The Outcomes of Trocheoplasty in Patellofemoral Instability: A Systematic Review and Meta-Analysis
ESSKA Academy. Sethi E. May 11, 2018; 218047; FP24-1625
Ervin Sethi
Ervin Sethi
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Objectives: Trochlear dysplasia is one of the commonest causes of patellofemoral instability, affecting 96% of patients with patellofemoral instability. It has also been proven to be one of the predictors of recurrent instability. Trocheoplasty is then developed to improve the outcomes of patients with patellofemoral instability.

This article aims to provide a comprehensive systematic review and meta-analysis to examine the outcomes of trocheoplasty, and the factors affecting these outcomes.

Methods: The review was conducted according to PRISMA guidelines. All studies that reported clinical outcomes before and after trocheoplasty were included in the review. Quantitative random effects meta-analysis was performed to compare between the pre-operative and post-operative outcomes. Meta-regression was employed to identify potential moderators. Articles were evaluated qualitatively when quantitative data were not reported.

Results: A total of 21 publications with 779 knees were included. Surgical indications include recurrent patellar dislocation, high-grade trochlear dysplasia (Dejour B, C and D), lateral patellar glide, positive apprehension test, persistent pain and failed conservative management. Statistically significant improvement in all outcomes was noted post-operatively, including patient satisfaction (RR 46.7; 95% CI: 16.5 - 131.9), Tegner score (1.91; 95% CI: 0.97 - 2.84), Kujula scores (SMD 1.84; 95% CI 1.07 - 2.62), International Knee Documentation Committee score (SMD 1.55; 95% CI 1.16 - 1.94) and Visual Analogue Scale for pain (RR 1.46; 95% CI 0.83 - 1.09). This statistically significant improvement was independent of the other concomitant procedures performed. The patient's age and Dejour's classification for trochlear dysplasia also did not affect the post-surgical outcomes. Complications reported include redislocation, patellofemoral pain, range of motion deficit, arthritis, need for further surgeries including arthroplasty, thromboembolic events and wound infection.

Conclusions: Trocheoplasty is an effective procedure to independently improve the outcomes of patients with patellofemoral instability, regardless of the presence of concomitant procedures as well as the patient's age and classification of trochlear dysplasia.

trochleoplasty; trochlear; trochlea; trochlear dysplasia; trochlea dysplasia; patellofemoral instability; medial patellofemoral ligament; MPFL reconstruction
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