Tibial Derotational Osteotomy for Patellofemoral Instability: A Systematic Review

Area of Science:

• Orthopedic surgery
• Biomechanics
• Knee joint disorders

Background:

• Patellofemoral (PF) instability and anterior knee pain are often multifactorial.
• Excessive external tibial torsion is linked to recurrent patellar subluxation and persistent knee pain.
• Surgical options include medial patellofemoral ligament reconstruction, tibial tuberosity transfer (TTT), trochleoplasty, and tibial derotation osteotomy (TDO).

Purpose of the Study:

• To systematically review the safety and efficacy of tibial derotation osteotomy (TDO) for treating patellofemoral instability and pain.

Main Methods:

• A comprehensive literature search was performed on July 15, 2022.
• Seven studies, encompassing 179 subjects and 204 operative knees, met the inclusion criteria for this systematic review.

Main Results:

• Mean follow-up was 66.31 months, with a low complication rate of 12.8%.
• TDO achieved an average anatomical correction of 19.9 degrees, increasing to 34 degrees when combined with TTT.
• Patient-reported outcome measures (PROMs) significantly improved postoperatively (p < 0.05), though age over 25 and advanced chondromalacia may negatively impact outcomes.

Conclusions:

• TDO significantly improves pain and PROM ratings in patients with PF pain and/or instability.
• The risk of complications, including recurrent patellar subluxation, is low but potentially higher in older patients.
• Concurrent TTT can augment the anatomical correction achieved by TDO in select cases.