The arthroscopic deepening trochleoplasty

Abstract

Since a dysplastic trochlea has been identified as the main pathomorphology in recurrent patellofemoral instability, trochleoplasty became a surgical solution in some of these cases. However, in comparison to other surgical procedures stabilizing the patellofemoral joint, trochleoplasty is a major operation with an arthrotomy, and associated typical risks of open surgery such as arthrofibrosis. Therefore, we developed a technique to perform an arthroscopic deepening trochleoplasty via suprapatellar portals using shaver burrs. Comparable to the open procedure, a cartilage flake is released and a new bony trochlea is created according to the normal anatomy. Then, the cartilage flake is re-fixated using Vicryl tapes and anchors. This method seems to be an obvious advantage in patellofemoral surgery, since an arthrotomy can be avoided, and postoperative pain as well as soft tissue healing time can be reduced.

Arthroscopic Deepening Trochleoplasty: The Technique

“…The technique has been found to be reproducible and safe, without serious complications, but should only be performed by experienced surgeons. The postoperative level of pain and the length of recovery seem to be less compared with the open method, 25 though no randomized studies have yet compared the 2 methods. Clinically, the ADT results in significant improvements in postoperative Kujala and KOOS scores, and also provides stable patellae with no cases of arthrofibrosis having been reported.…”

“…Since the original article was published in 2010, the procedure has undergone a minor change, with the omission of the superior lateral cannula, which was found to be superfluous. 25 In the primary study, a median visual analog scale(VAS) pain score of 3 was observed 24 hours after the operation, and this equalized the level of pain scores from MPFL reconstructions alone. Based on these findings, we found the combined ADT and MPFL procedures to be suitable for 1-day surgery.…”

“…This article describes the technique of the ADT, a technique that been slightly simplified since the original description. 25 …”

Patellofemoral Joint Instability: A Review of Current Concepts

“…The presence of trochlear dysplasia can be addressed with a trochlear groove deepening trochleoplasty procedure, as described by Dejour (Lyon's procedure) [66], or its variants which led to good clinical outcomes in the literature [41,67,68,69,70,71,72]. Long-term studies on the effectiveness of trochleoplasty are scarce.…”

Trochleoplasty: Historical Overview and Dejour Technique

“…Working through suprapatellar portals, they elevated a thin osteochondral trochlear flap, undermined the cancellous bone behind it with the use of a shaver, and fixed the flap with the use of anchors and absorbable sutures. 31 When an open surgery is not required by associated procedures, the arthroscopy procedure is appealing.…”