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Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 2/2021

01-02-2021 | Computed Tomography | KNEE

Linear influence of distal femur osteotomy on the Q-angle: one degree of varization alters the Q-angle by one degree

Authors: A. Flury, L. Jud, A. Hoch, R. S. Camenzind, S. F. Fucentese

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 2/2021

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Abstract

Purpose

The effect of a distal femur varization osteotomy on patellofemoral biomechanics in genu valgum is unknown. The purpose of this study was to quantify the influence of frontal leg axis correction on the Q-angle with a novel three-dimensional (3-D) measurement method.

Methods

3-D surface models of ten lower extremities were generated using patient computed tomography (CT) data. The preoperative 3-D Q-angle was measured using a novel defined and validated 3-D measurement method. Biplanar supracondylar osteotomies were simulated with different degrees of varus correction (from 1° to 15°) in one-degree steps beginning from the preoperative valgus deformity, resulting in a total of 150 simulations. Additionally, mechanical leg axis and 3-D Q-angle measurements were performed on 3-D surface models of the postoperative CT scans of the same individuals. Further, pre- and postoperative TT–TG distance was measured.

Results

Mean preoperative Q-angle was 15.8 ± 3.9° (range 10°–21.4°) with a mean preoperative mechanical leg axis of 6.5° ± 2.4 valgus (range 3.8°–11.6° valgus). The Q-angle changed linearly 0.9 ± 0° per 1° of varization. No difference was detected between simulated 3-D Q-angles and effectively corrected postoperative values (n.s.). TT–TG distance changed irregularly and minimally, and with no correlation to the degree of varization.

Conclusion

Distal femur varization osteotomy has a linear effect on the Q-angle with a change of 1° per 1° of varization. The difference in TT–TG distance was mainly due to an unintentional rotational component implemented during surgery.
Literature
1.
Arendt EA, Fithian DC, Cohen E (2002) Current concepts of lateral patella dislocation. Clin Sports Med 21(3):499–519PubMedCrossRef
2.
Biedert RM, Warnke K (2001) Correlation between the Q angle and the patella position: a clinical and axial computed tomography evaluation. Arch Orthop Trauma Surg 121(6):346–349PubMedCrossRef
3.
Caylor D, Fites R, Worrell TW (1993) The relationship between quadriceps angle and anterior knee pain syndrome. J Orthop Sports Phys Ther 17(1):11–16PubMedCrossRef
4.
Dejour H, Walch G, Nove-Josserand L, Guier C (1994) Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc 2(1):19–26PubMedCrossRef
5.
Eckhoff DG, Montgomery WK, Kilcoyne RF, Stamm ER (1994) Femoral morphometry and anterior knee pain. Clin Orthop Relat Res 302:64–68
6.
Frings J, Krause M, Akoto R, Wohlmuth P, Frosch KH (2018) Combined distal femoral osteotomy (DFO) in genu valgum leads to reliable patellar stabilization and an improvement in knee function. Knee Surg Sports Traumatol Arthrosc 26(12):3572–3581PubMedCrossRef
7.
Fulkerson JP, Arendt EA (2000) Anterior knee pain in females. Clin Orthop Relat Res 372:69–73CrossRef
8.
Fürnstahl P, Schweizer A, Graf M, Vlachopoulos L, Fucentese S, Wirth S et al (2016) Surgical treatment of long-bone deformities: 3D preoperative planning and patient-specific instrumentation. Computational radiology for orthopaedic interventions. Springer, New York, pp 123–149
9.
Goldthwait JE (1899) V. permanent dislocation of the patella. The report of a case of twenty years’ duration, successfully treated by transplantation of the patella tendons with the tubercle of the tibia. Ann Surg 29(1):62–68PubMedPubMedCentral
10.
Goutallier D, Bernageau J, Lecudonnec B (1978) The measurement of the tibial tuberosity patella groove distanced technique and results. Rev Chir Orthop Repar Appar Mot 64(5):423–428
11.
Graf KH, Tompkins MA, Agel J, Arendt EA (2018) Q-vector measurements: physical examination versus magnetic resonance imaging measurements and their relationship with tibial tubercle–trochlear groove distance. Knee Surg Sports Traumatol Arthrosc 26(3):697–704PubMedCrossRef
12.
Greene CC, Edwards TB, Wade MR, Carson EW (2001) Reliability of the quadriceps angle measurement. Am J Knee Surg 14(2):97–103PubMed
13.
Hermans K, Claes S, Bellemans J (2013) Valgus instability as a cause for recurrent lateral patellar dislocation: a new mechanism for patellofemoral instability? Acta Orthop Belg 79(5):495–501PubMed
14.
Hochreiter B, Hess S, Moser L, Hirschmann MT, Amsler F, Behrend H (2020) Healthy knees have a highly variable patellofemoral alignment: a systematic review. Knee Surg Sports Traumatol Arthrosc 28(2):398–406PubMedCrossRef
15.
Huberti HH, Hayes WC (1984) Patellofemoral contact pressures. The influence of q-angle and tendofemoral contact. J Bone Joint Surg Am 66(5):715–724PubMedCrossRef
16.
Imhoff FB, Beitzel K, Zakko P, Obopilwe E, Voss A, Scheiderer B et al (2018) Derotational osteotomy of the distal femur for the treatment of patellofemoral instability simultaneously leads to the correction of frontal alignment: a laboratory cadaveric study. Orthop J Sports Med 6(6):2325967118775664PubMedPubMedCentralCrossRef
17.
Imhoff FB, Cotic M, Liska F, Dyrna FGE, Beitzel K, Imhoff AB et al (2019) Derotational osteotomy at the distal femur is effective to treat patients with patellar instability. Knee Surg Sports Traumatol Arthrosc 27(2):652–658PubMedCrossRef
18.
Imhoff FB, Funke V, Muench LN, Sauter A, Englmaier M, Woertler K et al (2019) The complexity of bony malalignment in patellofemoral disorders: femoral and tibial torsion, trochlear dysplasia, TT-TG distance, and frontal mechanical axis correlate with each other. Knee Surg Sports Traumatol Arthrosc 28(3):897–904PubMedCrossRef
19.
20.
Kwon JH, Kim JI, Seo DH, Kang KW, Nam JH, Nha KW (2013) Patellar dislocation with genu valgum treated by DFO. Orthopedics 36(3):840–843PubMedCrossRef
21.
Lan TY, Lin WP, Jiang CC, Chiang H (2010) Immediate effect and predictors of effectiveness of taping for patellofemoral pain syndrome: a prospective cohort study. Am J Sports Med 38(8):1626–1630PubMedCrossRef
22.
Nelitz M, Dreyhaupt J, Williams SR, Dornacher D (2015) Combined supracondylar femoral derotation osteotomy and patellofemoral ligament reconstruction for recurrent patellar dislocation and severe femoral anteversion syndrome: surgical technique and clinical outcome. Int Orthop 39(12):2355–2362PubMedCrossRef
23.
Purushothaman B, Agarwal A, Dawson M (2012) Posttraumatic chronic patellar dislocation treated by distal femoral osteotomy and medial patellofemoral ligament reconstruction. Orthopedics 35(11):e1668–1672PubMedCrossRef
24.
Ramappa AJ, Apreleva M, Harrold FR, Fitzgibbons PG, Wilson DR, Gill TJ (2006) The effects of medialization and anteromedialization of the tibial tubercle on patellofemoral mechanics and kinematics. Am J Sports Med 34(5):749–756PubMedCrossRef
25.
Schneider PED (2003) Geometric tools for computer graphics. Morgan Kaufmann Publishers Inc., San Francisco, CA
26.
Sheehan FT, Derasari A, Fine KM, Brindle TJ, Alter KE (2010) Q-angle and J-sign: indicative of maltracking subgroups in patellofemoral pain. Clin Orthop Relat Res 468(1):266–275PubMedCrossRef
27.
Smith TO, Hunt NJ, Donell ST (2008) The reliability and validity of the Q-angle: a systematic review. Knee Surg Sports Traumatol Arthrosc 16(12):1068–1079PubMedCrossRef
28.
Swarup I, Elattar O, Rozbruch SR (2017) Patellar instability treated with distal femoral osteotomy. Knee 24(3):608–614PubMedCrossRef
Metadata
Title
Linear influence of distal femur osteotomy on the Q-angle: one degree of varization alters the Q-angle by one degree
Authors
A. Flury
L. Jud
A. Hoch
R. S. Camenzind
S. F. Fucentese
Publication date
01-02-2021
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 2/2021
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-020-05970-1

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