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Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 9/2023

07-05-2023 | Osteoarthrosis | KNEE

In closed wedge distal femur osteotomies for correction of valgus malalignment overcorrection of mLDFA should be avoided

Authors: Steffen Schröter, Christian Konrads, Marco Maiotti, Moritz Mederake, Cornelius Fischer, Marc Ahrend, Daniel Schüll

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 9/2023

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Abstract

Purpose

The purpose of the study was to investigate the influence of the mLDFA (mechanical lateral distal femur angle) as a parameter in varus realignment osteotomies for valgus deformities of the knee. We hypothesized that joint line obliquity with mLDFA > 90° after distal femur osteotomy (DFO) is associated with inferior clinical outcome.

Methods

In a retrospective study, a total of 52 patients with isolated femoral valgus deformities were included in the study. The mean postoperative follow-up was 70.5 (SD 33.3) months (standard deviation SD±33.3). In all patients, a distal femur osteotomy was performed. A clinical examination and survey of questionnaires was conducted with the HSS (Hospital for Special Surgery), LG (Lysholm-Gilquist), and KOOS (Knee Injury and Osteoarthritis Outcome Score) scores. Several radiological parameters were assessed on long-standing x-rays: mechanical tibio-femoral angle (mTFA), mLDFA, mechanical medial proximal tibia angle (mMPTA), joint-line convergence angle (JLCA). The t test was used for normally distributed data. The Mann-Whitney U test was performed in non-normally distributed data.

Results

The mLDFA was 84.9° (SD±2.3) preop and changed to 91.9° (SD±3, 22.9) postop. The mTFA (mechanical tibio-femoral angle) was 5.2° (SD±2.9°) preop and − 1.8° (SD±2.9) postop demonstrating a difference of 6.7°. For analysis, the data was divided into two groups based on postop mLDFA. Group 1: mLDFA ≤ 90°; Group 2: > 90°. Postoperatively, a mean mLDFA of 88.6° (SD±1.4°) was measured in group 1 and 93.9° (SD±2.1) in group 2. The change in mLDFA was 4.7° (SD±1.6) in group 1 and 8.4° (SD±2.8) in group 2. Preoperatively, the mTFA was 4.8° (SD±1.9) in group 1 and 5.5° (SD±3.3) in group 2. Postoperatively, the mTFA decreased in group 1 by 4.8° (SD±2.3) to − 0.1° (SD±2.1). In group 2, the mTFA decreased by 8.2° (SD±3.8) to − 2.8° (SD±2.9). Regarding the HSS, group 1 showed a 10.4 points better score than group 2 (p<0.01). Also, regarding the Lysholm, a significant difference of 16.9 points was found (p<0.01).

Conclusion

Correction of valgus knees using closed wedge DFO leads to good clinical results. A postoperative mLDFA of 85–90° results in superior clinical outcome compared to mLDFA > 90°. Joint-line obliquity should be avoided using double level osteotomy, if needed.

Level of evidence

III.
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Metadata
Title
In closed wedge distal femur osteotomies for correction of valgus malalignment overcorrection of mLDFA should be avoided
Authors
Steffen Schröter
Christian Konrads
Marco Maiotti
Moritz Mederake
Cornelius Fischer
Marc Ahrend
Daniel Schüll
Publication date
07-05-2023
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 9/2023
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-023-07449-1

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