Avoiding Complications in Patellofemoral Surgery

Abstract

The diagnosis and treatment of patellofemoral disorders can challenge even the experienced orthopedic surgeon. Differential diagnosis is broad and multiple anatomic abnormalities must be taken into account in order to manage care. The majority of patients with patellofemoral disorders can be treated successfully nonoperatively. When nonoperative management fails, and in the carefully selected patient, a variety of surgical options exist based on the anatomic pathology involved, but each brings its own potential for complication. We discuss several of the surgical treatment options that are available to the orthopedic surgeon for the treatment of patellofemoral disorders, including lateral retinacular release, medial soft-tissue reconstructive procedures, and bony procedures (including trochleoplasty and tibial tubercle osteotomy. We describe potential complications of each procedure and what the orthopedic surgeon can do to avoid them.

The Incidence of Complications of Tibial Tubercle Osteotomy: A Systematic Review

“…4 Conversely, if the osteotomized fragment is too thick, this can lead to a stress riser at the site of the osteotomy or just distal to it. 5 The findings of this review also suggest that maintaining the distal cortical hinge may minimize the risk of fracture. An overaggressive postoperative protocol can also lead to fracture.…”

“…7 High-impact activities should be avoided for 6 months, and a return to competitive sports should be delayed for 9 months to a year postoperatively. 5 It is important to note that this review is focused on the incidence of early complications of TTO, and the 4.6% overall risk of complications does not imply that more than 95% of patients who undergo this procedure are doing well with no problems. Numerous subsequent events can lead to poor results, including recurrent lateral patellar instability, medial patellar instability resulting from excessive medialization of the tubercle, patella infera, and the development of patellofemoral joint osteoarthritis.…”

“…These complications range from minor (superficial wound infections and skin irritation) to severe (tibial fracture, osteotomy nonunion, neurovascular complications, deep infection) and can result in significant morbidity. 4,5 Previous reports of complications are typically case series or case reports focused on specific complications [6][7][8] or are more general reviews with a focus on avoidance of complications. 4,5 As a result, the specific risks of individual complications are difficult to estimate, and data regarding the influence of surgical technique on the risk of complications are lacking.…”

Multiligamentous injuries and knee dislocations

“…Medial-sided repair is recommended to prevent recurrence of patellar dislocations, with MPFL reconstruction being the mainstay of treatment over medial capsular plication [48]. Lateral retinacular release is now only recommended as an addition to MPFL reconstruction to recenter the patella or in situations of extensive lateral tilt [46,48].…”

“…Trochlear dysmorphology can be corrected surgically with trochlear osteotomies and trochleoplasties to increase the trochlear depth and elevate the lateral trochlear facet [46,48].…”