Background:In carefully selected patients with an arthritic valgus knee, distal femoral osteotomy (DFO) can improve symptoms at medium- to long-term follow-up, reducing osteoarthritis progression. To date, there is no clear evidence in the current literature regarding the role of postoperative joint line obliquity (JLO) in valgus deformity correction.Purpose:To assess the clinical and radiological outcomes of medial closing-wedge DFO (MCW-DFO) for the treatment of valgus knees, considering both tibial- and femoral-based deformities, as well as to verify the efficacy and safety of MCW-DFO according to JLO boundaries (≤4°).Study Design:Cohort study; Level of evidence, 3.Methods:A retrospective analysis was conducted on a cohort of patients with valgus knees. Patients were divided into 2 groups: femoral-based valgus (FB-V) and tibial-based valgus (TB-V). Knee radiographs were collected before surgery and at the last follow-up. The clinical outcome was evaluated through several validated scores (International Knee Documentation Committee, Knee Society Score, Knee injury and Osteoarthritis Outcome Score, Tegner, Numeric Rating Scale, Crosby-Insall).Results:A total of 30 patients (34 knees) with a mean age of 49.3 ± 9.1 years were included in the study. The overall mean follow-up was 9.4 ± 5.9 years. The mean preoperative hip-knee-ankle angle was 187.6°± 3.3° (range, 181.5°-191°) and the postoperative angle was 180°± 3.1° (range, 176°-185°). Most postoperative JLOs were within the safe zone of ≤4° in both groups (the postoperative JLO was >4° in 4 patients in the TB-V group and 1 patient in the FB-V group), although FB-V knees exhibited significant superior JLO correction (postoperative JLO in the TB-V group: mean, 4.0°± 2.5° [ P = .1]; postoperative JLO in the FB-V group: mean, 2.4°± 1.4° [ P = .5]). Significant improvements in all clinical scores were observed in both groups ( P < .01). Additionally, the severity of the osteoarthritis did not worsen at the last follow-up.Conclusion:MCW-DFO is an effective procedure for treating pathological valgus knees, regardless of the site of the deformity. Both FB-V and TB-V groups showed comparable improvements in the clinical scores, development of osteoarthritis, and the restoration of a neutral mechanical axis. Notably, FB-V knees achieved more JLO correction compared with the TB-V ones.

中文翻译：

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内侧闭合楔形股骨远端截骨术治疗股骨和胫骨外翻畸形的结果


背景：在精心挑选的膝关节外翻关节炎患者中，股骨远端截骨术 (DFO) 可以在中长期随访中改善症状，从而减少骨关节炎的进展。迄今为止，目前的文献中还没有明确的证据表明术后关节线倾斜（JLO）在外翻畸形矫正中的作用。 目的：评估内侧闭合楔形 DFO（MCW-DFO）的临床和影像学结果治疗外翻膝，考虑胫骨和股骨畸形，并根据 JLO 边界（≤4°）验证 MCW-DFO 的有效性和安全性。研究设计：队列研究；证据级别，3。方法：对一组膝外翻患者进行回顾性分析。患者被分为两组：股骨外翻（FB-V）和胫骨外翻（TB-V）。在手术前和最后一次随访时收集膝关节X光片。临床结果通过多个经过验证的评分（国际膝关节文献委员会、膝关节协会评分、膝关节损伤和骨关节炎结果评分、Tegner、数字评定量表、Crosby-Insall）进行评估。 结果：共有 30 名患者（34 个膝关节）患有该研究的平均年龄为 49.3 ± 9.1 岁。总体平均随访时间为 9.4 ± 5.9 年。术前平均髋膝踝角度为187.6°±3.3°（范围181.5°-191°），术后平均角度为180°±3.1°（范围176°-185°）。两组中大多数术后 JLO 均在 ≤4° 的安全区内（TB-V 组中 4 名患者和 FB-V 组中 1 名患者术后 JLO >4°），尽管 FB-V 膝关节表现出显着的变化优越的 JLO 矫正（TB-V 组术后 JLO：平均值，4.0°± 2.5° [ P = .1]; FB-V 组术后 JLO：平均 2.4°± 1.4° [ P = .5]）。两组的所有临床评分均显着改善 ( P < .01)。此外，末次随访时骨关节炎的严重程度并未恶化。结论：MCW-DFO 是治疗病理性膝外翻的有效手术，无论畸形部位如何。 FB-V 组和 TB-V 组在临床评分、骨关节炎的发展和中性机械轴的恢复方面均显示出相当的改善。值得注意的是，与 TB-V 膝盖相比，FB-V 膝盖实现了更多的 JLO 校正。