Forschung & Innovation
Publikationen
Tibial tuberosity-trochlear groove distance is significantly decreased by medial closing wedge distal femoral osteotomy
PMU Autor*in
P. Augat
Alle Autor*innen
J. Watrinet, M. Joergens, P. Blum, Y. Ehmann, P. Augat, F. Stuby, S. Schroeter, J. Harrer, J. Fuermetz
Fachzeitschrift
KNEE SURGERY SPORTS TRAUMATOLOGY ARTHROSCOPY
Kurzfassung
Purpose: While medial closing wedge distal femoral osteotomy (MCWDFO) has been used to address patella instability combined with valgus malalignment, its impact on patellofemoral parameters remains uncharted. Hence, this study seeks to establish a three-dimensional (3D) planning of MCWDFO and measure its effect on the tibial tubercle - trochlear groove distance (TTTG) through simulation and calculation. Methods: MCWDFO with a stepwise increment of one-degree varisation (1 degrees-15 degrees) was performed on 3D surface models of 14 lower extremities with valgus malalignment and 24 lower extremities with neutral alignment of the lower limb, resulting in a total of 608 simulations. Anatomic landmarks were employed to measure hip-knee-ankle angle (HKA), TTTG, and femoral torsion for each simulation. A mathematical formula was adopted to calculate TTTG changes following MCWDFO, and subsequently the mean simulated and calculated TTTG values were compared. Following a standardised protocol, MCWDFO was performed without rotational changes. Results: MCWDFO exhibited an almost linear reduction in TTTG, at a rate of approximately -1.05 +/- 0.13 mm per 1 degrees of varisation, demonstrating a strong negative correlation (R = -0.83; p < 0.001). Limb alignment did not exert an influence on TTTG change; however, it correlated with tibial plateau width. The mean difference between the simulated and calculated TTTG values amounted to 0.03 +/- 0.03 mm per 1 degrees varisation (p < 0.001). Conclusion: The TTTG distance is linearly reduced by 1.05 mm for every 1 degrees of varisation within the varus correction range of 0 degrees-15 degrees during MCWDFO. Patients with combined valgus and patellar instability may benefit from MCWDFO due to frequently pathological TTTG.
Keywords
OUTCOMES, Humans, RISK, CT, ALIGNMENT, VALGUS, Retrospective Studies, OSTEOTOMY, closing-wedge, patellofemoral, TTTG, PATELLAR INSTABILITY, Femur/surgery, Joint Instability/surgery, Knee Joint/surgery, Osteotomy/methods, Patellofemoral Joint/diagnostic imaging, Tibia/surgery