Linear influence of distal femur osteotomy on the Q-angle: one degree of varization alters the Q-angle by one degree.
Distal femur osteotomy
Genu valgum
Patellar instability
Q-angle
TT–TG distance
Varization osteotomy
Journal
Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA
ISSN: 1433-7347
Titre abrégé: Knee Surg Sports Traumatol Arthrosc
Pays: Germany
ID NLM: 9314730
Informations de publication
Date de publication:
Feb 2021
Feb 2021
Historique:
received:
16
02
2020
accepted:
24
03
2020
pubmed:
11
4
2020
medline:
14
4
2021
entrez:
11
4
2020
Statut:
ppublish
Résumé
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. 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. 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. 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.
Identifiants
pubmed: 32274549
doi: 10.1007/s00167-020-05970-1
pii: 10.1007/s00167-020-05970-1
doi:
Types de publication
Historical Article
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
540-545Références
Arendt EA, Fithian DC, Cohen E (2002) Current concepts of lateral patella dislocation. Clin Sports Med 21(3):499–519
pubmed: 12365240
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):346–349
pubmed: 11482469
Caylor D, Fites R, Worrell TW (1993) The relationship between quadriceps angle and anterior knee pain syndrome. J Orthop Sports Phys Ther 17(1):11–16
pubmed: 8467330
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):19–26
pubmed: 7584171
Eckhoff DG, Montgomery WK, Kilcoyne RF, Stamm ER (1994) Femoral morphometry and anterior knee pain. Clin Orthop Relat Res 302:64–68
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):3572–3581
pubmed: 29869201
Fulkerson JP, Arendt EA (2000) Anterior knee pain in females. Clin Orthop Relat Res 372:69–73
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
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):62–68
pubmed: 17860670
pmcid: 1427123
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
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):697–704
pubmed: 28378138
Greene CC, Edwards TB, Wade MR, Carson EW (2001) Reliability of the quadriceps angle measurement. Am J Knee Surg 14(2):97–103
pubmed: 11401177
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):495–501
pubmed: 24350508
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):398–406
pubmed: 31256215
Huberti HH, Hayes WC (1984) Patellofemoral contact pressures. The influence of q-angle and tendofemoral contact. J Bone Joint Surg Am 66(5):715–724
pubmed: 6725318
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):2325967118775664
pubmed: 29900182
pmcid: 5985607
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):652–658
pubmed: 30315327
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):897–904
pubmed: 31127313
Jud L, Vlachopoulos L, Beeler S, Tondelli T, Furnstahl P, Fucentese SF (2020) Accuracy of three dimensional-planned patient-specific instrumentation in femoral and tibial rotational osteotomy for patellofemoral instability. Int Orthop. https://doi.org/10.1007/s00264-020-04496-y
pubmed: 32055971
Kwon JH, Kim JI, Seo DH, Kang KW, Nam JH, Nha KW (2013) Patellar dislocation with genu valgum treated by DFO. Orthopedics 36(3):840–843
pubmed: 23746026
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):1626–1630
pubmed: 20505056
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):2355–2362
pubmed: 26156717
Purushothaman B, Agarwal A, Dawson M (2012) Posttraumatic chronic patellar dislocation treated by distal femoral osteotomy and medial patellofemoral ligament reconstruction. Orthopedics 35(11):e1668–1672
pubmed: 23127463
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):749–756
pubmed: 16436533
Schneider PED (2003) Geometric tools for computer graphics. Morgan Kaufmann Publishers Inc., San Francisco, CA
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):266–275
pubmed: 19430854
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):1068–1079
pubmed: 18841346
Swarup I, Elattar O, Rozbruch SR (2017) Patellar instability treated with distal femoral osteotomy. Knee 24(3):608–614
pubmed: 28318932