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Combined trochleoplasty and MPFL reconstruction for treatment of chronic patellofemoral instability: a prospective minimum 2-year follow-up study

  • Knee
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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Excessive trochlear dysplasia may be responsible for recurrent patellofemoral instability (PFI) due to a missing bony guidance for the patella in early flexion. Thus, an isolated medial patellofemoral ligament reconstruction (MPFLR) can be insufficient, since it mainly addresses instability close to extension and additionally can increase patellofemoral pressure leading to pain in flat or convex trochlear dysplasia. Therefore, in combination with a trochleoplasty, an anatomical trochlear groove is created, resulting in patellofemoral stability also in flexion, while patellofemoral pressure is normalized. In this prospective study, we evaluated the outcome of open trochleoplasty in combination with MPFLR with a minimum follow-up of 2 years for treatment of excessive PFI.

Methods

In between 2007 and 2009, 18 knees of 17 consecutive patients (mean age of 22.2 ± 4.9 years) with trochlear dysplasia type B, C or D according to Dejour et al. and positive apprehension from 0 to 60° of flexion were included. Tegner, Kujala and IKDC scores, apprehension and pain, trochlear dysplasia, sulcus angle, tibial tuberosity trochlear groove, patellar tilt and shift, Caton–Deschamps index as well as patellofemoral arthrosis according to the classification of Iwano et al. were assessed pre- and postoperatively.

Results

At a mean of 30.5 ± 5.9 months, all but one patient were subjectively satisfied with the outcome of the procedure, all showing absence of positive apprehension or redislocation. Significant (p < 0.001) reduction in pain (5.6 to 2.5 ± 2.8 points, VAS) and increase in Tegner (2, range 0–4 points to 6, range 3–8 points), Kujala (51.1 to 87.9 ± 20.0 points) and IKDC (49.5 to 80.2 ± 21.0 %) scores could be achieved. Radiologically significant (p < 0.02) improvement of patellofemoral positional parameters leading to more normal anatomy was recorded, while short-term arthrosis was absent.

Conclusions

Combined treatment for trochleoplasty with MPFLR serves as a successful therapy for chronic PFI. This combinatory treatment concept is a reliable option not only as salvage therapy but also as primary procedure regarding treatment for excessive PFI.

Level of evidence

Prospective case series, Level IV.

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Acknowledgments

We gratefully acknowledge the help of Dipl. Stat. A. Hapfelmeier (Institut für Medizinische Statistik und Epidemiologie, TU München) for statistical analyses.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Orthopedic Sports Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany

    Ingo J. Banke, Ludwig M. Kohn, Gebhart Meidinger, Alexander Otto, Daniel Hensler, Knut Beitzel, Andreas B. Imhoff & Philip B. Schöttle

  2. Isar Medizin Zentrum, Sonnenstrasse 24, 80331, Munich, Germany

    Philip B. Schöttle

  3. Clinic of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany

    Ingo J. Banke

  4. Clinic Landshut-Achdorf, Achdorfer Weg 3, 84036, Landshut, Germany

    Ludwig M. Kohn

  5. Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Murnau, Prof.-Küntscher-Str. 8, 82418, Murnau, Germany

    Gebhart Meidinger, Daniel Hensler & Knut Beitzel

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  1. Ingo J. Banke
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Correspondence to Andreas B. Imhoff.

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Banke, I.J., Kohn, L.M., Meidinger, G. et al. Combined trochleoplasty and MPFL reconstruction for treatment of chronic patellofemoral instability: a prospective minimum 2-year follow-up study. Knee Surg Sports Traumatol Arthrosc 22, 2591–2598 (2014). https://doi.org/10.1007/s00167-013-2603-z

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