Abstract
Purpose
Prospectively, a consecutive group of patients troubled by recurrent patella dislocation and trochlear dysplasia has been followed after a combined arthroscopic deepening trochleoplasty and reconstruction of the medial patellofemoral ligament. The purpose of this follow-up study is to report the clinical results.
Methods
Indications for combined arthroscopic deepening trochleoplasty and reconstruction of the medial patellofemoral ligament were two or more patellar dislocations with a persistent apprehension sign above 20° of flexion and trochlear dysplasia grade B or more. Prospectively, the Tegner, Kujala and KOOS scores were recorded. Thirty-one consecutive patients (37 knees), 21 women and 10 men, with a median age of 19 (12–39) underwent the procedure.
Results
Results were obtained for 29 knees with a minimum of 12-month follow-up (average 29 months; range 12–57). No complications, redislocations or arthrofibrosis have been recorded. Five patients needed further surgery. The median pre- and postoperative scores (range) are as follows: Kujala 64 (12–90) to 95 (47–100); Tegner 4 (1–6) to 6 (4–9); KOOS score pain 86–94; symptoms 82–86; ADL 91–99; sport 40–86; QDL 25–81. No significant correlation was found with respect to the results and recorded parameters. Significant improvement for all of the scores was observed (p < 0.001).
Conclusions
The use of arthroscopic deepening trochleoplasty in combination with reconstruction of the medial patellofemoral ligament was found to be a safe and reproducible procedure. Considering the stability achieved, the knee scores and the patient’s level of satisfaction, the results are encouraging.
Level of evidence
Prospective consecutive case series, with evaluation of confounding factor. No control group, Level IV.
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References
Amis A, Oguz C, Bull A, Senavongse W, Dejour D (2008) The effect of trochleoplasty on patellar stability and kinematics: a biomechanical study in vitro. J Bone Joint Surg Br 90:864–869
Arendt EA (2010) MPFL Reconstruction: The Adductor Sling Approach. In: Zaffagnini S, Dejour D, Arendt EA (eds) Patellofemoral pain, instability, and arthritis. Springer, Berlin, pp 175–179
Barbari S, Raugstad TS, Lichtenberg N, Refvem D (1990) The Hauser operation for patellar dislocation. 3–32-year results in 63 knees. Acta Orthop Scand 61:32–35
Bereiter H, Gautier E (1994) Die trochleaplastik als Chirurgische therapie der Reziderenden patellaluxation bei trochleadysplasie. Arthroskopie 7:281–286
Biedert RM, Netzer P, Gal I, Sigg A, Tscholl PM (2011) The lateral condyle index: a new index for assessing the length of the lateral articular trochlea as predisposing factor for patellar instability. Int Orthop 35:1327–1331
Biedert RM, Albrecht S (2006) The patellotrochlear index: a new index for assessing patellar height. Knee Surg Sports Traumatol Arthrosc 14:707–712
Blackburne JS, Peel TE (1977) A new method of measuring patellar height. J Bone Joint Surg Br 59:241–242
Blønd L (2009) Prospective evaluation of open trochleoplasty in patients with recurrent patella dislocation and severe trochlea dysplasia. Danish association of orthopaedics annual meeting http://www.ortopaedi.dk/fileadmin/bulletin/DOS%20nr.%203%20%202009-netbrug.pdf
Blønd L, Schöttle PB (2010) The arthroscopic deepening trochleoplasty. Knee Surg Sports Traumatol Arthrosc 18:480–485
Buckens C, Saris D (2010) Reconstruction of the medial patellofemoral ligament for treatment of patellofemoral instability: a systematic review. Am J Sports Med 38:181–188
Carney JR, Mologne TS, Muldoon M, Cox JS (2005) Long-term evaluation of the Roux-Elmslie-Trillat procedure for patellar instability: a 26-year follow-up. Am J Sports Med 33:1220–1223
Carrillon Y, Abidi H, Dejour D, Fantino O, Moyen B, Tran-Minh VA (2000) Patellar instability: assessment on MR images by measuring the lateral trochlear inclination-initial experience. Radiology 216:582–585
Caton J, Deschamps G, Chambat P, Lerat JL, Dejour H (1982) Patella infera. apropos of 128 cases. Rev Chir Orthop 68:317–325
Christiansen SE, Jacobsen BW, Lund B, Lind M (2008) Reconstruction of the medial patellofemoral ligament with gracilis tendon autograft in transverse patellar drill holes. Arthroscopy 24:82–87
Christoforakis J, Bull AM, Strachan RK, Shymkiw R, Senavongse W, Amis AA (2006) Effects of lateral retinacular release on the lateral stability of the patella. Knee Surg Sports Traumatol Arthrosc 14:273–277
Crosby EB, Insall J (1976) Recurrent dislocation of the patella. Relation of treatment to osteoarthritis. J Bone Joint Surg Am 58:9–13
Dejour D, Saggin P (2010) The sulcus deepening trochleoplasty-the Lyon’s procedure. Int Orthop 34:311–316
Dejour H, Walch G, Neyret P, Adeleine P (1990) Dysplasia of the femoral trochlea. Rev Chir Orthop Reparatrice Appar Mot 76:45–54
Dejour H, Walch G, Nove-Josserand L, Guier C (1994) Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc 2:19–26
Donell ST, Joseph G, Hing CB, Marshall TJ (2006) Modified Dejour trochleoplasty for severe dysplasia: operative technique and early clinical results. Knee 13:266–273
Fucentese SF, Zingg PO, Schmitt J, Pfirrmann CW, Meyer DC, Koch PP (2011) Classification of trochlear dysplasia as predictor of clinical outcome after trochleoplasty. Knee Surg Sports Traumatol Arthrosc 19:1655–1661
Galland O, Walch G, Dejour H, Carret JP (1990) An anatomical and radiological study of the femoropatellar articulation. Surg Radiol Anat 12:119–125
Gougeon F, Vanovermeire P, Migaud H, Debroucker MJ, Spiers A, Duquennoy A (1996) Resultats aprés 3 ans de recul de 51 trochléoplasties pour instabilité frontale fémoropatellaire. Rev Chir Orthop 87:85–86
Goutallier D, Raou D, Van Driessche S (2002) Retro-trochlear wedge reduction trochleoplasty for the treatment of painful patella syndrome with protruding trochleae. Technical note and early results. Rev Chir Orthop 88:678–685
Grelsamer RP, Dejour D, Gould J (2008) The pathophysiology of patellofemoral arthritis. Orthop Clin N Am 39:269–274
Hampson WG, Hill P (1975) Late results of transfer of the tibial tubercle for recurrent dislocation of the patella. J Bone Joint Surg Br 57:209–213
Huri G, Atay OA, Ergen B, Atesok K, Johnson DL, Doral MN (2012) Development of femoral trochlear groove in growing rabbit after patellar instability. Knee Surg Sports Traumatol Arthrosc 20:232–238
Insall J, Salvati E (1971) Patella position in the normal knee joint. Radiology 101:101–104
Juliusson R, Markhede G (1984) A modified Hauser procedure for recurrent dislocation of the patella. A long-term follow-up study with special reference to osteoarthritis. Arch Orthop Trauma Surg 103:42–46
Kalichman L, Zhang Y, Niu J, Goggins J, Gale D, Felson DT, Hunter D (2007) The association between patellar alignment and patellofemoral joint osteoarthritis features—an MRI study. Rheumatology (Oxford) 46:1303–1308
Keser S, Savranlar A, Bayar A, Ege A, Turhan E (2008) Is there a relationship between anterior knee pain and femoral trochlear dysplasia? Assessment of lateral trochlear inclination by magnetic resonance imaging. Knee Surg Sports Traumatol Arthrosc 16:911–915
Von Knoch F, Bohm T, Burgi ML, Von Knoch M, Bereiter H (2006) Trochleoplasty for recurrent patellar dislocation in association with trochlear dysplasia. A 4- to 14-year follow-up study. J Bone Joint Surg Br 88:1331–1335
Maenpaa H, Lehto MU (1996) Patellar dislocation has predisposing factors. A roentgenographic study on lateral and tangential views in patients and healthy controls. Knee Surg Sports Traumatol Arthrosc 4:212–216
Meidinger G, Tecklenburg K, Fink C, Hoser C (2011) Sports activity seven years after primary patellar dislocation. Arthroscopy 27:e141–e142
Monk AP, Doll HA, Gibbons CL, Ostlere S, Beard DJ, Gill HL, Murray DW (2011) The patho-anatomy of patellofemoral subluxation. J Bone Joint Surg Br 93:1341–1347
Nakagawa K, Wada Y, Minamide M, Tsuchiya A, Moriya H (2002) Deterioration of long-term clinical results after the Elmslie-Trillat procedure for dislocation of the patella. J Bone Joint Surg Br 84:861–864
Nelitz M, Theile M, Dornacher D, Wolfle J, Reichel H, Lippacher S (2012) Analysis of failed surgery for patellar instability in children with open growth plates. Knee Surg Sports Traumatol Arthrosc 20:822–828
Nomura E, Inoue M, Kobayashi S (2007) Long-term follow-up and knee osteoarthritis change after medial patellofemoral ligament reconstruction for recurrent patellar dislocation. Am J Sports Med 35:1851–1858
Pfirrmann CW, Zanetti M, Romero J, Hodler J (2000) Femoral trochlear dysplasia. Radiology 3:858–868
Schoettle PB, Zanetti M, Seifert B, Pfirrmann CW, Fucentese SF, Romero J (2006) The tibial tuberosity-trochlear groove distance; a comparative study between CT and MRI scanning. Knee 13:26–31
Schottle PB, Fucentese SF, Pfirrmann C, Bereiter H, Romero J (2005) Trochleaplasty for patellar instability due to trochlear dysplasia: a minimum 2-year clinical and radiological follow-up of 19 knees. Acta Orthop 76:693–698
Sillanpaa PJ, Mattila VM, Visuri T, Maenpaa H, Pihlajamaki H (2011) Patellofemoral osteoarthritis in patients with operative treatment for patellar dislocation: a magnetic resonance-based analysis. Knee Surg Sports Traumatol Arthrosc 19:230–235
Smith TO, Donell ST, Chester R, Clark A, Stephenson R (2011) What activities do patients with patellar instability perceive makes their patella unstable? Knee 18:333–339
Stefanik JJ, Roemer FW, Zumwalt AC, Zhu Y, Gross KD, Lynch JA, Frey-Law LA, Lewis CE, Guermazi A, Powers CM, Felson DT (2012) Association between measures of trochlear morphology and structural features of patellofemoral joint osteoarthritis on MRI: the most study. J Orthop Res 30:1–8
Steiner TM, Torga-Spak R, Teitge RA (2006) Medial patellofemoral ligament reconstruction in patients with lateral patellar instability and trochlear dysplasia. Am J Sports Med 34:1254–1261
Tecklenburg K, Dejour D, Hoser C, Fink C (2006) Bony and cartilaginous anatomy of the patellofemoral joint. Knee Surg Sports Traumatol Arthrosc 14:235–240
Teichtahl AJ, Hanna F, Wluka AE, Urquhart DM, Wang Y, English DR, Giles GG, Cicuttini FM (2012) A flatter proximal trochlear groove is associated with patella cartilage loss. Med Sci Sports Exerc 44:496–500
Thaunat M, Bessiere C, Pujol N, Boisrenoult P, Beaufils P (2011) Recession wedge trochleoplasty as an additional procedure in the surgical treatment of patellar instability with major trochlear dysplasia: early results. Orthop Traumatol Surg Res 97:833–845
Thaunat M, Erasmus PJ (2008) Recurrent patellar dislocation after medial patellofemoral ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 16:40–43
Thaunat M, Erasmus PJ (2007) The favourable anisometry: an original concept for medial patellofemoral ligament reconstruction. Knee 14:424–428
Utting MR, Mulford JS, Eldridge JDJ (2008) A prospective evaluation of trochleoplasty for the treatment of patellofemoral dislocation and instability. J Bone Joint Surg Br 90:180–185
Verdonk R, Jansegers E, Stuyts B (2005) Trochleoplasty in dysplastic knee trochlea. Knee Surg Sports Traumatol Arthrosc 13:529–533
Wagner D, Pfalzer F, Hingelbaum S, Huth J, Mauch F, Bauer G (2013) The influence of risk factors on clinical outcomes following anatomical medial patellofemoral ligament (MPFL) reconstruction using the gracilis tendon. Knee Surg Sports Traumatol Arthrosc 21:318–324
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Blønd, L., Haugegaard, M. Combined arthroscopic deepening trochleoplasty and reconstruction of the medial patellofemoral ligament for patients with recurrent patella dislocation and trochlear dysplasia. Knee Surg Sports Traumatol Arthrosc 22, 2484–2490 (2014). https://doi.org/10.1007/s00167-013-2422-2
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DOI: https://doi.org/10.1007/s00167-013-2422-2