The Knee · 2026
Outcomes of supramalleolar tibial derotational osteotomy in paediatric patients with recurrent patellar dislocation or anterior knee pain and associated torsional malalignment.
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Dalal N, Denton M, Stanier P, Nicolaou N
Аннотация
BACKGROUND: Correction of torsional abnormalities in children with patellofemoral pathology remains controversial, with a limited evidence base to guide treatment. Isolated medial patellofemoral ligament (MPFL) reconstruction for instability in this group has been associated with high failure rates at mid-term follow-up.
PURPOSE: To evaluate whether single-level supramalleolar tibial osteotomy in paediatric patients with femoral and tibial torsional abnormalities is safe and effective, with or without concomitant patellar stabilisation in patients with instability.
METHODS: This was an observational study with prospective data collection over 10 years. Patients with recurrent patellar dislocation or anterior knee pain, torsional malalignment of both the tibia and femur, and hip external rotation of more than 15° who underwent tibial derotation osteotomy were included. Mean tibial extorsion was 49.1 ± 5.24° on preoperative CT imaging.
RESULTS: Thirty knees in 21 patients, with a mean age at surgery of 13.9 years and a mean follow-up of 5.05 years, were treated. Twenty knees were treated for recurrent instability (Cohort 1) and 10 for anterior knee pain with subjective instability (Cohort 2). The mean KOOS-Child score improved significantly from 38.1 preoperatively to 78.7 postoperatively (P < 0.005) across all five KOOS subscales. The mean Pedi-IKDC score increased from 35.6 preoperatively to 74.0 postoperatively, while the mean Kujala score increased from 35.9 preoperatively to 73.0 postoperatively. No patient required subsequent surgery for recurrent dislocation, although one patient with an open physis and a convex trochlea developed clinical failure and was listed for trochleoplasty. Metalwork removal was required in half of the cohort.
CONCLUSIONS: Distal tibial derotation osteotomy for patellofemoral instability or pain in children appears to be safe and may be considered as part of the treatment strategy for patients with torsional malalignment, with the potential to reduce recurrence rates associated with isolated MPFL reconstruction.
PURPOSE: To evaluate whether single-level supramalleolar tibial osteotomy in paediatric patients with femoral and tibial torsional abnormalities is safe and effective, with or without concomitant patellar stabilisation in patients with instability.
METHODS: This was an observational study with prospective data collection over 10 years. Patients with recurrent patellar dislocation or anterior knee pain, torsional malalignment of both the tibia and femur, and hip external rotation of more than 15° who underwent tibial derotation osteotomy were included. Mean tibial extorsion was 49.1 ± 5.24° on preoperative CT imaging.
RESULTS: Thirty knees in 21 patients, with a mean age at surgery of 13.9 years and a mean follow-up of 5.05 years, were treated. Twenty knees were treated for recurrent instability (Cohort 1) and 10 for anterior knee pain with subjective instability (Cohort 2). The mean KOOS-Child score improved significantly from 38.1 preoperatively to 78.7 postoperatively (P < 0.005) across all five KOOS subscales. The mean Pedi-IKDC score increased from 35.6 preoperatively to 74.0 postoperatively, while the mean Kujala score increased from 35.9 preoperatively to 73.0 postoperatively. No patient required subsequent surgery for recurrent dislocation, although one patient with an open physis and a convex trochlea developed clinical failure and was listed for trochleoplasty. Metalwork removal was required in half of the cohort.
CONCLUSIONS: Distal tibial derotation osteotomy for patellofemoral instability or pain in children appears to be safe and may be considered as part of the treatment strategy for patients with torsional malalignment, with the potential to reduce recurrence rates associated with isolated MPFL reconstruction.