title: Knee Pain and Activity Outcomes After Femoral Derotation Osteotomy for Excessive Femoral Anteversion.
abstract: BACKGROUND
  Excessive femoral anteversion is a developmental condition that can become symptomatic into adolescence and manifest as anterior knee pain, tripping, and or problems with sports. Femoral derotational osteotomy about an antegrade intramedullary nail (IMN) is an accepted option to treat this condition. This is the first report of the clinical and functional outcomes of treatment of excessive anteversion with femoral derotational osteotomy stabilized with an IMN.
  
  
  METHODS
  We prospectively enrolled 28 consecutive patients between 2013 and 2014 who underwent derotational osteotomy. Physical examination measures were used to calculate the amount of angular correction with focus on internal and external rotation of the hip, as well as the trochanteric prominence angle test of femoral anteversion. The International Knee Documentation Committee-9, Marx, and Tegner activity scales were 3 patient-reported outcomes recorded.
  
  
  RESULTS
  After femoral derotation osteotomy over an IMN, femoral anteversion, as measured by the trochanteric prominence angle, improved an average of 29 degrees (P<0.0001). At 1-year minimum follow-up, 22 of 28 subjects (78.5%) demonstrated a mean significant improvement of 13 points for International Knee Documentation Committee-9 (SD=15.4, P=0.0007), which surpassed the level of minimal clinically important change. Furthermore, the Tegner inventory scores for the cohort improved by an average of 1.9 activity levels (SD=2.4, P=0.0012).
  
  
  CONCLUSIONS
  For adolescents with symptomatic excessive femoral anteversion, derotational osteotomy over an IMN offers a reliable surgical option that provides predictable deformity correction and significant improvements in both function and pain scales.
  
  
  METHODS
  Level II-prospective, consecutive, nonrandomized, internally controlled cohort study.
authors.affiliation: Department of Orthopaedic Surgery, Washington University School of Medicine.
authors.forename: Jeffrey B
authors.initials: JB
authors.lastname: Stambough
authors.affiliation: Division of Orthopaedic Surgery, St Louis Children's Hospital.
authors.forename: Lauren
authors.initials: L
authors.lastname: Davis
authors.affiliation: Shriners Hospital for Children, St Louis, MO.
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Szymanski
authors.affiliation: Division of Orthopaedic Surgery, St Louis Children's Hospital.
authors.forename: June C
authors.initials: JC
authors.lastname: Smith
authors.affiliation: Division of Orthopaedic Surgery, St Louis Children's Hospital.|Shriners Hospital for Children, St Louis, MO.
authors.forename: Perry L
authors.initials: PL
authors.lastname: Schoenecker
authors.affiliation: Division of Orthopaedic Surgery, St Louis Children's Hospital.|Shriners Hospital for Children, St Louis, MO.
authors.forename: J Eric
authors.initials: JE
authors.lastname: Gordon
mesh_terms: D000293:Adolescent; D018771:Arthralgia / Q000209:etiology*; D060750:Bone Anteversion / Q000150:complications / Q000601:surgery*; D001858:Bone Nails; D002648:Child; D005260:Female; D005269:Femur / Q000002:abnormalities / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D007719:Knee Joint; D008297:Male; D010027:Osteotomy / Q000295:instrumentation / Q000379:methods*; D011446:Prospective Studies; D012399:Rotation; D016896:Treatment Outcome