Derotational distal femoral osteotomy for patellar dislocati
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There are controversies about surgical care with an increased femoral anti-version (FAA) angle of recurrent patellary dislocation (PSD). Medial patellofemoral ligament reconstruction (MPFL-R) either alone or combined with derotational distal femoral osteotomy (DDFO) results in favorable clinical outcomes. A Study was conducted to compare the clinical outcomes of MPFL-R versus MPFL-R with DDFO in treating RPD with increased FAA (more than 30°).

Analysis was done on 126 patients (135 knees) with RPD and increased FAA (more than 30°) & were surgically treated using MPFL-R with or without DDFO and eligible for this retrospective study. These patients were allocated into 2 groups based on whether an additional DDFO was performed: -DDFO group (MPFL-R + DDFO with or without tibial tubercle transfer; n = 66) and
-Control group (MPFL-R with or without tibial tubercle transfer; n = 69).
Pre- and postoperative patellar stability was measured using stress radiography. Patellar maltracking (J-sign) and patient-reported outcomes were evaluated and compared between the 2 groups.
-Subgroup analysis was performed by stratifying the results in terms of the severity of preoperative patellar maltracking (low-grade vs high-grade J-sign).

Results:
A total of 135 knees (126 patients) with a mean follow-up time of 3.7 ± 1.2 years were evaluated in the present study.
-The rates of postoperative MPFL residual graft laxity and residual J-sign were significantly lower in the DDFO group than in the control group (6% vs 19%; 33% vs 54%).
-The DDFO group had significantly higher Kujala (82.3 vs 76.7) and Lysholm (83.7 vs 77.7) scores than the control group had postoperatively.
-For patients with a preoperative high-grade J-sign, further subgroup analysis demonstrated that the DDFO group had a significantly lower rate of MPFL residual graft laxity than the control group had (18% vs 57%).

Conclusively, in this retrospective study, treatment of RPD with increased femoral anteversion using MPFL-R with DDFO yielded more favorable subjective and objective outcomes than did MPFL-R without DDFO, and this circumstance was more remarkable when the patients had a preoperative high-grade J-sign.

Source: https://journals.sagepub.com/doi/abs/10.1177/0363546520968566
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