S, Varacallo M, Thomas J D, et al. Patellar Instability//StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing, 2023: 1-11.Wolfe S, Varacallo M, Thomas J D, et al. Patellar Instability//StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing, 2023: 1-11.
2. Watts JC, Farrow LD, Elias JJ. Anatomical characteristics contributing to patellar dislocations following mpfl reconstruction: A dynamic simulation study. J Biomech Eng, 2023, 145(4): 041003.
3. Fan C, Niu Y, Wang F. Local torsion of distal femur is a risk factor for patellar dislocation. J Orthop Surg Res, 2023, 18(1): 163.
4. Danielsen O, Poulsen TA, Eysturoy NH, et al. Trochlea dysplasia, increased TT-TG distance and patella alta are risk factors for developing first-time and recurrent patella dislocation: a systematic review. Knee Surg Sports Traumatol Arthrosc, 2023. doi: 10.1007/s00167-022-07255-1.
5. Migliorini F, Maffulli N, Vaishya R. Patellofemoral instability: Current status and future perspectives. J Orthop, 2022, 36: 49-50.
6. 孫玖陽, 楊久山. 嚴重膝外翻致復發性髕骨脫位1例并文獻復習. 中國骨與關節損傷雜志, 2022, 37(12): 1334-1336.
7. 陳志偉, 冉訊, 崔俊成, 等. 3D打印輔助難復性髕骨脫位外翻膝關節表面置換病例報告. 中南醫學科學雜志, 2022, 50(2): 290-292.
8. Rupp MC, Lindner F, Winkler PW, et al. Clinical effect of isolated lateral closing wedge distal femoral osteotomy compared to medial opening wedge high tibial osteotomy for the correction of varus malalignment: A propensity score-matched analysis. Am J Sports Med, 2023, 51(2): 437-445.
9. Diaz CC, Lavoie-Gagne OZ, Knapik DM, et al. Outcomes of distal femoral osteotomy for valgus malalignment: A systematic review and meta-analysis of closing wedge versus opening wedge techniques. Am J Sports Med, 2023, 51(3): 798-811.
10. Liska F, Voss A, Imhoff FB, et al. Nonunion and delayed union in lateral open wedge distal femoral osteotomies-a legitimate concern? Int Orthop, 2018, 42(1): 9-15.
11. Rupp MC, Themessl A, Merkle M, et al. Favorable rates of return to activity and work following lateral closing wedge distal femoral osteotomy for femoral-based symptomatic varus malalignment: an analysis at a mean 6-year follow-up. Knee Surg Sports Traumatol Arthrosc, 2023. doi: 10.1007/s00167-022-07303-w.
12. Kandhari V, Angadi D, Myat D, et al. Long term outcomes of computer-navigated lateral opening wedge distal femoral osteotomy for lateral compartment knee arthrosis. Rev Bras Ortop (Sao Paulo), 2020, 57(1): 96-102.
13. Agarwalla A, Liu JN, Garcia GH, et al. Return to sport following isolated lateral opening wedge distal femoral osteotomy. Cartilage, 2021, 13(1_suppl): 846S-852S.
14. Pietsch M, Hochegger M, Winkler M, et al. Opening-wedge osteotomies of the distal femur: minor advantages for a biplanar compared to a uniplanar technique. Knee Surg Sports Traumatol Arthrosc, 2019, 27(7): 2375-2384.
15. Sternheim A, Garbedian S, Backstein D. Distal femoral varus osteotomy: unloading the lateral compartment: long-term follow-up of 45 medial closing wedge osteotomies. Orthopedics, 2011, 34(9): e488-e490.
16. Forkel P, Achtnich A, Metzlaff S, et al. Midterm results following medial closed wedge distal femoral osteotomy stabilized with a locking internal fixation device. Knee Surg Sports Traumatol Arthrosc, 2015, 23(7): 2061-2067.
17. Kolb A, Isak V, Hobusch GM, et al. Distal femoral varus osteotomy: results of the lateral open-wedge technique without bone grafting. Int Orthop, 2019, 43(10): 2315-2322.
18. Ekeland A, Nerhus TK, Dimmen S, et al. Good functional results of distal femoral opening-wedge osteotomy of knees with lateral osteoarthritis. Knee Surg Sports Traumatol Arthrosc, 2016, 24(5): 1702-1709.
19. Nelitz M, Dreyhaupt J, Williams SR, et al. Combined supracondylar femoral derotation osteotomy and patellofemoral ligament reconstruction for recurrent patellar dislocation and severe femoral anteversion syndrome: surgical technique and clinical outcome. Int Orthop, 2015, 39(12): 2355-2362.
20. Zheng X, Hu Y, Xie P, et al. Surgical medial patellofemoral ligament reconstruction versus non-surgical treatment of acute primary patellar dislocation: a prospective controlled trial. Int Orthop, 2019, 43(6): 1495-1501.
21. Biedert RM. Combined deepening trochleoplasty and supracondylar external rotation osteotomy for recurrent patellar instability in patients with trochlear dysplasia and increased femoral antetorsion. Knee, 2020, 27(4): 1158-1166.
22. 李遠, 劉俊才, 雷蕾, 等. 股骨遠端去旋轉截骨聯合內側髕股韌帶重建術治療復發性髕骨脫位的早期療效. 中國修復重建外科雜志, 2021, 35(3): 343-348.
23. Yang GM, Wang YY, Zuo LX, et al. Good outcomes of combined femoral derotation osteotomy and medial retinaculum plasty in patients with recurrent patellar dislocation. Orthop Surg, 2019, 11(4): 578-585.
24. Hinz M, Cotic M, Diermeier T, et al. Derotational distal femoral osteotomy for patients with recurrent patellar instability and increased femoral antetorsion improves knee function and adequately treats both torsional and valgus malalignment. Knee Surg Sports Traumatol Arthrosc, 2022. doi: 10.1007/s00167-022-07150-9.
25. Tian G, Yang G, Zuo L, et al. Femoral derotation osteotomy for recurrent patellar dislocation. Arch Orthop Trauma Surg, 2020, 140(12): 2077-2084.
26. Imhoff FB, Beitzel K, Zakko P, et al. Derotational osteotomy of the distal femur for the treatment of patellofemoral instability simultaneously leads to the correction of frontal alignment: A laboratory cadaveric study. Orthop J Sports Med, 2018, 6(6): 2325967118775664. doi: 10.1177/2325967118775664.
27. Zhang Z, Song G, Li Y, et al. Medial patellofemoral ligament reconstruction with or without derotational distal femoral osteotomy in treating recurrent patellar dislocation with increased femoral anteversion: A retrospective comparative study. Am J Sports Med, 2021, 49(1): 200-206.
28. 周元博, 王晉東. 股骨滑車發育不良的病因及治療: 是先天基因還是后天髕骨應力刺激. 中國組織工程研究, 2021, 25(24): 3908-3913.
29. Rush J, Diduch D. When is trochleoplasty a rational addition? Sports Med Arthrosc Rev, 2019, 27(4): 161-168.
30. Dejour H, Walch G, Nove-Josserand L, et al. Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc, 1994, 2(1): 19-26.
31. Tigchelaar S, van Sambeeck J, Koeter S, et al. A stand-alone lateral condyle-elevating trochlear osteotomy leads to high residual instability but no excessive increase in patellofemoral osteoarthritis at 12-year follow-up. Knee Surg Sports Traumatol Arthrosc, 2018, 26(4): 1216-1222.
32. Thaunat M, Bessiere C, Pujol N, et al. Recession wedge trochleoplasty as an additional procedure in the surgical treatment of patellar instability with major trochlear dysplasia: early results. Orthop Traumatol Surg Res, 2011, 97(8): 833-845.
33. Longo UG, Vincenzo C, Mannering N, et al. Trochleoplasty techniques provide good clinical results in patients with trochlear dysplasia. Knee Surg Sports Traumatol Arthrosc, 2018, 26(9): 2640-2658.
34. Coakley A, McNicholas M, Biant L, et al. A systematic review of outcomes of high tibial osteotomy for the valgus knee. Knee, 2023, 40: 97-110.
35. van Lieshout WAM, van Ginneken BJT, Kerkhoffs GMMJ, et al. Medial closing wedge high tibial osteotomy for valgus tibial deformities: good clinical results and survival with a mean 4.5 years of follow-up in 113 patients. Knee Surg Sports Traumatol Arthrosc, 2020, 28(9): 2798-2807.
36. Collins B, Getgood A, Alomar AZ, et al. Correction to: A case series of lateral opening wedge high tibial osteotomy for valgus malalignment. Knee Surg Sports Traumatol Arthrosc, 2018, 26(7): 2215.
37. Mitani G, Serigano K, Takagaki T, et al. MPFL reconstruction combined with a modified elmslie-trillat procedure for recurrent patellofemoral instability. J Knee Surg, 2023. doi: 10.1055/a-2001-6565.
38. Mitani G, Maeda T, Takagaki T, et al. Modified elmslie-trillat procedure for recurrent dislocation of the patella. J Knee Surg, 2017, 30(5): 493-500.
39. 熊炎, 包家鵬, 陳煒平, 等. 內側髕股韌帶重建聯合Fulkerson脛骨結節截骨術治療復發性髕骨脫位的適應癥及療效. 2018年浙江省骨科學學術年會論文匯編, 2018.
40. 王嘯, 王培召, 韓旭, 等. 關節鏡下內側髕股韌帶重建聯合半脛骨結節內移術治療復發性髕骨脫位. 中國修復重建外科雜志, 2020, 34(7): 836-842.
41. 孫振杰, 袁一, 劉瑞波. 髕股關節紊亂與脛骨扭轉畸形的相關性分析. 中國骨傷, 2015, 28(3): 222-225.
42. Huettner F, Lutter C, Zuehlke C, et al. Determination of standard values for knee version in a healthy population. Am J Sports Med, 2023, 51(4): 949-956.
43. Balcarek P, Radebold T, Schulz X, et al. Geometry of torsional malalignment syndrome: trochlear dysplasia but not torsion predicts lateral patellar instability. Orthop J Sports Med, 2019, 7(3): 2325967119829790. doi: 10.1177/2325967119829790.
44. Hogg J, Hampton M, Madan S. Supra tubercular tibial osteotomy and gradual correction with Taylor spatial frame for the management of Torsional malalignment syndrome-surgical technique and outcomes. Knee, 2023, 40: 8-15.
45. Albersheim M, Noonan B, Chau M, et al. Rotational osteotomy for femoral version/tibial torsion. Curr Rev Musculoskelet Med, 2022, 15(6): 667-672.
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Chinese Journal of Reparative and Reconstructive Surgery

Advances in peripatellar osteotomy for treating recurrent patellar dislocation

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