Treatment of Proximal Trochlear Dysplasia in the Setting of Patellar Instability: An Arthroscopic Technique

Trasolini, Nicholas A.; Serino, Joseph; Dandu, Navya; Yanke, Adam B.

doi:10.1016/j.eats.2021.05.027

Cited by 10 publications

(4 citation statements)

References 25 publications

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“…Trochlear dysplasia (TD) is one of the leading causes of patellar instability [ 22 ]. The most commonly used MRI parameters for TD are LTI and TFA [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Morphometric Parameters and MRI Morphological Changes of the Knee and Patella in Physically Active Adolescents

et al. 2023

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Background and Objectives: The immature skeleton in a pediatric population exposed to frequent physical activity might be extremely prone to injuries, with possible consequences later in adulthood. The main aim of this study is to present specific morphometric parameters and magnetic resonance imaging (MRI) morphological changes of the knee and patella in a physically active pediatric population. Additionally, we wanted to investigate the morphological risk factors for patellar instability. Materials and Methods: The study included the MRI findings of 193 physically active pediatric patients with knee pain. The participants underwent sports activities for 5 to 8 h per week. Two divisions were performed: by age and by patellar type. We evaluated three age groups: group 1 (age 11–14), group 2 (age 15–17), and group 3 (age 18–21 years). In addition, participants were divided by the patellar type (according to Wiberg) into three groups. The following morphometric parameters were calculated: lateral trochlear inclination (LTI), the tibial tubercle–trochlear groove distance (TT-TG), trochlear facet asymmetry (TFA), Insall–Salvati index, modified Insall–Salvati index, Caton–Deschamps index, articular overlap, morphology ratio and contact surface ratio. Results: We found a statistically significant association between patellar type groups in LTI (p < 0.001), TFA (p < 0.001), Insal–Salvati (p = 0.001) index, and Caton–Deschamps index (p = 0.018). According to age groups, we found statistical significance in the Caton–Deschamps index (p = 0.039). The most frequent knee injury parameter, according to Wiberg, in physically active pediatric patients was patella type 2 in boys and type 3 in girls. Conclusions: The MRI morphometric parameters observed in our study might be factors of prediction of knee injury in physically active children. In addition, it might be very useful in sports programs to improve the biomechanics of the knee in order to reduce the injury rate in sports-active children.

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“…Trochlear dysplasia (TD) is one of the leading causes of patellar instability [ 22 ]. The most commonly used MRI parameters for TD are LTI and TFA [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Morphometric Parameters and MRI Morphological Changes of the Knee and Patella in Physically Active Adolescents

et al. 2023

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Reinholz

Till

Crowe

et al. 2023

Arthroscopy, Sports Medicine, and Rehabilitation

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“…Furthermore, it has been stated that only the most proximal part of the trochlear groove, the part that represents the trochlear prominence, needs to be deepened and that a more distal deepening might be pointless and unwanted. 40 Many MRI measurements have been used to investigate TD. 30 We chose the measurements in the present study based on several reasons.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Trochlear Shape and Patient-Reported Outcomes After Arthroscopic Deepening Trochleoplasty and Medial Patellofemoral Ligament Reconstruction: A Retrospective Cohort Study Including MRI Assessments of the Trochlear Groove

Blønd

Barfod

2023

Orthopaedic Journal of Sports Medicine

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Background: Sparse objective data are available documenting changes of trochlear shape after trochleoplasty. Purpose/Hypothesis: The purpose was to investigate whether standardized magnetic resonance imaging (MRI) measurements that characterize trochlear dysplasia (TD) change significantly after arthroscopic deepening trochleoplasty (ADT) combined with medial patellofemoral ligament (MPFL) reconstruction. It was hypothesized that MRI measurements would approximate normal values. Study Design: Case series; Level of evidence, 4. Methods: Patients who underwent ADT between October 2014 and December 2017 were considered for this study. The preoperative inclusion criteria for ADT surgery were patellar instability, a dynamic patellar apprehension sign at 45° of flexion, a lateral trochlear inclination (LTI) angle of <11°, and failed physical therapy. MRI was performed pre- and postoperatively, and standardized MRI measurements were calculated: LTI angle, trochlear depth, trochlear facet asymmetry, cartilage thickness, and trochlear height. The Banff Patella Instability Instrument 2.0 (BPII) score, Knee injury and Osteoarthritis Outcome Score (KOOS), and Kujala score were obtained pre- and postoperatively. Results: A total of 16 knees in 15 patients (12 female and 3 male; median age, 20.9 years; range, 14.1-51.3 years) were evaluated. The mean follow-up time was 63.6 months (range, 23-97 months). The median LTI angle improved from 1.25° (range, –25.1° to 10.6°) preoperatively to 10.7° (range, –17.7° to 25.8°) postoperatively ( P < .001), trochlear depth increased from 0.0 mm (range, –4.2 to 1.8 mm) to 3.23 mm (range, 0.25-5.3 mm) ( P < .001), and trochlear facet asymmetry improved from 4.55% (range, 0.0%-28.6%) to 17.8% (range, 0.0%-55.6%) ( P < .003). Cartilage thickness was unchanged: 4.5 mm (range, 1.9-7.4 mm) preoperatively and 4.9 mm (range, 0.6-8.3 mm) postoperatively ( P = .796). BPII, KOOS, and Kujala scores improved significantly ( P < .0034 for all). Conclusion: Combined ADT and MPFL reconstruction led to statistically significant and clinically relevant improvements in patient-reported outcomes and standardized MRI measurements that characterize TD. The improvements corresponded to those obtained by open trochleoplasty. No significant reduction in cartilage thickness was seen.

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Treatment of Proximal Trochlear Dysplasia in the Setting of Patellar Instability: An Arthroscopic Technique

Cited by 10 publications

References 25 publications

Morphometric Parameters and MRI Morphological Changes of the Knee and Patella in Physically Active Adolescents

Morphometric Parameters and MRI Morphological Changes of the Knee and Patella in Physically Active Adolescents

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

Trochlear Shape and Patient-Reported Outcomes After Arthroscopic Deepening Trochleoplasty and Medial Patellofemoral Ligament Reconstruction: A Retrospective Cohort Study Including MRI Assessments of the Trochlear Groove

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