Available online 30 November 2023, 151038

Author links open overlay panel, Abstract

Valgus lower extremity alignment with excessive femoral anteversion and tibial external torsion (Miserable Malalignment Syndrome) results in patellar maltracking. Sagittal plane deformities (rotational alignment) should be quantified along with typical frontal plane alignment. Femoral and tibial rotation can be assessed with both physical examination and radiographic studies. Derotational osteotomies of both the femur and the tibia can then be used for correction. In this chapter, we attempt to provide guidelines for assessing lower extremity rotation and an understanding of normal femoral and tibial rotational values. We then provide examples of corrective femoral osteotomies and tibial rotational osteotomies.

Section snippetsOur technique for diaphyseal femoral percutaneous derotational osteotomy over an intramedullary nail

We begin with careful clinical measurements of femoral internal and external rotation at the hip. Ideally we would like to correct a patient to equal 45° of internal rotation and 45° of external rotation. For instance, if we measured hip internal rotation at 70° and external rotation at 20°, then we would plan a femoral change in rotation (derotation) of 25° so that both internal rotation and external rotation postoperatively would be equal and matched at 45 degrees. With this clinical

Surgical Technique

A 4cm oblique incision is made over the neck of the fibula. The common and deep peroneal nerves are decompressed at the first and second tunnels according to Paley.16,24. This allows for safe exposure of the proximal fibula just distal to the neck. The interval between the gastrocnemius and peroneal muscles is used to reach the fibula and expose it subperiosteally. Care should be taken when placing a mini Hohmann around the fibular anteriorly. The branch to the EHL can easily be injured if this

References (28)Y Yoshioka et al.Femoral anteversion: assessment based on function axes

J Orthop Res Off Publ Orthop Res Soc

(1987)

P Kaiser et al.Significant differences in femoral torsion values depending on the CT measurement technique

Arch Orthop Trauma Surg

(2016)

FB Imhoff et al.Derotational osteotomy at the distal femur is effective to treat patients with patellar instability

Knee Surg Sports Traumatol Arthroscopy

(2018)

P Kaiser et al.Isolated medial patellofemoral ligament reconstruction for patella instability is insufficient for higher degrees of internal femoral torsion

Knee Surg Sports Traumatol Arthroscopy

(2018)

View full text

© 2023 Published by Elsevier Inc.