Summary

Medial distal femoral varus and detortion osteotomy can control both coronal and axial alignment at same time.

Abstract

Case: Femoral valgus osteotomy for sever varus deformity of the femur was performed on sixteen years old female. 2 years after the surgery, she had suffered from giving way caused by patellar dislocation.
Clinical findings: Severe patellar apprehension was seen. X-ray demonstrated mild medial knee OA and lateral patellar tilt. Deformity analysis showed severe valgus deformity. In addition, CT showed 20 degree internal tortion deformity of the femur.
Diagnosis: Recurrent patellar dislocation caused by sever valgus and tortion deformity of the femur.
Treatment: Varus and detortion reosteotomy and MPFL reconstruction was performed simultaneously. Wedge shaped autograft bone from the closed wedge osteotomy site was transplanted into the anterior osteotomy site to fill the gap caused by tortion correction. MPFL reconstruction was performed at the same time by use of semitendinosus tendon. Weight bearing and ROM exercise was started 2 weeks after the surgery. Patellar apprehension was disappeared and Kujala score was improved from 35 points to 80 points. X-ray showed %MA changed from 168 degree to 172 degree, aLDFA 70 degree to 75 degree, internal tortion angle changed 25 degree externally.

Discussion

Medial distal femoral varus osteotomy is an established method to treat valgus knee. This procedure can control coronal alignment in normal method, but cannot control tortion. In this case report, the patient knee had both coronal and axial deformity of the femur and moreover recurrent patellar dislocation. If tortional correction is added to this procedure, wedge shaped gap occurred at anterior osteotomy site. In our case, wedge shaped autograft bone was transplanted into the gap and early bone healing was obtained.