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Patient specific instrumentation allow precise derotational correction of femoral and tibial torsional deformities

  • Grégoire Micicoi
    Affiliations
    IULS-University Institute for Locomotion and Sports, Pasteur 2 Hospital, University Côte d'Azur, Nice, France

    Aix Marseille University, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopedics and Traumatology, Marseille, France
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  • Boris Corin
    Affiliations
    Institute of Movement and Locomotion, Department of Orthopedics and Traumatology, St Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29, 13274 Marseille, France

    Aix Marseille University, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopedics and Traumatology, Marseille, France
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  • Jean-Noël Argenson
    Affiliations
    Institute of Movement and Locomotion, Department of Orthopedics and Traumatology, St Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29, 13274 Marseille, France

    Aix Marseille University, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopedics and Traumatology, Marseille, France
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  • Christophe Jacquet
    Affiliations
    Institute of Movement and Locomotion, Department of Orthopedics and Traumatology, St Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29, 13274 Marseille, France

    Aix Marseille University, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopedics and Traumatology, Marseille, France
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  • Raghbir Khakha
    Affiliations
    Guys and St Thomas’ Hospitals, Great Maze Pond, London SE1 9RT, UK
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  • Pierre Martz
    Affiliations
    Service de chirurgie orthopédique et traumatologique adulte, CHU Dijon-Bourgogne, 14, rue Paul-Gaffarel, 21079 Dijon, France
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  • Matthieu Ollivier
    Correspondence
    Corresponding author at: Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St. Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29, 13274 Marseille, France.
    Affiliations
    Institute of Movement and Locomotion, Department of Orthopedics and Traumatology, St Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29, 13274 Marseille, France

    Aix Marseille University, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopedics and Traumatology, Marseille, France
    Search for articles by this author
Published:September 01, 2022DOI:https://doi.org/10.1016/j.knee.2022.04.002

      Abstract

      Background

      Rotational malalignment deformities of the lower limb in adults mostly arise from excessive femoral anteversion and/or excessive external tibial torsion. The aim of this study was to assess the correction accuracy of a patient specific cutting guides (PSCG) used in tibial and femoral correction for lower-limb torsional deformities.

      Methods

      Forty knees (32 patients) were included prospectively. All patients had patellofemoral pain or instability with torsional malalignment for which a proximal tibial (HTO) or distal femoral (DFO) or a double-level osteotomy (DLO) had been performed. Accuracy of the correction between the planned and the postoperative angular values including femoral anteversion, tibial torsion, coronal and sagittal alignment were assessed after tibial and/or femoral osteotomy.

      Results

      Forty knees were included in this study. In cases of HTO, the correction accuracy obtained with PSCG was 1.3 ± 1.1° for tibial torsion (axial plane), 0.8 ± 0.7° for MPTA (coronal plane) and 0.8 ± 0.6° for PPTA (sagittal plane). In cases of DFO, the correction accuracy obtained with PSCG was 1.5 ± 1.4° for femoral anteversion (axial plane), 0.9 ± 0.9° for LDFA (coronal plane) and 0.9 ± 0.9° for PDFA (sagittal plane). The IKSG was improved from 58.0 ± 13.2° to 71.4 ± 10.9 (p = 0.04) and the IKSF from 50.2 ± 14.3 to 87.0 ± 6.9 (p < 0.001).

      Conclusions

      Using the PSCG for derotational osteotomy allows excellent correction accuracy in all the three planes for femoral and tibial torsional deformities associated with patellofemoral instability.
      Level of clinical evidence II, prospective cohort study.

      Keywords

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