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Derotational distal femoral osteotomy for patellar dislocation yielded favorable outcomes

Orthopedics Today highlights the perspectives of Beth E. Shubin Stein, MD, sports medicine surgeon at HSS, and Austin T. Fragomen, MD, limb lengthening surgeon at HSS, on study findings showing medial patellofemoral (MPFL) reconstruction with derotational distal femoral osteotomy yielded favorable subjective and objective outcomes among patients with recurrent patellar dislocation and increased femoral anteversion.

Drs. Shubin Stein and Fragomen wrote, “We read the article by ZhiJun Zhang, MD, and colleagues with great enthusiasm as it revealed clinical insights into a surgical approach that has dominated our practices: combined distal femoral osteotomy and tibial tubercle osteotomy/MPFL reconstruction for patients with complex patellofemoral instability. Dedicated to patellofemoral pathology-surgical sports medicine and limb deformity surgery, we have brought our separate skills together to deliver comprehensive surgical plans where osteotomies for valgus and femoral anteversion often accompany surgery to address coronal plane malalignment through tibial tubercle transfer, address incompetent medial structures via MPFL reconstruction and address cartilage defects with cartilage restoration. Historically, femoral anteversion was corrected through a mid-diaphyseal osteotomy fixed with an antegrade intramedullary nail with minimal impact on the extensor mechanism tracking.”

They added, “We have been performing transverse distal femoral rotational osteotomy to externally rotate the femoral condyles toward the patella while addressing varus or valgus malalignment. This is done with simultaneous MPFL reconstruction, tibial tubercle osteotomy, knee arthroscopy and cartilage restoration work if indicated. Femoral plate position and screw lengths are modified to accommodate the MPFL graft tunnel on the medial femur.”

Drs. Shubin Stein and Fragomen concluded, “Zhang and colleagues provide a sound clinical comparison that echoes the amazing clinical results we have witnessed in our collaborative practice.”

Read the full article at Healio.com/news/orthopedics.