Trochlear Dysplasia

Sanctis, Edoardo Giovannetti de; Mesnard, Guillaume; Dejour, David

doi:10.1016/j.csm.2021.09.001

Cited by 17 publications

(11 citation statements)

References 27 publications

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“…Meanwhile, Noonan et al studied the time when femoral torsion became the leading pathological factor for patellar dislocation [28]. Patellofemoral joint disease is a complex multifactorial problem, and "à la carte" is considered a strategy for treating patellar dislocation [10,26,35]. We should focus on the main factors for patellar dislocation in each patient.…”

Section: Discussionmentioning

confidence: 99%

Clinical outcomes of derotational femoral osteotomy combined with medial patellofemoral ligament reconstruction in patients with patellar dislocation and increased femoral anteversion unaffected by the pattern of distribution of femoral torsion

Fan,

Niu,

Hao

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeThe aim of this study was to evaluate the clinical effect of derotational femoral osteotomy combined with medial patellofemoral ligament reconstruction for patellar dislocation and the effect of the distribution of femoral torsion at different segments on postoperative function.MethodsForty‐two patients with patellar dislocation who underwent derotational femoral osteotomy from 2017 to 2021 were retrospectively analysed. All patients received computed tomography scans from the hip to the knee to evaluate correction of the femoral anteversion (FA) angle, patellar tilt angle (PTA) and congruence angle (CA) after derotational femoral osteotomy. Subjective scores, such as the Kujala, Lysholm, International Knee Documentation Committee (IKDC), Tegner and visual analog scale (VAS) scores, were used to evaluate knee function before and after the operation. Patients with supracondylar torsion > distal torsion were categorized into the supracondylar torsion group and patients with distal torsion > supracondylar torsion were categorized into the distal torsion group. Subgroup analyses were performed.ResultsNo presentation of redislocation occurred in these patients at the minimum 2‐year follow‐up visit. The mean preoperative FA angle in the supracondylar torsion group was 30.2° ± 4.2°, and the mean postoperative FA angle was 14.5° ± 2.5° (p < 0.001). The mean preoperative FA angle was 26.7° ± 1.4° and the mean postoperative FA angle was 14.1° ± 1.4° in the distal torsion group. In addition, postoperative PTA and CA were significantly corrected in both groups (p < 0.001). The postoperative Kujala, Lysholm, IKDC, Tegner and VAS scores were significantly improved in both groups (p < 0.001). Subgroup analyses showed a higher preoperative FA in the supracondylar torsion group and a higher occurrence of high‐grade trochlear dysplasia in the distal torsion group. However, there was no significant difference in their postoperative clinical outcomes.ConclusionThrough a minimum of 2‐year follow‐up visits of patients with patellar dislocation and increased FA, it was found that derotational femoral osteotomy could significantly reduce FA and improve subjective knee function. The pattern of torsion distribution did not significantly affect the clinical outcomes of derotational femoral osteotomy. These findings readvised orthopaedic surgeons that derotational femoral osteotomy remains the preferred procedure for correcting rotational malalignment, but that they should be more cautious about its indications.Level of Evidence: Level IV.

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Section: Discussionmentioning

confidence: 99%

Clinical outcomes of derotational femoral osteotomy combined with medial patellofemoral ligament reconstruction in patients with patellar dislocation and increased femoral anteversion unaffected by the pattern of distribution of femoral torsion

Fan,

Niu,

Hao

et al. 2024

Knee surg. sports traumatol. arthrosc.

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“…Trochleoplasty is a surgical procedure whose primary goal is to modify the femoral trochlea’s abnormal shape in patients suffering from patellar instability. It is a technically demanding technique, requiring careful patient selection, detailed knowledge, and surgical skills to avoid severe complications [21, 37]. Recent studies showed satisfactory long‐term results with the restoration of patellar stability, improving radiological findings of patellofemoral instability.…”

Section: Discussionmentioning

confidence: 99%

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

Ferrua

Compagnoni

Calanna

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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Purpose Trochlear dysplasia has been recognized as the most common factor in patients with patellofemoral dislocation. Trochleoplasty is a surgical procedure whose primary goal is to modify the femoral trochlea's abnormal shape in patients sufering from patellar instability, requiring good surgical skills, correct indication, and accurate patient information. Methods The review aims to describe preoperative planning, patient selection, most common surgical techniques, and clinical results of trochleoplasty in patellar instability in a reproducible manner. Results Trochleoplasty can be considered a general term to describe a group of diferent procedures that reduce trochlear dysplasia's impact on patellar instability, aiming to restore patella-trochlear congruency, remove the supratrochlear bump, allowed a new groove positioning and are generally associated with other procedures. Recent studies showed satisfactory long-term results with the restoration of patellar stability, improving radiological indings of patellofemoral instability. Conclusion Trochleoplasty is a technically demanding technique, requiring careful patient selection, detailed knowledge, and surgical skills to avoid severe complications. Good patient satisfaction with a low risk of signiicant complications such as patellofemoral arthritis has been revealed. In conclusion, trochleoplasty should be systematically included in the treatment of patellar dislocation, if indicated. Level of evidence V.

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“…Trochlear dysplasia has been shown to cause biomechanical deviations and is the most important factor in the lateral vector of patella translation in knee extension, leading to long‐term knee instability and potential osteoarthritis [17]. According to Dejour’s classification, Dejour types B, C, and D are considered high‐grade trochlear dysplasia [7, 20].…”

Section: Introductionmentioning

confidence: 99%

Derotational distal femur osteotomy combined with medial patellofemoral ligament reconstruction yields satisfactory results in recurrent patellar dislocation with excessive femoral anteversion angle and trochlear dysplasia

Zhou

Sun

Feng

et al. 2023

Knee surg. sports traumatol. arthrosc.

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Purpose The purpose of this study was to evaluate the clinical outcomes of medial patellofemoral ligament (MPFL) reconstruction combined with derotational distal femur osteotomy in patients with recurrent patellar dislocation who had excessive femoral anteversion angle and trochlear dysplasia. Methods Between 2015 and 2020, 64 patients (64 knees) with recurrent patellar dislocation, who had excessive femoral anteversion angle (≥ 25°) and trochlear dysplasia and were surgically treated using derotational distal femur osteotomy and MPFL reconstruction, were eligible for this retrospective study. These patients were assigned to two groups according to the grade of trochlear dysplasia. Group A (type A trochlear dysplasia, n = 33) and Group B (type B, C, D trochlear dysplasia, n = 31). Preoperative and postoperative patellar tilt angle (PTA), Caton–Deschamps index (CD‐I), tibial tubercle–trochlear groove (TT–TG) distance and femoral anteversion angle were evaluated. Patient outcomes were assessed using the preoperative and postoperative International Knee Documentation Committee (IKDC) score, Kujala score, Lysholm score, Tegner score, and visual analog scale (VAS) score. Results A total of 64 patients (64 knees) were evaluated in this study, with a mean follow‐up period of 28.4 ± 3.6 months. There were no cases of wound infection, osteotomy site fractures, deep venous thrombosis of the lower extremities, or re‐dislocation in the two groups during the postoperative follow‐up period. All patients returned to full extension and flexion. The postoperative Tegner score, Lysholm score, Kujala score, IKDC score, VAS score, PTA, CD‐I, TT–TG distance, and femoral anteversion angle were significantly improved compared with the preoperative status (P < 0.05). There was no significant difference between the two groups (n.s.). Conclusion MPFL reconstruction combined with derotational distal femur osteotomy showed satisfactory clinical outcomes during follow‐up in patients with recurrent patellar dislocation who had excessive femoral anteversion angle and trochlear dysplasia. Even patients with high‐grade trochlear dysplasia showed satisfactory results. For those patients, additional surgery is not necessary. Level of evidence Level III.

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Trochlear Dysplasia

Cited by 17 publications

References 27 publications

Clinical outcomes of derotational femoral osteotomy combined with medial patellofemoral ligament reconstruction in patients with patellar dislocation and increased femoral anteversion unaffected by the pattern of distribution of femoral torsion

Clinical outcomes of derotational femoral osteotomy combined with medial patellofemoral ligament reconstruction in patients with patellar dislocation and increased femoral anteversion unaffected by the pattern of distribution of femoral torsion

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

Derotational distal femur osteotomy combined with medial patellofemoral ligament reconstruction yields satisfactory results in recurrent patellar dislocation with excessive femoral anteversion angle and trochlear dysplasia

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