In the JournalsPerspective

Trochleoplasty yielded good clinical outcomes, low redislocation rate at short-, long-term follow-up

According to recently published results, trochleoplasty yielded good clinical outcomes, a low redislocation rate and an “acceptable” complication profile at short- and long-term follow-up.

“Trochleoplasty clearly needs to be in the toolbox of the experienced patellofemoral surgeon,” Laurie A. Hiemstra, MD, PhD, FRCSC, told Healio.com/Orthopedics. “A greater understanding of the interaction of the varying risky anatomic features associated with patellofemoral instability, as well as a more comprehensive and reliable classification system for trochlear dysplasia, will help us to determine which patients are most likely to benefit from this procedure. “

Hiemstra and colleagues used OVID Medline, OVID EMBASE and the Cochrane Library to identify 29 studies which included 998 patients who underwent trochleoplasty for lateral patellofemoral instability. Investigators abstracted information from 21 studies for the secondary analysis of clinical outcomes and found a degree of trochlear dysplasia and significant heterogeneity in patient selection and patient-reported outcomes.

Results showed most of the studies were performed in Europe. The open thin flap technique was used in most studies.

Investigators noted significant improvements in clinical outcomes for all trochleoplasty techniques at an average of 50 months postoperatively. Most patients reported they were satisfied with their procedure. There were low rates of redislocation and complications. – by Monica Jaramillo

Disclosures: The authors report no relevant financial disclosures.

According to recently published results, trochleoplasty yielded good clinical outcomes, a low redislocation rate and an “acceptable” complication profile at short- and long-term follow-up.

“Trochleoplasty clearly needs to be in the toolbox of the experienced patellofemoral surgeon,” Laurie A. Hiemstra, MD, PhD, FRCSC, told Healio.com/Orthopedics. “A greater understanding of the interaction of the varying risky anatomic features associated with patellofemoral instability, as well as a more comprehensive and reliable classification system for trochlear dysplasia, will help us to determine which patients are most likely to benefit from this procedure. “

Hiemstra and colleagues used OVID Medline, OVID EMBASE and the Cochrane Library to identify 29 studies which included 998 patients who underwent trochleoplasty for lateral patellofemoral instability. Investigators abstracted information from 21 studies for the secondary analysis of clinical outcomes and found a degree of trochlear dysplasia and significant heterogeneity in patient selection and patient-reported outcomes.

Results showed most of the studies were performed in Europe. The open thin flap technique was used in most studies.

Investigators noted significant improvements in clinical outcomes for all trochleoplasty techniques at an average of 50 months postoperatively. Most patients reported they were satisfied with their procedure. There were low rates of redislocation and complications. – by Monica Jaramillo

Disclosures: The authors report no relevant financial disclosures.

    Perspective
    Jason L. Koh

    Jason L. Koh

    Dr. Hiemstra’s study adds a provocative and important contribution to the literature on trochleoplasty, a poorly understood and infrequently used procedure for the treatment of patella instability in the setting of trochlear dysplasia. Trochleoplasty is a technically challenging procedure; unlike most orthopaedic osteotomies, the surgeon performs a geometrically complex intra-articular osteotomy that radically reshapes a convex trochlea into a concave one by creating a highly mobile articular cartilage flap. Naturally, this raises fears of incongruity, catastrophic articular cartilage damage and subsequent arthritis. Dr. Hiemstra’s study, based on a systematic review of 29 studies with nearly 1,000 patients, shows that trochleoplasty significantly improved clinical outcomes and patella stability at an average of 50 months. Importantly, complication rates, including rates of arthritis, were low. The vast majority of these patients were treated in Europe, where the most commonly performed thin flap (Swiss) and thick flap (Lyon) procedures originated more than 25 years ago. Several important questions remain unanswered. There was significant variability in patient selection, and it remains unclear which patients may require this procedure or could undergo a less invasive and less complex one. Another question is whether results from the decades-long experience of European surgeons can be replicated elsewhere. From personal experience, I agree that good results with acceptable complication rates can be achieved with trochleoplasty, but for the majority of patients with patella instability, other procedures, such as medial patellofemoral ligament reconstruction and distal realignment, can also achieve excellent outcomes.

    • Jason L. Koh, MD
    • Shoulder and knee Injuries, hip arthroscopy, sports medicine
      North Shore University Health System
      Glenview, Illinois

    Disclosures: Koh reports no relevant financial disclosures.

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