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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Abstract Full text Figures/Tables Video References Cited by

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.	孙玖阳, 杨久山. 严重膝外翻致复发性髌骨脱位1例并文献复习. 中国骨与关节损伤杂志, 2022, 37(12): 1334-1336.
7.	陈志伟, 冉讯, 崔俊成, 等. 3D打印辅助难复性髌骨脱位外翻膝关节表面置换病例报告. 中南医学科学杂志, 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.	李远, 刘俊才, 雷蕾, 等. 股骨远端去旋转截骨联合内侧髌股韧带重建术治疗复发性髌骨脱位的早期疗效. 中国修复重建外科杂志, 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, 王晋东. 股骨滑车发育不良的病因及治疗: 是先天基因还是后天髌骨应力刺激. 中国组织工程研究, 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, 包家鹏, 陈炜平, 等. 内侧髌股韧带重建联合Fulkerson胫骨结节截骨术治疗复发性髌骨脱位的适应症及疗效. 2018年浙江省骨科学学术年会论文汇编, 2018.
40.	王啸, 王培召, 韩旭, 等. 关节镜下内侧髌股韧带重建联合半胫骨结节内移术治疗复发性髌骨脱位. 中国修复重建外科杂志, 2020, 34(7): 836-842.
41.	孙振杰, 袁一, 刘瑞波. 髌股关节紊乱与胫骨扭转畸形的相关性分析. 中国骨伤, 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.
46.	张志军, 张辉, 宋关阳, 等. 复发性髌骨脱位高度髌骨轨迹不良的发生率及危险因素分析. 中国运动医学杂志, 2018, 37(11): 905-909.
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60.	王雪松, 张志军, 张辉. 股骨远端去旋转截骨术联合内侧髌股韧带重建治疗伴股骨前倾角增大的复发性髌骨脱位的中期临床疗效. 中国运动医学杂志, 2022, 41(7): 499-503.

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. 孙玖阳, 杨久山. 严重膝外翻致复发性髌骨脱位1例并文献复习. 中国骨与关节损伤杂志, 2022, 37(12): 1334-1336.
7. 陈志伟, 冉讯, 崔俊成, 等. 3D打印辅助难复性髌骨脱位外翻膝关节表面置换病例报告. 中南医学科学杂志, 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. 李远, 刘俊才, 雷蕾, 等. 股骨远端去旋转截骨联合内侧髌股韧带重建术治疗复发性髌骨脱位的早期疗效. 中国修复重建外科杂志, 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, 王晋东. 股骨滑车发育不良的病因及治疗: 是先天基因还是后天髌骨应力刺激. 中国组织工程研究, 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, 包家鹏, 陈炜平, 等. 内侧髌股韧带重建联合Fulkerson胫骨结节截骨术治疗复发性髌骨脱位的适应症及疗效. 2018年浙江省骨科学学术年会论文汇编, 2018.
40. 王啸, 王培召, 韩旭, 等. 关节镜下内侧髌股韧带重建联合半胫骨结节内移术治疗复发性髌骨脱位. 中国修复重建外科杂志, 2020, 34(7): 836-842.
41. 孙振杰, 袁一, 刘瑞波. 髌股关节紊乱与胫骨扭转畸形的相关性分析. 中国骨伤, 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.
46. 张志军, 张辉, 宋关阳, 等. 复发性髌骨脱位高度髌骨轨迹不良的发生率及危险因素分析. 中国运动医学杂志, 2018, 37(11): 905-909.
47. Geraghty L, Humphries D, Fitzpatrick J. Assessment of the reliability and validity of imaging measurements for patellofemoral instability: an updated systematic review. Skeletal Radiol, 2022, 51(12): 2245-2256.
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Chinese Journal of Reparative and Reconstructive Surgery

Advances in peripatellar osteotomy for treating recurrent patellar dislocation

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