Precise Arthroscopic Mini-trochleoplasty and Medial Patellofemoral Ligament Reconstruction for Recurrent Patellar Instability With Severe Trochlear Dysplasia

Abstract

More than 100 surgical procedures have been reported to address recurrent patellar instability. Trochlear dysplasia is the most common finding among the anatomic risk factors for recurrent patellar instability. Various studies have shown that trochleoplasty combined with medial patellofemoral ligament reconstruction is an effective technique to treat recurrent patellar instability. Nevertheless, trochleoplasty is still a daunting procedure for surgeons because of its multiple and gloomy complications. This article introduces a technique to treat recurrent patellar instability with severe trochlear dysplasia: precise arthroscopic mini-trochleoplasty (PAM trochleoplasty) combined with medial patellofemoral ligament reconstruction. This technique precisely removes the supratrochlear spur and trochlear bump, accurately reshapes the trochlear sulcus with minimal invasion and less osteotomy volume, and keeps the sulcus cartilage intact. The purpose of this technique is to develop trochleoplasty into a common and safe technique, which has good outcomes and low complications.

Grooveplasty Compared With Trochleoplasty for the Treatment of Trochlear Dysplasia in the Setting of Patellar Instability

“…Trochlear dysplasia exists on a spectrum, resulting in an array of surgical options from minimally invasive arthroscopic bumpectomy 21 to various methods of trochleoplasty. 10 , 12 , 13 , 14 , 15 , 22 For patients with grade B and D trochlear dysplasia with a supratrochlear spur, evidence has shown that sulcus deepening trochleoplasty can improve patellofemoral stability, 17 , 23 although patients tend to also have congruent dysplasia that likewise affects the patella. 24 At a mean of 15 years’ follow-up, Rouanet et al.…”

“… 10 Trochleoplasty has historically been indicated in cases of objective patellar instability associated with high-grade (grade B or D) dysplasia or recurrent instability after previous surgery. 10 Several trochlear deepening techniques have been described, 11 , 12 , 13 , 14 , 15 with Duncan et al. 16 succinctly summarizing many of them.…”

Good patient satisfaction with low complications rate after trochleoplasty in patellofemoral instability

“…Blønd and Schottle described an arthroscopic thin‐flap trochleoplasty through multiple superior portals with the use of a motorized shaver and resorbable sutures and anchors [8]. This technique, which has been further modified, is very promising for decreasing invasivity and improving clinical results but still need medium and long‐term follow‐up confirmation [50].…”

Die Trochleaplastik als Behandlungsoption bei chronischer Patellainstabilität

“…Aktuell ist die Methode nach Bereiter weit verbreitet, die von uns bevorzugt und im Weiteren näher beschrieben wird 4 . Des Weiteren existieren auch arthroskopische Verfahren, um die Invasivität zu minimieren 5 18 .…”