Trochleoplasty: Indications and Technique

Abstract

Patellar instability with severe trochlear dysplasia is the main indication for trochleoplasty. Three types of trochleoplasty have emerged: (1) lateral facet elevation; (2) sulcus deepening; and (3) recession wedge. Deepening and recession wedge trochleoplasties are the most commonly performed. Trochleoplasty is a surgical option for addressing patellar instability in patients with severe trochlear dysplasia. Deepening and recession wedge trochleoplasties that address Dejour B and D dysplastic trochleas are the most studied, with both short- and midterm outcomes reported. Long-term outcomes are lacking and comparative studies are needed.

Precise Arthroscopic Mini-trochleoplasty and Medial Patellofemoral Ligament Reconstruction for Recurrent Patellar Instability With Severe Trochlear Dysplasia

“…On the contrary, in the techniques of Bereiter-Gautier sulcus-deepening trochleoplasty and PAM trochleoplasty, the thin cartilage flaps are molded malleable enough to fit the new groove more smoothly in fine shape. Previous studies of trochleoplasty have shown that OA is a common complication, 5 , 13 , 15 which may be associated with patellofemoral incongruence caused by the trochleoplasty technique. Theoretically, in minute structure, when the new trochlear groove is more congruent with patellar tracking, less impingement will occur between the new sulcus and patella, which may result in the occurrence of less OA and less postoperative pain.…”

Atualização em instabilidade patelar

“…A instabilidade patelar com displasia troclear grave é a principal indicação para a trocleoplastia, uma técnica cirúrgica capaz de corrigir e remodelar a arquitetura óssea da tróclea femoral. 50 Indicações específicas para a trocleoplastia incluem pacientes com mau alinhamento patelar extremo (identificado pelo sinal "J" ao exame clínico e distância TA-GT > 10 mm), morfologia troclear anormal, na presença de cartilagem articular normal ou quase normal. 15,51 Diferentes técnicas para correção cirúrgica da displasia troclear foram descritas: 1) elevação da faceta lateral; 2) aprofundamento do sulco com ou sem remoção troclear subcondral, seguido pela fixação da cartilagem troclear corrigida; e 3) ressecção de um retalho cartilaginoso subcondral, remodelamento da tróclea e refixação da cartilagem.…”

Sulcus-Deepening Trochleoplasty as an Isolated or Combined Treatment Strategy for Patellar Instability and Trochlear Dysplasia: A Systematic Review

“…Although MPFL reconstruction and tibial tubercle osteotomies are common approaches for patellar stabilization, trochlear dysplasia continues to be a risk factor for poor surgical outcomes in many series. 2 , 3 , 4 , 5 , 6 …”

“…There are 3 principal types of trochleoplasty: lateral facet elevation, sulcus deepening, and recession wedge, which are often performed in combination with bony or soft-tissue corrective procedures. 2 , 3 , 4 , 6 , 9 , 10 , 11 , 12 The modern sulcus-deepening technique was described by Dejour in 1987 and additionally modified by Bereiter and Gautier in 1994. 2 , 13 , 14 , 15 , 16 Dejour et al.…”

“… 2 , 5 , 7 In the modified sulcus-deepening procedure described by Bereiter and Gautier, a cartilage “flake” is elevated in the trochlear groove and a burr or straight osteotome is used to remove the underlying bone to effectively deepen the trochlear groove, after which the cartilage flake is replaced and secured such that it plastically conforms over the contour of the deepened groove. 2 , 3 , 9 , 16 More recently, a variation of this approach has been described in which a thick osteochondral flap is elevated rather than a thin cartilage flake. 14 …”