Tibial Derotational Osteotomy for Patellofemoral Instability: A Systematic Review
Table 2
Summary of study characteristics and salient findings.
Author
Procedure (s) performed
Subjects (knees)
Follow-up
Salient findings
Drexler, et al. (2013)
TKA + TDO + TTT
10 (12)
7 years (average)
Anatomical correction
(i) Average rotational correction of tibial torsion: 30 degrees (range, 20–35)
Patient reported outcome measures (preop vs postop)
(i) KSS part 1 improved from 30.2 ± 11.51 to 86.8 ± 11.75 (); part 2 improved from 28 ± 17.8 to 75.8 ± 11.75 ()
(ii) SF-12 physical score improved from 31 ± 3.68 to 51.2 ± 8.8 (); mental score improved from 23.8 ± 5.34 to 55 ± 8.6
(iii) WOMAC total score improved from 12.74 ± 7.63 to 84 ± 14.95 ()
Pain
(i) Visual analogue scale pain ratings improved from 8.5 ± 0.9 to 1.3 ± 1.4 on average
Patient satisfaction
(i) 9/10 subjects stated they were “satisfied” with the procedure
Complications: 5 subjects (5 knees)
(i) Persistent anterior knee pain (2)
(ii) Subsequent patellar resurfacing procedure (1)
(iii) Tibial pain secondary to buttress plate and screws (2)
(iv) Postoperative stiffness with flexion to only 70 degrees (1)
Dickschas, et al. (2017)
TDO
42 (49)
42 months (range, 6–131)
Anatomical correction
(i) External tibial torsion was corrected on average by 10.8 deg (SD 3.01; range 5–18)
Patient-reported outcome measures
(i) Tegner activity score: increased 0.4 points on average ()
(ii) Lysholsm score: increased 26 points on average ()
(iii) Japanese knee society score: increased 18 points on average ()
Pain and symptoms
(i) Visual analogue scale pain ratings were reduced by 3.4 points on average ()
(ii) Zero subjects reported redislocation of the joint during the follow-up period
Complications: 4
(i) No bone healing detectable on X-ray at 4 months (1)
(ii) Painful fibular pseudarthrosis (1)
(iii) Compartment syndrome (1)
(iv) Peroneal nerve deficiency without compartment syndrome (1)
Drexler, et al. (2014)
TDO + TTT
12 (15)
84 months (range, 15–156)
Anatomical correction
(i) Median preop EETT = 62 degrees (range, 55–70)
(ii) Median correction = 36 degrees (range, 30–45 degrees)
Patient reported outcome measures
(i) KSS part 1 improved from 37 ± 14 to 89 ± 11 points; part 2 improved from 25 ± 26 to 85 ± 14 points ()
(ii) Kujala patellofemoral score improved from 31.3 ± 15.1 to 86.8 ± 12.5 ()
(iii) WOMAC total improved from 27.3 ±1 8.3 to 87.7 ± 10.3 ()
(iv) SF-12 physical improved from 32.2 ± 5.7 to 50.4 ± 7.9 ()
(v) SF-12 mental improved from 23.8 ± 5.5 to 57 ± 5.6 ()
Complications: 2
(i) Nonunion of the tibial osteotomy (2)
Stevens, et al. (2014)
TDO + femoral osteotomy
16 (23)
59 months (range, 11–145)
Pain
(i) Improvement in visual analogue scale pain ratings from a mean of 8.6 to 3.3 ()
Patient-reported questionnaire
(i) Continued knee instability in 10/23 knees
(ii) 13/23 knees were “trusted” by patients
(iii) “Activity levels” improved in 15/23 knees, remained the same in 3 knees, and decreased in 5 knees
(iv) 2/23 subjects required additional surgery: bilateral guided growth (1) and arthroscopic debridement and microfracture (1)
Complications: 2
(i) Femoral nonunion (1)
(ii) Peroneal nerve injury from loose proximal tibial interlocking screw (1)
Fouilleron, et al. (2010)
TDO
29 (36)
4.7 years
Anatomical correction
(i) Mean derotation was 25 degrees
Patient satisfaction
(i) 27/29 patients were “satisfied” or “very satisfied” with the procedure (94%)
Patient-reported outcome measures
(i) Lille score increased from 54.8 ± 16.9 to 85.2 ± 14.2
(ii) IKS knee score increased from 56 ± 14.8 to 94 ± 12.1; IKS function score increased from 71 ± 18.4 to 96 ± 11.9 ()
Complications: 4
(i) Stiffness requiring knee manipulation under general anesthesia (2)
(ii) Subsequent surgical fibular fibrous arch release (1)
(iii) Regressive palsy of the common fibular nerve (1)
Manilov, et al. (2020)
TDO
54 (60)
66 months
Patient-reported outcome measures
(i) Kujala score improved from 47.5 to 93 () on average
(ii) Fulkerson score improved from 40.6 to 91.6 on average ()
(iii) Kujala subscores for pain improved from 8.6 to 30.4, instability improved from 6.4 to 17.9, and ability to climb stairs increased from 6.9 to 17.9 (all )
Complications: 5
(i) Intraoperative proximal tibial fracture distal to the osteotomy (1)
(ii) Neuroproxia of the peroneal nerve (1)
(iii) Permanent palsy of EHL (1)
(iv) Subsequent arthroscopic lysis of adhesions due to postoperative stiffness (2)
(v) 11 subjects required hardware removal within the first postoperative year due to local pain
