Trochleoplasty may be a good solution for patients with patellar instability with dysplasia
LAS VEGAS — A presenter at the Arthroscopy Association of North America and American Orthopaedic Society for Sports Medicine Specialty Day at the American Academy of Orthopaedic Surgeons Annual Meeting discussed factors orthopedic surgeons should look for when they consider trochleoplasty in patients with patellar instability with dysplasia.
“It is technically demanding and certainly frightening when you first start doing trochleoplasty but at least for some patients, it’s a good surgical solution; in fact, the best surgical solution for stabilization,” Julian Feller, MD, said during his presentation.
He added, “The key theme is to remove the supratrochlear spur.”
Feller said there are four grades of dysplasia: types A, B, C and D, with types B and D being high grades of dysplasia. High-grade dysplasia is defined by the presence of supratrochlear spurs, and these patients have significant symptoms such as habitual dislocations. He said key considerations for trochleoplasty include a large J-sign on the physical examination and no significant patella alta.
Feller said surgeons should pay attention to patella alta because patients may need an alternative procedure if its significant .
“[The] decision to consider trochleoplasty is based on a combination of patient factors — a large J-sign, significant disability and instability, and imaging factors that show the presence of supratrochlear spur,” Feller said. “Importantly, know that patella alta may need an alternative procedure.”– by Monica Jaramillo
Feller J. Patella instability with dysplasia: My surgical algorithm. Presented at: Arthroscopy Association of North American and American Orthopaedic Society for Sports Medicine Specialty Day at the American Academy of Orthopaedic Surgeons Annual Meeting; March 16, 2019; Las Vegas.
Disclosure: Feller reports he is on the editorial or governing board of the American Journal of Sports Medicine, Knee Surgery, Sports Traumatology, Arthroscopy, Orthopaedic Journal of Sports Medicine; is a board or committee member of the International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine and is a paid presenter or speaker for Smith & Nephew.