In the JournalsPerspective

Higher rates of instability seen with trochleoplasty alone vs trochleoplasty, MPFL reconstruction for trochlear dysplasia

Compared with combined trochleoplasty and medial patellofemoral ligament reconstruction in patients with trochlear dysplasia, trochleoplasty alone showed lower outcome scores and higher rates of residual instability, according to results.

Researchers searched current literature in PubMed, EMBASE and Medline databases using the terms ‘trochleoplasty’ and ‘medial patellofemoral ligament (MPFL) reconstruction' and identified 515 abstracts. Of these abstracts, six articles met inclusion criteria. The six articles included information for 192 knees in 168 patients with severe trochlear dysplasia. In the meta-analysis, the Kujala score was analyzed as the primary clinical outcome. Investigators calculated pooled estimates for postoperative complications.

Results showed three articles with a total of 111 knees that underwent isolated trochleoplasty and three articles with a total of 81 knees that underwent trochleoplasty combined with MPFL reconstruction. The preoperative Kujala score increased significantly at the final follow-up in patients who underwent isolated trochleoplasty by 21.39 points and by 24.91 points in patients who underwent trochleoplasty combined with MPFL reconstruction.

The rates of subjective patellar instability, which included subluxation and anterior knee pain, were 1.03% for patients who underwent isolated trochleoplasty and 8.45% for those who underwent trochleoplasty with MPFL reconstruction. Rates of objective patella re-dislocation in patients who underwent isolated trochleoplasty and trochleoplasty with MPFL reconstruction were 2.06% and 0%, respectively.

There were 8.24% of patients who underwent trochleoplasty and returned to the OR for additional surgery and 7.04% of patients who underwent trochleoplasty with MPFL reconstruction and returned to the OR. – by Monica Jaramillo

 

Disclosures: The authors report no relevant financial disclosures.

Compared with combined trochleoplasty and medial patellofemoral ligament reconstruction in patients with trochlear dysplasia, trochleoplasty alone showed lower outcome scores and higher rates of residual instability, according to results.

Researchers searched current literature in PubMed, EMBASE and Medline databases using the terms ‘trochleoplasty’ and ‘medial patellofemoral ligament (MPFL) reconstruction' and identified 515 abstracts. Of these abstracts, six articles met inclusion criteria. The six articles included information for 192 knees in 168 patients with severe trochlear dysplasia. In the meta-analysis, the Kujala score was analyzed as the primary clinical outcome. Investigators calculated pooled estimates for postoperative complications.

Results showed three articles with a total of 111 knees that underwent isolated trochleoplasty and three articles with a total of 81 knees that underwent trochleoplasty combined with MPFL reconstruction. The preoperative Kujala score increased significantly at the final follow-up in patients who underwent isolated trochleoplasty by 21.39 points and by 24.91 points in patients who underwent trochleoplasty combined with MPFL reconstruction.

The rates of subjective patellar instability, which included subluxation and anterior knee pain, were 1.03% for patients who underwent isolated trochleoplasty and 8.45% for those who underwent trochleoplasty with MPFL reconstruction. Rates of objective patella re-dislocation in patients who underwent isolated trochleoplasty and trochleoplasty with MPFL reconstruction were 2.06% and 0%, respectively.

There were 8.24% of patients who underwent trochleoplasty and returned to the OR for additional surgery and 7.04% of patients who underwent trochleoplasty with MPFL reconstruction and returned to the OR. – by Monica Jaramillo

 

Disclosures: The authors report no relevant financial disclosures.

    Perspective
    Vicente Sanchis-Alfonso

    Vicente Sanchis-Alfonso

    The objective of Ren and colleagues is to evaluate the efficacy of isolated trochleoplasty for treating recurrent lateral patellar dislocation comparing it with combined MPFL reconstruction associated to a trocheoplasty. They conclude that isolated trochleoplasty has lower outcome and higher residual instability compared with combined MPFL reconstruction and trochleoplasty.

    I agree with the findings observed by Ren and colleagues. The results they present make perfect sense. Several anatomic and biomechanical studies have demonstrated that the MPFL is the most important restraint to lateral patellar displacement between 0° and 30° of knee flexion. The trochlear shape assumes a dominant role regarding stability of the patellofemoral joint beyond 30º of knee flexion. Most patients suffering from chronic lateral patellar instability have instability in the first 30º of knee flexion. Therefore, it is logical that isolated trochleoplasty has higher residual instability and therefore lower outcome than the combination of MPFL reconstruction and trochleoplasty.

    In my clinical experience sulcus deepening trochleoplasty is not a routine surgical procedure. It is a valuable tool only in a small subset of patients mostly in revision surgeries, when there is a severe trochlear dysplasia (Grade D according to the classification of Dejour), when the patella dislocates not only during the first 30º of knee flexion but also at high degrees of knee flexion and when there is a patellofemoral maltracking.

     

    • Vicente Sanchis-Alfonso, MD, PhD
    • Department of Orthopaedic Surgery,
      Hospital Amau de Vilanova,
      Valencia, Spain

    Disclosures: Sanchis-Alfonso reports no relevant financial disclosures.

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