Results of medial patellofemoral ligament reconstruction compared with trochleoplasty plus individual extensor apparatus balancing in patellar instability caused by severe trochlear dysplasia: a systematic review and meta-analysis

Balcarek, Peter; Rehn, Stephan; Howells, Nick; Eldridge, Jonathan; Kita, Keisuke; Dejour, David; Nelitz, Manfred; Banke, Ingo J.; Lambrecht, Delphine; Harden, Markus; Friede, Tim

doi:10.1007/s00167-016-4365-x

Cited by 90 publications

(84 citation statements)

References 31 publications

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“…Most authors describe the results at short- or mid-term follow-up. In a recent systemic review by Balcarek et al [ 4 ], the results of a sulcus-deepening trochleoplasty were reviewed. They included six studies with a total of 186 knees, with and without concomitant stabilizing procedures.…”

Section: Discussionmentioning

confidence: 99%

“…Patellar instability is associated with a number of predisposing factors [ 8 ], with trochlear dysplasia as the largest contributor preventing lateral patellar displacement [ 25 , 26 ]. In patients with persistent patellofemoral instability due to trochlear dysplasia, a trochleoplasty can be an effective way to permanently regain stability [ 4 , 31 ], especially in cases with high-grade trochlear dysplasia or when other procedures have failed [ 5 ]. Based on the Dejour classification [ 7 ], trochleoplasty may be indicated for trochlear dysplasia grade B, C and D [ 5 , 19 , 21 ].…”

Section: Introductionmentioning

confidence: 99%

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A stand-alone lateral condyle-elevating trochlear osteotomy leads to high residual instability but no excessive increase in patellofemoral osteoarthritis at 12-year follow-up

Tigchelaar

Sambeeck

Koëter

et al. 2017

Knee Surg Sports Traumatol Arthrosc

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Purpose and hypothesisTrochlear osteotomy is a rarely performed procedure, only indicated in selected cases. Due to its nature, it can potentially lead to cartilage damage and subsequent early osteoarthritis. Satisfactory short-term results from lateral condyle-elevating osteotomy have previously been reported. The long-term effects of this procedure on clinical outcomes, patellar stability and radiological osteoarthritis are reported here.MethodsSixteen patients (19 knees) with patellar instability due to trochlear dysplasia were included. An isolated lateral condyle-elevating trochlear osteotomy was performed between 1995 and 2002. All patients were re-examined at a minimum of 12-year follow-up. Three patients were lost to follow-up, and one patient underwent a patellofemoral arthroplasty 3 years post-operatively due to progressive osteoarthritis. Complete follow-up was therefore available in 12 patients (15 knees). Recurrent instability, VAS pain, WOMAC, Lysholm and Kujala scores were used as outcome measures. Radiological osteoarthritis was recorded using the Iwano and the Kellgren–Lawrence classifications. A repeated-measures ANOVA was used to test for repeated measures (pre-operative, 2-year and final follow-up), and Spearman’s correlation coefficient for relationships between osteoarthritis and functional scores.ResultsAt final follow-up, VAS pain showed a non-significant improvement from 52 to 25, and the median Kujala score was 78. Median Lysholm (54–71, p = 0.021) and WOMAC (78–96, p = 0.021) scores improved from the pre-operative assessment to final follow-up. There was no significant difference observed between clinical scores at the 2-year and final follow-up. Residual patellar instability was reported in four out of 15 knees. Three knees showed no patellofemoral osteoarthritis, eight knees had grade 1 and four knees grade 2. No correlation between VAS pain, Lysholm, WOMAC or Kujala scores and osteoarthritis could be identified (n.s.).ConclusionA stand-alone lateral condyle-elevating trochleoplasty results in the significant improvement of most clinical scores; however, when performed as a stand-alone procedure, it leads to a high percentage of residual instability. In contrast to general belief, the development of patellofemoral osteoarthritis at 12-year follow-up did not exceed the findings from other trochleoplasty case series.Level of evidenceCase series with no comparison group, Level IV.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A stand-alone lateral condyle-elevating trochlear osteotomy leads to high residual instability but no excessive increase in patellofemoral osteoarthritis at 12-year follow-up

Tigchelaar

Sambeeck

Koëter

et al. 2017

Knee Surg Sports Traumatol Arthrosc

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“…Patients with recurrent dislocation typically have abnormalities of knee anatomy and soft tissue integrity, with substantial inter‐subject variability. Clinical interventions that are tailored to the anatomy and mechanics of the individual patient may have benefit in optimizing post‐operative joint stability …”

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confidence: 99%

“…Clinical interventions that are tailored to the anatomy and mechanics of the individual patient may have benefit in optimizing post-operative joint stability. [23][24][25] Patients with persistent symptoms of patellar instability are candidates for surgical interventions, with treatment options that include MPFL reconstruction, tibial tubercle osteotomy, sulcus-deepening TP, or combinations of these procedures. 1,[26][27][28] However, currently, there is no universally accepted algorithm for choosing the appropriate procedure(s) for a particular individual.…”

mentioning

confidence: 99%

“…32,33 Little research has been done to determine the minimally invasive procedure to prevent recurrent patellar dislocation on symptomatic knees. Researchers have compared the outcomes of different surgeries, 25,30,34 however, the patient-specific indicators for which surgery to perform is relatively unknown. 29 Furthermore, studies often use subjective measures to compare preand post-operative performance, 8 with patients often unable to return to pre-injury performance despite reducing further patellar dislocation.…”

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confidence: 99%

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Computational approach to correcting joint instability in patients with recurrent patellar dislocation

Alvarez

Steensen

Rullkoetter

et al. 2019

Journal Orthopaedic Research

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Patellar dislocation is a debilitating injury common in active adolescents and young adults. Conservative treatment after initial dislocation is often recommended, but almost half of these patients continue to suffer from recurrent dislocation. The objective of this study was to compare preoperative patellofemoral joint stability with stability after a series of simulated procedures, including restorative surgery to correct to pre‐injury state, generic tibial tubercle osteotomy, patient‐specific reconstructive surgery to correct anatomic abnormality, less invasive patient‐specific surgery, and equivalent healthy controls. Three‐dimensional, subject‐specific finite element models of the patellofemoral joint were developed for 28 patients with recurrent patellar dislocation. A 50 N lateral load was applied to the patella to assess the lateral stability of the patellofemoral joint at 10° intervals from 0° to 40° flexion. Medial patellofemoral ligament reconstruction, along with reconstructive procedures to correct anatomic abnormality were simulated. Of all the simulations performed, the healthy equivalent control models showed the least patellar internal–external rotation, medial–lateral translation, and medial patellofemoral ligament restraining load during lateral loading tests. Isolated restorative medial patellofemoral ligament reconstruction was the surgery that resulted in the most patellar internal–external rotation, medial–lateral translation, and medial patellofemoral ligament reaction force across all flexion angles. Patient‐specific reconstruction to correct anatomic abnormality was the only surgical group to have non‐significantly different results compared with the healthy equivalent control group across all joint stability metrics evaluated. Statement of clinical significance: This study suggests patient‐specific reconstructive surgery that corrects underlying anatomic abnormalities best reproduces the joint stability of an equivalent healthy control when compared with the pre‐injury state, generic tibial tubercle osteotomy, and less invasive patient‐specific surgery. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:768‐776, 2020

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Groove‐deepening trochleoplasty reduces lateral patellar maltracking and increases patellofemoral contact pressures: Dynamic simulation

Elias

Rezvanifar

Koh

2021

Journal Orthopaedic Research

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Groove‐deepening trochleoplasty is performed to restore patellar stability by increasing the lateral constraint applied to the patella by the trochlear groove. Multibody dynamic simulation of knee function was used to characterize the influence of groove‐deepening trochleoplasty on patellar tracking and patellofemoral contact pressures. Computational models were created to represent seven knees with trochlear dysplasia, indicated by a flat trochlear groove and supratrochlear spur. The models were manipulated to remove the spur and deepen the trochlear groove to represent the average shape following a trochleoplasty. Knee squatting was simulated for the preoperative and postoperative conditions. Statistically significant (p < 0.05) differences in output parameters were identified with repeated measures comparisons at every 5° of knee flexion. Trochleoplasty significantly decreased lateral patellar tracking, particularly at low knee flexion angles. Trochleoplasty decreased the peak lateral shift of the patella (bisect offset index) with the knee extended from 0.87 ± 0.14 to 0.75 ± 0.12. Trochleoplasty also significantly decreased the contact area and increased the maximum contact pressure at multiple flexion angles. Trochleoplasty decreased the average contact area by approximately 10% in mid‐flexion, with a corresponding increase in the average maximum contact pressure of 13%–23%. Decreased contact area and increased contact pressures are related to altered patellofemoral congruity due to reshaping the femur without a corresponding change to the patella. Clinical significance: The results indicate groove‐deepening trochleoplasty decreases lateral patellar maltracking, reducing the risk of patellar dislocations, but can elevate patellofemoral contact pressures, which could contribute to long‐term degradation of cartilage.

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Results of medial patellofemoral ligament reconstruction compared with trochleoplasty plus individual extensor apparatus balancing in patellar instability caused by severe trochlear dysplasia: a systematic review and meta-analysis

Abstract: IV.

Cited by 90 publications

References 31 publications

A stand-alone lateral condyle-elevating trochlear osteotomy leads to high residual instability but no excessive increase in patellofemoral osteoarthritis at 12-year follow-up

A stand-alone lateral condyle-elevating trochlear osteotomy leads to high residual instability but no excessive increase in patellofemoral osteoarthritis at 12-year follow-up

Computational approach to correcting joint instability in patients with recurrent patellar dislocation

Groove‐deepening trochleoplasty reduces lateral patellar maltracking and increases patellofemoral contact pressures: Dynamic simulation

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