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Clinical outcome of patella stabilizing surgery including trochleoplasty for treatment of recurrent patellar dislocations and severe trochlear dysplasia
Author(s):
Miller Lene (Denmark)
,
Miller Lene (Denmark)
Affiliations:
Nielsen T.
,
Nielsen T.
Affiliations:
Mygind-Klavsen B.
,
Mygind-Klavsen B.
Affiliations:
Sørensen O.
,
Sørensen O.
Affiliations:
Fauno P.
,
Fauno P.
Affiliations:
Lind M.
Lind M.
Affiliations:
ESSKA Academy. Miller L. May 9, 2018; 209707; P12-778 Topic: Knee
Lene Miller
Lene Miller
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Abstract
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Objectives: Patella instability is highly correlated to trochlea dysplasia (TD). Severe TD leads to biomechanical and kinematic changes that may require surgical correction by trochleoplasty in order to obtain successful surgical treatment of patella instability and normal patella tracking.
The goal of trochleoplasty is to change the abnormal shape of the femoral trochlea in patients with recurrent patellar dislocation. This is to provide increased patellofemoral stability.
Failure after patella stabilizing surgery may be caused by lack of correction of severe TD.
The purpose of this present study is to clarify the effect on patella stability and level of function in patients who underwent a trochleoplasty surgical procedure. This as an additional procedure to medial patellofemoral ligament (MPFL) reconstruction for surgical treatment of patella instability or after failed patella instability surgery.

Methods: Twenty-two patients operated between 2013 and 2017 were included in the present study. Three males and nineteen females. Mean age is twenty-four years (15-41 years). They all had more than five dislocations of the patella and a positive J-sign prior to this operation. Thirteen patients had one or more previous unsuccessful patellofemoral surgeries. Trochleoplasty was performed using the Bereiter technique either open or arthroscopically. Kujala score and Pain numeric rating scale (NRS) were used to evaluate the effects of intervention. Patella instability was assessed by redislocations and continued patella maltracking

Results: Eight patients (36%) had a trochleoplasty procedure done bilaterally. Eighteen patients (82%) had TD Dejour type D, three patients (14%) type C and one patient type B (4%). The procedure was done arthroscopically in 50% of the patients. The Kujala score increased from 52 preoperatively to 70 at 1-year follow up. The NRS score at rest decreased from 3,1 to 1,6 and NRS at exercise decreased from 5,4 to 3,6. Five patients (23%) had a reoperation due to arthrofibrosis. None of the patients had redislocation of the patella or continued maltracking.

Conclusions: In patients with severe trochlea dysplasia and after failed previous patella stabilizing surgery,
sulcus-deepening trochleoplasty results in predictive patella stabilization and improvement in subjective outcome when used as supplement for MPFL reconstruction.

Keywords:
Trochleoplasty, surgery, patella stabilization, trochlear dysplasia, patella dislocation
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