Sulcus deepening trochleoplasty is a technically demanding procedure with precise indications: high grade trochlear dysplasia with patellar instability and/or abnormal tracking. The main goal is to decrease the prominence of the trochlea and to create a new groove with normal depth, thus optimising patellar tracking. Associated abnormalities should be specifically treated. Recurrence of instability is very rare after this procedure and is more likely to result from missed associated abnormalities. Although results seem very good in terms of instability, further evidence is still needed since the groups of patients in the published series are heterogeneous. Trochleoplasty is not indicated for patellofemoral arthritis or pain. As any surgical procedure, sulcus deepening trochleoplasty is liable to complications.

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Purpose The aim of the study was to compare three different procedures performed by the same surgeon: monobundle patellar tendon reconstruction (bone-patellar tendonbone, BPTB), double-bundle hamstring reconstruction (DBH) and mono-bundle patellar tendon combined with extraarticular reconstruction (Lemaire) (BPTB + L). Methods A total of 75 patients (25 in each group) were evaluated at a mean follow-up of 25 months. Laxity was assessed pre-and post-operatively with Telos™ stress radiographs (15 kg). The amount of anterior tibial translation (ATT) corrected by the surgery was quantified. Secondary outcomes were International Knee Documentation Committee (IKDC) scores, pivot shift grading, pain complaints, sensory deficits, subsequent surgical procedures, return to sports and patients' ability to kneel or squat on their affected knee. Results Absolute correction of ATT for the internal compartment was not statistically significant [analysis of variance (ANOVA), p=0.377]. For the external compartment BPTB + L (8.2 mm) showed superiority over DBH (5.6 mm) and BPTB (4

Level III (case-control study).

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