title: [Torsional osteotomy : Operative treatment of patellofemoral maltracking].
abstract: BACKGROUND
  Patellofemoral maltracking may congenitally be caused by excessive internal maltorsion of the femur and/or excessive external maltorsion of the tibia.
  
  
  OBJECTIVE
  Pain relief, femoropatellar stability, well-balanced charge of femoral and patellar cartilage.
  
  
  METHODS
  Anterior knee pain, patellar instability, associated with "inwardly pointing knee" syndrome.
  
  
  METHODS
  Open physes, > 50 years, chronic/fixed patella luxation, congenital connective tissue and bone healing disorders.
  
  
  METHODS
  Analysis of leg geometry and patellofemoral anatomy. Knee arthroscopy. Supracondylar external torsional osteotomy of the femur: medial approach, ventral shift of vastus medialis muscle. Definition of osteotomy plane. Torsion control. Complete transversal osteotomy. Acute external torsional correction. Fixation with internal plate. Supratuberositary internal torsional osteotomy of the tibia: exposure of lateral tibial head, detachment of the tibialis anterior muscle. Partial chisel osteotomy of the proximal tibial tuberosity. Definition of supratuberositary osteotomy plane. Torsion control with Schanz screws. Bending of a DC plate (DCP). Complete transversal osteotomy. Acute internal torsional correction and fixation with prebent DCP. With internal torsional correction > 10°, decompression of the peroneal nerve and proximal tibialis anterior fasciotomy.
  
  
  METHODS
  Neurovascular and muscle function follow-up. On postsurgery day 1, drainage removal, x-ray control, mobilization. Partial weight bearing (20 kg) for 4 weeks with stepwise load increments. Active/passive exercises. Thromboprophylaxis.
  
  
  RESULTS
  In 25 patients, 30 external torsional osteotomies of the supracondylar femur with 13.8° (5-26°); in 45 patients, 53 internal torsional osteotomies of the supratuberositary tibial head with an average 10.8° (5-18°). No persisting compartment syndrome or infection. One non-union healed after revision. One dysfunction of the peroneal nerve resolved with time. No subluxation or redislocation of the patella. Anterior knee pain decreased significantly in both groups.
authors.affiliation: Klinik für Orthopädie und Unfallchirurgie, Klinikum am Bruderwald, Buger Straße 80, 96049, Bamberg, Deutschland. lupo.extensor@t-online.de.
authors.forename: W
authors.initials: W
authors.lastname: Strecker
authors.affiliation: Klinik für Orthopädie und Unfallchirurgie, Klinikum am Bruderwald, Buger Straße 80, 96049, Bamberg, Deutschland.
authors.forename: J
authors.initials: J
authors.lastname: Dickschas
mesh_terms: D000328:Adult; D001178:Arthroplasty / Q000295:instrumentation / Q000379:methods*; D001860:Bone Plates; D001863:Bone Screws; D003131:Combined Modality Therapy / Q000295:instrumentation / Q000379:methods; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000295:instrumentation / Q000379:methods; D057071:Patellofemoral Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000295:instrumentation* / Q000379:methods*; D014102:Torsion Abnormality / Q000601:surgery*; D016896:Treatment Outcome
keywords: Femur; Knee joint; Pain; Patellar dislocation; Tibia; Torsional malalignment