Sport participation after isolated distal femoral osteotomy in young patients: High return-to-sport rates and predictive role of preoperative activity level.

Lucidi, Gian Andrea; Adravanti, Federico Maria; Rossi, Claudio; Bonaiuti, Margherita; Di Paolo, Stefano; Grassi, Alberto; Zaffagnini, Stefano · Knee Surg Sports Traumatol Arthrosc · 2026

retrospective_cohort · Level III

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Abstract

The present study aimed to assess return to sport (RTS) rate, activity level and return to work (RTW) in young, physically active patients who underwent isolated distal femoral osteotomy (DFO) for lateral knee pain and valgus malalignment. A retrospective analysis was conducted on consecutive isolated DFO procedures performed at a single institution with a minimum 2-year follow-up. Inclusion criteria specified patients under the age of 45 who were active in sports 2 years prior to surgery. Data were collected regarding RTS rate, type of sports, sports impact level, RTW and complications. Univariate regression analyses were performed to identify predictors influencing RTS and the level of RTS. Thirty-four patients (mean age 31.7 ± 9.7 years) were evaluated at a mean follow-up of 7.2 ± 3.8 years. The mean preoperative hip-knee-ankle (HKA) was 187.1 ± 3.1 with a mean achieved correction value of 7.7 ± 2.5°. The RTS rate was 79.4% (27/34), with a mean time to resumption of 5.4 ± 5.4 months. Among those returning to sports, 85.2% maintained their pre-symptom IMPACT level, though no patients reported an improvement in status. At the final follow-up, 67.7% remained active, averaging 4.5 ± 7.1 h of sports participation per week. Univariate regression identified the pre-symptom Tegner scale as a significant predictor of absolute RTS (odds ratio = 2.33, p = 0.018). Regarding occupational outcomes, 100% of patients returned to work at a mean of 4.4 months, with 86.4% of active workers resuming previous or similar physical demands. The complication rate was 11.8% (4/34), with no clinical failures reported. DFO performed in a young and active population results in high RTS rates and continuous sports participation even 7 years after surgery. Moreover, higher pre-symptoms Tegner scale was associated with higher odds of returning to sport compared to lower Tegner scale values. Level IV, case series.