Supra tubercular tibial osteotomy and gradual correction with Taylor spatial frame for the management of Torsional malalignment syndrome – surgical technique and outcomes

• Published in: The knee Vol. 40; pp. 8 - 15
• Main Authors: Hogg, Jack, Hampton, Matthew, Madan, Sanjeev
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.01.2023
• Subjects: Adolescent; Femur - diagnostic imaging; Femur - surgery; Humans; Knee Joint - diagnostic imaging; Knee Joint - surgery; Malalignment syndrome; Miserable; Osteotomy - methods; Pain; Retrospective Studies; Supratubercular tibial osteotomy; Taylor Spatial Frame; Tibia - diagnostic imaging; Tibia - surgery; Torsional; Torsional; Taylor Spatial Frame; Malalignment syndrome; Miserable; Supratubercular tibial osteotomy
• ISSN: 0968-0160; 1873-5800
• DOI: 10.1016/j.knee.2022.11.004

Surgical management of Torsional Malalignment Syndrome (TMS) traditionally consists of simultaneous correction of both femoral anteversion and external tibial torsion. We hypothesise that a single supra tubercular osteotomy followed by tibial derotation with Taylor Spatial Frame (TSF) is sufficient to provide significant improvement in both appearance and function. This is a retrospective single surgeon case series performed at a tertiary referral centre in the UK. Data collected included patient demographics, clinical findings and CT rotational profile measurements. All patients completed pre and post-operative Oxford Knee Score (OKS) and Kujala Anterior Knee Pain Scale (AKPS) functional outcome scores for analysis. There were 16 osteotomies in 11 patients with complete data sets for analysis performed between 2006 and 2017. Mean age of 16.7 ± 0.8 years. The results show significant improvements in post-operative functional assessment scores, with mean OKS increasing by 18.3 and mean AKPS increasing by 31.4. Average pre-operative thigh-foot angle (TFA) was 44.7°, this was reduced to 12.8° post-operatively, representing an average correction of 31.9°. The results show that supra tubercular osteotomy, followed by gradual correction with TSF, can be used to provide a significant improvement in both appearance and function for patients suffering from TMS.