Derotational Osteotomies of the Femur and Tibia for Recurrent Patellar Instability

Lower extremity rotational alignment must be quantified in cases of recurrent patellofemoral instability. Femoral and tibial rotation can be measured with both physical examination and radiographic studies. Derotational osteotomies of both the femur and the tibia can be used to correct patients with excessive femoral anteversion and tibial external rotation (Miserable Malalignment Syndrome). In this chapter, an attempt to provide guidelines for assessing lower extremity rotation and an understanding of normal femoral and tibial rotational values are explored. Examples of one type of corrective femoral osteotomy and three types of tibial rotational osteotomies are provided.