Abstract

BackgroundMedial patellofemoral ligament reconstruction (MPFLR) is a well-established procedure for addressing recurrent patellar dislocation (RPD) in young patients. However, despite being a promising procedure for RPD with genu valgum, there is a scarcity of reports on simultaneous MPFLR and closing-wedge distal femoral osteotomy (CWDFO). The purpose of the present study was to observe and analyse the clinical and imaging findings of CWDFO combined with MPFLR for RPD with genu valgum.MethodsFrom May 2015 to April 2018, 25 patients with RPD and genu valgum were surgically treated in our department. Anteroposterior long-leg, weight-bearing, lower-extremity radiographs, lateral radiographs and computed tomography (CT) scans of the patellofemoral joint were obtained, and the anatomical femorotibial angle (aFTA), mechanical lateral distal femoral angle (mLDFA), weight-bearing line rate (WBLR), patellar height, patellar lateral shift (PLS) and tibial tubercle–trochlear groove (TT-TG) distance were analysed. Validated knee scores, such as the Kujala, Lysholm, visual analogue scale (VAS) scores and Tegner socres, were evaluated preoperatively and 2 years postoperatively.Results25 patients, with an average age of 19.8 years (14–27), were evaluated. During the 2-year follow-up period, all patients were able to achieve a better sports level without any problems, with no recurrence of patellar instability. Compared with preoperation, the aFTA, mLDFA, WBLR and PLS showed statistically significant improvement following the procedure (p < 0.001). Meanwhile, no significant differences in the Insall index and TT-TG distance were found. The mean Kujala score, average Lysholm score, VAS score and Tegner socres showed significant postoperative improvement.ConclusionsCWDFO combined with MPFLR is a suitable treatment for RPD with genu valgum, and can lead to significant improvement in the clinical and imaging findings of the knee in the short term.

Highlights

  • Medial patellofemoral ligament reconstruction (MPFLR) is a well-established procedure for addressing recurrent patellar dislocation (RPD) in young patients

  • RPD is relatively common among teenagers [1], with numerous factors contributing thereto, such as patella alta, femoral malrotation, tibial tubercle lateralisation, and genu valgum [2, 3] there is need for an individual treatment option based on potential pathoanatomy

  • From May 2015 to April 2018, 27 patients underwent closing-wedge distal femoral osteotomy (CWDFO) combined with MPFLR at our institution

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Summary

Introduction

Medial patellofemoral ligament reconstruction (MPFLR) is a well-established procedure for addressing recurrent patellar dislocation (RPD) in young patients. Despite being a promising procedure for RPD with genu valgum, there is a scarcity of reports on simultaneous MPFLR and closing-wedge distal femoral osteotomy (CWDFO). RPD is relatively common among teenagers [1], with numerous factors contributing thereto, such as patella alta, femoral malrotation, tibial tubercle lateralisation, and genu valgum [2, 3] there is need for an individual treatment option based on potential pathoanatomy. MPFLR is the most common surgical procedure for PRD, but genu valgum is a significant risk factor that can lead to failure of an isolated MPFLR [6, 7]. As a significant risk factor for RPD, correcting the valgus deformity simultaneously could be a reasonable approach

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