Combined arthroscopic deepening trochleoplasty and reconstruction of the medial patellofemoral ligament for patients with recurrent patella dislocation and trochlear dysplasia

Abstract

Prospective consecutive case series, with evaluation of confounding factor. No control group, Level IV.

Arthroscopic Deepening Trochleoplasty: The Technique

“…In the second publication, which was a follow-up study of a consecutive series of 29 knees in patients troubled by patella instability and treated by combined ADT and MPFL reconstruction, we found significantly improved median knee scores for all measured parameters with no redislocations. 20 These results have been confirmed in a more recent review including 18 more knees. 27 Since 2008, we have allowed full weight bearing after the operation.…”

“…No redislocations have been reported. The results from the first 29 cases have been published, 20 in which significant improvements in Kujala and Knee injury and Osteoarthritis Outcome (KOOS) scores were observed with 93% of patients reporting satisfaction with the outcome and 55% returning to sports.…”

“…The indication for ADT has until lately (and in our case series) 20 indication has been expanded to also include patients with the same degree of trochlear dysplasia but without instability. These patients may have been troubled by severe AKP for years without responding to at least 1 year of physiotherapy-guided training consisting of a variety of modalities such as an exercise program for lower limb, hip, and trunk conditioning, foot orthotic insoles, and taping.…”

“…This is illustrated by multiple studies in which improvements in patella stability, reduction of anterior knee pain (AKP), and better quality of life have been shown compared with other surgical procedures in cases with severe trochlear dysplasia. [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23] The open trochleoplasty is associated with the risk of arthrofibrosis, infection, prolonged pain, and scar formation. 24 With respect to other surgical procedures, the use of minimally invasive surgery has been found to reduce these risks; the same applies to the arthroscopic deepening trochleoplasty (ADT) presented here.…”

Complications in Patellofemoral Instability Surgery

“…Banke et al 42 also noted in their series of combined trochleoplasty and MPFL reconstruction that 2 out of 18 cases developed arthrofibrosis, which was successfully treated with early arthroscopic arthrolysis. However, other studies [43][44][45] have reported no cases of arthrofibrosis in their series. In a systematic review of 17 studies in 459 knees, Song et al 41 found greater range of motion deficits in the group that underwent trochleoplasty.…”