Deepening trochleoplasty combined with balanced medial patellofemoral ligament reconstruction for an adequate graft tensioning

Abstract

AIMTo evaluate our modified deepening trochleoplasty combined with a balanced medial patellofemoral ligament (MPFL) reconstruction for soft tissue alignement.METHODSThirty-three knees with with recurrent patellar dislocations and a trochlear dysplasia in 30 patients (m/f = 12/21, mean age 24 ± 9 years) underwent a combination of a modified deepening trochleoplasty and a balanced MPFL reconstruction for a medial soft tissue alignement. After a mean follow-up period of 29 ± 23 mo, patients’ return to sports, possible complications as well as the clinical outcomes using the Kujala, International Knee Documentation Committee (IKDC) and Lysholm scoring were evaluated. Moreover, patients’ satisfaction with the general outcome, the cosmetic outcome, the pre- and postoperative pain and a potential avoidance behaviour were assessed with additional standardized questionnaires which also included different visual analog scales.RESULTSThere were no signs of a persistent instability. The Kujala score improved from a mean of 64 ± 16 points to 94 ± 9 points, the Lysholm score improved from a mean of 63 ± 17 to 95 ± 6 points and the IKDC score from 58 ± 11 to 85 ± 12 points, P < 0.0001, respectively. The assessment of pain using a visual analog scale showed a significant pain reduction from a mean of 4.8 ± 2.0 to 1.3 ± 3.4 points (P < 0.0001). Two of 26 cases (92%) who were engaged in regular physical activity before surgery did not return to full sporting activities. One patient felt that his sport was too risky for his knee and reported an ongoing avoidance behaviour. The other patient preferred to wait for surgery of her contralateral knee. Of the eight patients who were not engaged in sporting activities before surgery, three started regular sporting activities after surgery. In 31 of the 33 cases (94%), the patients were very satisfied with the clinical outcome of the surgery. Regarding the cosmetic results, no patients felt impaired in their self-confidence and in their clothing decisions.CONCLUSIONOur technique shows a good clinical outcome in terms of the common scorings as well as in terms of pain, return to sports and patient satisfaction.

Trochleoplasty provides good clinical outcomes and an acceptable complication profile in both short and long-term follow-up

“…There is mounting evidence that the addition of an MPFL reconstruction to a trochleoplasty procedure is likely to improve clinical outcomes [6, 38, 41, 62]. This is in keeping with the modern à la carte approach to LPI in which variable pathoanatomy can exist, and malalignment can be addressed with procedures such as a TTO, trochleoplasty or de‐rotation osteotomy, and the patella is subsequently stabilized in the groove with a proximal soft tissue stabilization procedure.…”

“…Most recently, an arthroscopic thin flap trochleoplasty has been described [10]. Although, originally described as an isolated procedure, recent reports combine the trochleoplasty with an MPFL reconstruction or medial reefing type procedure [52] to stabilize the patella in the newly formed groove [6, 38, 41, 62].…”

No significant difference in thick versus thin osteochondral flap trochleoplasty in the treatment of trochlear dysplasia: A systematic review

“…The respective ICC values between MINORS scores (ICC = 0.9) were excellent. A total of five papers described a ‘thick’ flap technique [7, 9, 16, 22, 30], while 19 papers described the use of a ‘thin’ flap technique [1–3, 5, 6, 11–14, 18–21, 32, 35, 37–41]. The mean follow‐up of all included studies was 45.7 ± 6.7 months.…”

Recurrent patellar dislocations: trochleoplasty improves the results of medial patellofemoral ligament surgery only in severe trochlear dysplasia

“…Among different studies, the rehabilitation protocol varied including different levels of weight‐bearing, different length of the period of immobilization and different physiotherapy exercises. No comparative randomized controlled trials were included, 15 articles were prospective observational studies [6–8, 15, 16, 20, 25, 26, 28, 36–39, 48, 57], and 16 were retrospective observational studies [1, 2, 12, 21–24, 29, 32, 33, 35, 42, 45, 53, 55, 56].…”