ArticleKnee surgery, sports traumatology, arthroscopy : official journal of the ESSKA2023
In closed wedge distal femur osteotomies for correction of valgus malalignment overcorrection of mLDFA should be avoided.
Article in Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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7 citing papers in PubMed, 15 citations in OpenAlex.
- Patellar Malalignment Combined With Deformed Valgus Knee Treated by Distal Femoral Varus Osteotomy and Retrograde Intramedullary Nailing.Orthopaedic surgery · 2026Article
- Medial closing wedge distal femoral osteotomy with patient-specific instrumentation: surgical technique, accuracy, and preliminary outcomes.Frontiers in surgery · 2026Article
- Article
- Ten-year minimal follow-up of lateral opening wedge distal femoral osteotomy for lateral femorotibial osteoarthritis: Good survivorship and high patient satisfaction.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2025Article
- Surgical Technique and Preliminary Outcomes of Double-Level Osteotomy for Valgus Deformity.Orthopaedic journal of sports medicine · 2024Article
- Morphological analysis of the distal femur as a surgical reference in biplane distal femoral osteotomy.Scientific reports · 2024Article
- Joint line and knee osteotomy.EFORT open reviews · 2024Review
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Authors and funding
7 authors at 5 institutions in 2 countries.
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No grant is acknowledged in the PubMed record.
Abstract
purposeThe purpose of the study was to investigate the influence of the mLDFA (mechanical lateral distal femur angle) as a parameter in varus realignment osteotomies for valgus deformities of the knee. We hypothesized that joint line obliquity with mLDFA > 90° after distal femur osteotomy (DFO) is associated with inferior clinical outcome.
methodsIn a retrospective study, a total of 52 patients with isolated femoral valgus deformities were included in the study. The mean postoperative follow-up was 70.5 (SD 33.3) months (standard deviation SD±33.3). In all patients, a distal femur osteotomy was performed. A clinical examination and survey of questionnaires was conducted with the HSS (Hospital for Special Surgery), LG (Lysholm-Gilquist), and KOOS (Knee Injury and Osteoarthritis Outcome Score) scores. Several radiological parameters were assessed on long-standing x-rays: mechanical tibio-femoral angle (mTFA), mLDFA, mechanical medial proximal tibia angle (mMPTA), joint-line convergence angle (JLCA). The t test was used for normally distributed data. The Mann-Whitney U test was performed in non-normally distributed data.
resultsThe mLDFA was 84.9° (SD±2.3) preop and changed to 91.9° (SD±3, 22.9) postop. The mTFA (mechanical tibio-femoral angle) was 5.2° (SD±2.9°) preop and - 1.8° (SD±2.9) postop demonstrating a difference of 6.7°. For analysis, the data was divided into two groups based on postop mLDFA. Group 1: mLDFA ≤ 90°; Group 2: > 90°. Postoperatively, a mean mLDFA of 88.6° (SD±1.4°) was measured in group 1 and 93.9° (SD±2.1) in group 2. The change in mLDFA was 4.7° (SD±1.6) in group 1 and 8.4° (SD±2.8) in group 2. Preoperatively, the mTFA was 4.8° (SD±1.9) in group 1 and 5.5° (SD±3.3) in group 2. Postoperatively, the mTFA decreased in group 1 by 4.8° (SD±2.3) to - 0.1° (SD±2.1). In group 2, the mTFA decreased by 8.2° (SD±3.8) to - 2.8° (SD±2.9). Regarding the HSS, group 1 showed a 10.4 points better score than group 2 (p<0.01). Also, regarding the Lysholm, a significant difference of 16.9 points was found (p<0.01).
conclusionCorrection of valgus knees using closed wedge DFO leads to good clinical results. A postoperative mLDFA of 85-90° results in superior clinical outcome compared to mLDFA > 90°. Joint-line obliquity should be avoided using double level osteotomy, if needed. LEVEL OF EVIDENCE: III.
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