Trochleoplasty: Historical Overview and Dejour Technique

Hinckel, Betina B.; Arendt, Elizabeth A.; Ntagiopoulos, Panagiotis G.; Dejour, David

doi:10.1053/j.otsm.2015.02.005

Cited by 8 publications

(3 citation statements)

References 50 publications

(48 reference statements)

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“…A procedure used to surgically treat patella instability combined with high‐grade dysplasia is a trochleoplasty [3, 5, 42]. A recent systematic review [50] including six studies showed higher‐grade PF OA in patients with severe TD (Dejour type B–D) treated with non‐trochleoplasty procedures (Insall's proximal realignment) [46] compared to trochleoplasty [2, 6, 41, 53, 63].…”

Section: Patellar Cartilage Lesions Without Patellar Dislocationsmentioning

confidence: 99%

Early osteoarthritis of the patellofemoral joint

Arendt

Berruto

Filardo

et al. 2016

Knee Surg Sports Traumatol Arthrosc

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Patellofemoral joint cartilage lesions are associated with a variety of clinical situations including blunt trauma, lateral patella dislocations, or as a secondary development in the setting of abnormal joint loading. There is a need for more clarity on how to best address these lesions. Most specifically, when is it necessary to surgically treat these lesions of the patella and trochlea and which technique to use? This review will focus on the spectrum of patellofemoral disease/injury and their treatment strategies, with special emphasis on cartilage damage and early osteoarthritis. Chapter sections will review the most common scenarios of cartilage damage in the patellofemoral joint, with an attempt to summarize current treatment, their outcomes, remaining challenges and unanswered questions.

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Section: Patellar Cartilage Lesions Without Patellar Dislocationsmentioning

confidence: 99%

Early osteoarthritis of the patellofemoral joint

Arendt

Berruto

Filardo

et al. 2016

Knee Surg Sports Traumatol Arthrosc

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“…He had stopped doing sports. Clinically, he presented the major signs of objective patellar instability bilaterally [8]: abnormal patellar tracking with “J” sign, patellar apprehension test positive, and patellofemoral pain.…”

Section: Case Reportmentioning

confidence: 99%

Femoral Trochleoplasty for Recurrent Patellar Dislocation: Treating the Underlying Trochlear Dysplasia

Santos

Ranger

Delisle

et al. 2018

Case Rep Orthop Res

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The patellofemoral joint presents a complex biomechanical interaction involving soft tissues and bony structures to maintain joint stability. The most relevant factor is trochlear dysplasia which is present in 85% of patients. Femoral trochleoplasty is a surgical procedure to recreate the trochlear groove. This case report describes a young patient who had all clinical factors of patellar instability and trochlear dysplasia. Radiology studies showed trochlear dysplasia type C according to the Dejour classification. The patient underwent a trochleoplasty with an elevated flap of cartilage and subchondral bone as described by Ryzek and Schöttle [J Knee Surg 2015; 28(4): 297–302], associated with the reconstruction of the medial patellofemoral ligament. Femoral trochleoplasty is a surgical procedure to recreate the trochlear groove by removing subchondral bone to create a new trochlear sulcus, while respecting the kinematics and biomechanics of the patellofemoral joint.

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“…Deepening trochleoplasty has been popularized in Europe and is a powerful, albeit technically challenging, procedure for correcting dysplastic distal femoral structure and restoring patellar stability. 11,18,26 Although it has been studied in isolation, trochleoplasty can be performed concurrently with other, more traditional, patellar stabilizing procedures such as medial patellofemoral ligament (MPFL) reconstruction, tibial tubercle anteromedialization, and lateral retinacular release. 2,3,6,23 –25,27…”

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confidence: 99%

Manipulation Under Anesthesia With Lysis of Adhesions Is Effective in Arthrofibrosis After Sulcus-Deepening Trochleoplasty: A Prospective Study

Carstensen

Feeley

Diduch

2019

Orthopaedic Journal of Sports Medicine

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Background: Sulcus-deepening trochleoplasty has been established as an effective treatment for patellar instability due to trochlear dysplasia. However, arthrofibrosis is a known complication following trochleoplasty, which may require manipulation under anesthesia (MUA) with or without lysis of adhesions (LOA) to increase the knee range of motion (ROM), especially flexion. Purpose: To prospectively follow patients for ROM improvements and subsequent complications after undergoing MUA with or without LOA in the setting of sulcus-deepening trochleoplasty. Study Design: Case series; Level of evidence, 4. Methods: A total of 76 knees with severe trochlear dysplasia were prospectively enrolled and underwent sulcus-deepening trochleoplasty, with a mean (±SD) follow-up of 32.5 ± 19.3 months. Concomitant procedures included medial patellofemoral ligament reconstruction, lateral retinacular release, and tibial tubercle osteotomy. Physical examination including ROM and findings of recurrent patellar instability were collected for all patients. Arthrofibrosis was defined as active and passive flexion less than 90° within 3 months of surgery combined with a plateau in progress with physical therapy. Paired-samples and independent-samples t tests were used. A P value less than .05 was considered significant. Results: A total of 62 knees met inclusion and exclusion criteria and were included in the study. Of these patients, 11 experienced arthrofibrosis as a complication and underwent MUA within 3 months of their index procedure. Of these 11 patients, 9 subsequently underwent arthroscopic LOA following MUA because acceptable ROM could not be achieved with manipulation alone. Patients with arthrofibrosis had a premanipulation mean ROM that was significantly different from those without arthrofibrosis (77.3° ±18.6° vs 133.3° ± 12.7°, respectively; P < .001). In the arthrofibrotic group, postoperative ROM increased significantly after MUA and/or LOA compared with the preoperative ROM (127.3° ± 12.5° vs 77.3° ± 18.6°, respectively; P < .001). ROM in the arthrofibrotic group after MUA/LOA was not significantly different from that in the nonarthrofibrotic group (flexion, 127.3° ± 12.5° vs 133.3° ± 12.7°, respectively; P = .156). No complications from the MUA or LOA were reported at subsequent follow-up visits. Conclusion: When indicated in the setting of severe trochlear dysplasia, sulcus-deepening trochleoplasty is a treatment for disabling recurrent patellar instability with a known complication of arthrofibrosis. Initiation of postoperative physical therapy within 3 days of surgery may reduce the incidence of arthrofibrosis. If arthrofibrosis is encountered after a sulcus-deepening trochleoplasty, MUA without LOA is not as effective as when following other procedures of the knee, whereas MUA with LOA is an effective procedure likely to result in ROM and patient outcome scores similar to those of a nonarthrofibrotic knee after the same procedure. Both MUA and LOA appear to be safe based on the limited number of patients in this study without complication.

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Trochleoplasty: Historical Overview and Dejour Technique

Cited by 8 publications

References 50 publications

Early osteoarthritis of the patellofemoral joint

Early osteoarthritis of the patellofemoral joint

Femoral Trochleoplasty for Recurrent Patellar Dislocation: Treating the Underlying Trochlear Dysplasia

Manipulation Under Anesthesia With Lysis of Adhesions Is Effective in Arthrofibrosis After Sulcus-Deepening Trochleoplasty: A Prospective Study

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