title: Torsional osteotomies of the tibia in patellofemoral dysbalance.
abstract: OBJECTIVE
  Anterior knee pain or patellofemoral instability is common symptom of patellofemoral dysbalance or maltracking. Tibial torsional deformities can be the reason of this pathology. After appropriate diagnostic investigation, the treatment of choice is a torsional osteotomy. This study addresses the diagnostic investigation, treatment, and the outcome of torsional osteotomies of the tibia. Does this treatment result in patellofemoral stability and provide pain relief?
  
  
  METHODS
  Forty-nine tibial torsional osteotomies were included. The major symptoms were patellofemoral instability in 19 cases and anterior knee pain in 42 cases. In addition to clinical and radiographic analysis, a torsional angle CT scan was performed pre-operatively. A visual analog scale (VAS), the Japanese Knee Society score, the Tegner activity score, and the Lysholm score were assessed pre-operatively and at the 42-month follow-up.
  
  
  RESULTS
  Mean tibial external torsion was 47.4° (SD 5.41; range 37°-66°; standard value 34°). Surgical treatment consisted of an acute supratuberositary tibial internal torsional osteotomy (mean 10.8°; SD 3.01°; range 5°-18°). At the follow-up investigation, the Tegner activity score was increased 0.4 points (p value 0.014) from 3.9 (SD 1.33; range 2-7) to 4.3 (SD 1.25; range 0-7). The Lysholm score increased 26 points (SD 16.32; p value 0.001) from 66 (SD 14.94; range 32-94) to 92 (SD 9.29; range 70-100) and the Japanese Knee Society score increased 18 points (SD 14.70; p value 0.001) from 72 (SD 13.72, range 49-100) to 90 (SD 9.85, range 60-100). VAS was reduced 3.4 points (SD 2.89; p value 0.001) from 5.7 (SD 2.78; range 0-10) to 2.3 (SD 1.83; range 0-7). As regards patellofemoral instability, no redislocation occurred in the follow-up period.
  
  
  CONCLUSIONS
  The results of this study show that in cases of tibial maltorsion, a torsional osteotomy can lead to patellofemoral stability and pain relief, and should be considered as a treatment option. The improved clinical scores in the present investigation show the value of the procedure. Level of evidence Level IV.
authors.affiliation: Klinik für Orthopädie und Unfallchirurgie, Klinikum Bamberg, Buger Strasse 80, 96049, Bamberg, Germany. JDICKSCHAS@web.de.
authors.forename: Jörg
authors.initials: J
authors.lastname: Dickschas
authors.affiliation: Klinik für Orthopädie und Unfallchirurgie, Klinikum Bamberg, Buger Strasse 80, 96049, Bamberg, Germany.
authors.forename: Aliki
authors.initials: A
authors.lastname: Tassika
authors.affiliation: CV Path Institute, Gaithersburg, MD, 20878, USA.
authors.forename: Christoph
authors.initials: C
authors.lastname: Lutter
authors.affiliation: Klinik für Orthopädie und Unfallchirurgie, Klinikum Bamberg, Buger Strasse 80, 96049, Bamberg, Germany.
authors.forename: Jörg
authors.initials: J
authors.lastname: Harrer
authors.affiliation: Klinik für Orthopädie und Unfallchirurgie, Klinikum Bamberg, Buger Strasse 80, 96049, Bamberg, Germany.
authors.forename: Wolf
authors.initials: W
authors.lastname: Strecker
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007593:Joint Instability / Q000503:physiopathology / Q000601:surgery*; D065466:Lysholm Knee Score; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods*; D057071:Patellofemoral Joint / Q000503:physiopathology / Q000601:surgery*; D013977:Tibia / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Anterior knee pain; Inwardly pointing knee; Patellofemoral maltracking; Rotational osteotomy; Torsional deformity; Torsional osteotomy