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Anterior knee pain, case 04

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This document summarizes a medical case involving a 29-year-old female hairdresser with a history of right hip pain for over 10 years and chronic ankle pain. Examination revealed increased internal femoral rotation of 80 degrees and limited external rotation. Imaging showed increased right femoral anteversion of 44 degrees. The patient underwent a distal femoral derotation osteotomy to rotate the femur outward by 25 degrees, fixed with a TomoFix plate. Follow up care involved full weight bearing and physical therapy with x-ray follow up planned in 3 months.

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M.D. Gleb Gavrilkin 21.11.2017
History 29 y.o. female Hairdresser Active smoker Normal BMI
History Right hip pain previously at least 10 years 3 x cortisone injection into trochanteric bursa (bursitis suspision) Fysiotherapy Repetetive low ankle sprains & chronic ankle pain Patellar subluxations Gastrocnemius elongation Ankle arthrosopy: no osteochondral lesions Knee arthroscopy: Normal, no chondral lesions
Examination Squinting patella Squats: internal compensatory rotation of the knee Clark test normal Torsion profile: Internal rotation of femur 80属 External rotation 10属
X-rays & MRI Normal mechanical axis Right femoral anteversion 44属 Tibial torsion physiological
What next? No patellar luxation but subluxation fear Anterior knee chronic pain Femoral high anteversion No rotational compensation in the ipsilateral hip Posterotrochanteric impingement
Preop. X-rays
Preop. X-rays Normal mechanical alignment No OA in hip/knee/ankle
Torsio MRI 44属 of femoral anteversion Right trochanteric posterior impingement
Torsio MRI 37属 of tibial torsion Normal tibial torsion
NFK30 Distal femoral derotation osteotomy Anteromedial approach TF joint parallel femoral osteotomy 25属 femoral distal rotation outwards TomoFix plate fixation with locking bicortical screws
Postop. Op X-rays
Rehab protocol Full weight bearing with full active ROM Active fysiotherapy Follow up with x-rays in 3 months

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Anterior knee pain, case 04

  • 2. History 29 y.o. female Hairdresser Active smoker Normal BMI
  • 3. History Right hip pain previously at least 10 years 3 x cortisone injection into trochanteric bursa (bursitis suspision) Fysiotherapy Repetetive low ankle sprains & chronic ankle pain Patellar subluxations Gastrocnemius elongation Ankle arthrosopy: no osteochondral lesions Knee arthroscopy: Normal, no chondral lesions
  • 4. Examination Squinting patella Squats: internal compensatory rotation of the knee Clark test normal Torsion profile: Internal rotation of femur 80属 External rotation 10属
  • 5. X-rays & MRI Normal mechanical axis Right femoral anteversion 44属 Tibial torsion physiological
  • 6. What next? No patellar luxation but subluxation fear Anterior knee chronic pain Femoral high anteversion No rotational compensation in the ipsilateral hip Posterotrochanteric impingement
  • 8. Preop. X-rays Normal mechanical alignment No OA in hip/knee/ankle
  • 9. Torsio MRI 44属 of femoral anteversion Right trochanteric posterior impingement
  • 10. Torsio MRI 37属 of tibial torsion Normal tibial torsion
  • 11. NFK30 Distal femoral derotation osteotomy Anteromedial approach TF joint parallel femoral osteotomy 25属 femoral distal rotation outwards TomoFix plate fixation with locking bicortical screws
  • 13. Rehab protocol Full weight bearing with full active ROM Active fysiotherapy Follow up with x-rays in 3 months