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Surgical treatment of patellofemoral instability using trochleoplasty or MPFL reconstruction: a systematic review

Knee Surgery, Sports Traumatology, Arthroscopy volume 25, pages 2309–2320 (2017)Cite this article

Abstract

Purpose

Trochleoplasty and reconstruction of the medial patellofemoral ligament (MPFL) are among the most commonly performed surgical treatments in patients with patellofemoral instability. The primary purpose of the study was to perform a systematic literature review on trochleoplasty in the treatment of patients with patellofemoral instability. The secondary purpose was to compare the outcomes with those seen in patients treated after reconstruction of the MPFL.

Methods

A standardised search on search engines was performed. All observational and experimental studies dealing with trochleoplasty were then obtained and reviewed in a consensus meeting. Fifteen articles out of 1543 were included and analysed using the CASP appraisal scoring system. Twenty-five studies on MPFL reconstruction were obtained for comparison. The clinical and radiological outcomes were statistically analysed.

Results

Both treatment groups showed significant improvement in outcomes from pre- to post-operatively. The mean post-operative Kujala and the Lysholm scores significantly increased in both groups when compared to preoperatively (trochleoplasty group: Kujala 61.4–80.8 and Lysholm 55.5–78.5; MPFL group: Kujala 46.9–88.8 and Lysholm 59.9–91.1). Post-operatively a positive apprehension test was found in 20 and 8 % of the trochleoplasty and MPFL groups, respectively. No significant differences in redislocation (2 %) and subluxation (5–6 %) rates were found.

Conclusions

This systematic review showed that both trochleoplasty and MPFL reconstruction are able to deliver good clinical outcomes with stable patellofemoral joints.

Level of evidence

III.

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References

  1. Banke IJ, Kohn LM, Meidinger G, Otto A, Hensler D, Beitzel K, Imhoff AB, Schöttle PB (2014) 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(11):2591–2598

    Article  PubMed  Google Scholar 

  2. Beals RK, Buehler K (1997) Treatment of patellofemoral instability in childhood with creation of a femoral sulcus. J Pediatr Orthop 17(4):516–519

    CAS  PubMed  Google Scholar 

  3. Berruto M, Ferrua P, Uboldi F, Usellini E, Gala L, Tassi A, Marelli B (2014) Medial patellofemoral ligament reconstruction with bioactive synthetic ligament is an option. A 3-year follow-up study. Knee Surg Sports Traumatol Arthrosc 22(10):2419–2425

    Article  PubMed  Google Scholar 

  4. Dejour D (2008) La trochleoplastie creusement dans les instabilities rotuliennes objective de haut grade. Maîtrise Orthopédique. 1762008. http://www.chirurgie-arthrose-sport-74.com/pdf/trochleoplaite%20rotuliennes.pdf

  5. Donell ST, Joseph G, Hing CB, Marshall TJ (2006) Modified Dejour trochleoplasty for severe dysplasia: operative technique and early clinical results. Knee 13(4):266–273

    Article  PubMed  Google Scholar 

  6. Eckhoff DG, Bach JM, Spitzer VM, Reinig KD, Bagur MM, Baldini TH et al (2003) Three-dimensional morphology and kinematics of the distal part of the femur viewed in virtual reality. Part II J Bone Joint Surg Am 85-A(Suppl 4):97–104

    Article  Google Scholar 

  7. Eckhoff DG, Dwyer TF, Bach JM, Spitzer VM, Reinig KD (2001) Three-dimensional morphology of the distal part of the femur viewed in virtual reality. J Bone Joint Surg Am 83-A(Suppl 2 (Pt 1)):43–50

    Article  Google Scholar 

  8. Ellera Gomes JL (1992) Medial patellofemoral ligament reconstruction for recurrent dislocation of the patella: a preliminary report. Arthroscopy 8(3):335–340

    Article  CAS  PubMed  Google Scholar 

  9. Fucentese SF, Schottle PB, Pfirrmann CW, Romero J (2007) CT changes after trochleoplasty for symptomatic trochlear dysplasia. Knee Surg Sports Traumatol Arthrosc 15(2):168–174

    Article  CAS  PubMed  Google Scholar 

  10. 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(10):1655–1661

    Article  PubMed  Google Scholar 

  11. Fulkerson JP, Schutzer SF, Ramsby GR, Bernstein RA (1987) Computerized tomography of the patellofemoral joint before and after lateral release or realignment. Arthroscopy 3(1):19–24

    Article  CAS  PubMed  Google Scholar 

  12. 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 Reparatrice Appar Mot 88(7):678–685

    CAS  PubMed  Google Scholar 

  13. Grelsamer RP, Bazos AN, Proctor CS (1993) Radiographic analysis of patellar tilt. J Bone Joint Surg Br 75(5):822–824

    CAS  PubMed  Google Scholar 

  14. Inoue M, Shino K, Hirose H, Horibe S, Ono K (1988) Subluxation of the patella. Computed tomography analysis of patellofemoral congruence. J Bone Joint Surg Am 70(9):1331–1337

    Article  CAS  PubMed  Google Scholar 

  15. Koeter S, Pakvis D, van Loon CJ, van Kampen A (2007) Trochlear osteotomy for patellar instability: satisfactory minimum 2-year results in patients with dysplasia of the trochlea. Knee Surg Sports Traumatol Arthrosc 15(3):228–232

    Article  PubMed  Google Scholar 

  16. Kujala UM, Jaakkola LH, Koskinen SK, Taimela S, Hurme M, Nelimarkka O (1993) Scoring of patellofemoral disorders. Arthroscopy 9(2):159–163

    Article  CAS  PubMed  Google Scholar 

  17. Lind M, Enderlein D, Nielsen T, Christiansen SE, Faunø P (2014) Clinical outcome after reconstruction of the medial patellofemoral ligament in paediatric patients with recurrent patella instability. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-014-3439-x

    Google Scholar 

  18. Martino F, De Serio A, Macarini L, Colaianni P, Solarino M, Fracella MR (1995) The sulcus angle of the femoral trochlea: ultrasonographic evaluation. Radiol Med 89(3):215–218

    CAS  PubMed  Google Scholar 

  19. Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 339:b2535

    Article  PubMed  PubMed Central  Google Scholar 

  20. Nelitz M, Dreyhaupt J, Lippacher S (2013) Combined trochleoplasty and medial patellofemoral ligament reconstruction for recurrent patellar dislocations in severe trochlear dysplasia: a minimum 2-year follow-up study. Am J Sports Med 41(5):1005–1012

    Article  PubMed  Google Scholar 

  21. Peterson L, Karlsson J, Brittberg M (1988) Patellar instability with recurrent dislocation due to patellofemoral dysplasia. Results after surgical treatment. Bull Hosp Jt Dis Orthop Inst 48(2):130–139

    CAS  PubMed  Google Scholar 

  22. Sasaki T, Yagi T (1986) Subluxation of the patella. Investigation by computerized tomography. Int Orthop. 10(2):115–120

    Article  Google Scholar 

  23. Schöttle PB, Fucentese SF, Pfirrmann C, Bereiter H, Romero J (2005) Trochleoplasty for patellar instability due to trochlear dysplasia: a minimum 2-year clinical and radiological follow-up of 19 knees. Acta Orthop 76(5):693–698

    Article  PubMed  Google Scholar 

  24. Shah JN, Howard JS, Flanigan DC, Brophy RH, Carey JL, Lattermann C (2012) A systematic review of complications and failures associated with medial patellofemoral ligament reconstruction for recurrent patellar dislocation. Am J Sports Med 40(8):1916–1923

    Article  PubMed  PubMed Central  Google Scholar 

  25. Smith T, Leigh D (2008) Outcomes following trochleoplasty for patella instability with trochlear dysplasia: a systematic review. Eur J Orthop Surg Traumatol 18:425–433

    Article  Google Scholar 

  26. Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 198:43–49

    Google Scholar 

  27. 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(8):833–845

    Article  CAS  PubMed  Google Scholar 

  28. Thaunat M, Erasmus PJ (2007) The favourable anisometry: an original concept for medial patellofemoral ligament reconstruction. Knee 14(6):424–428

    Article  PubMed  Google Scholar 

  29. Utting MR, Mulford JS, Eldridge JD (2008) A prospective evaluation of trochleoplasty for the treatment of patellofemoral dislocation and instability. J Bone Joint Surg Br 90(2):180–185

    Article  CAS  PubMed  Google Scholar 

  30. Vainionpaa S, Laasonen E, Silvennoinen T, Vasenius J, Rokkanen P (1990) Acute dislocation of the patella. A prospective review of operative treatment. J Bone Joint Surg Br 72(3):366–369

    CAS  PubMed  Google Scholar 

  31. Verdonk R, Jansegers E, Stuyts B (2005) Trochleoplasty in dysplastic knee trochlea. Knee Surg Sports Traumatol Arthrosc 13(7):529–533

    Article  CAS  PubMed  Google Scholar 

  32. Verhagen AP, de Vet HC, de Bie RA, Kessels AG, Boers M, Bouter LM et al (1998) The Delphi list: a criteria list for quality assessment of randomized clinical trials for conducting systematic reviews developed by Delphi consensus. J Clin Epidemiol 51(12):1235–1241

    Article  CAS  PubMed  Google Scholar 

  33. von Knoch F, Bohm T, Burgi ML, von Knoch M, Bereiter H (2006) Trochleaplasty for recurrent patellar dislocation in association with trochlear dysplasia. A 4- to 14-year follow-up study. J Bone Joint Surg Br 88(10):1331–1335

    Article  Google Scholar 

  34. Weiker GT, Black KP (1997) The anterior femoral osteotomy for patellofemoral instability. Am J Knee Surg 10(4):221–227

    CAS  PubMed  Google Scholar 

  35. Zaki S (2010) Femoral trochleoplasty for recurrent patellar instability: a modified surgical technique and its medium-term results. Curr Orthop Pract 21(2):153–157

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland, 4101, Bruderholz, Switzerland

    Enrique Adrian Testa & Michael Tobias Hirschmann

  2. Department of Orthopaedic Surgery, Universitäts-Kinderspital Beider Basel, Basel, Switzerland

    Carlo Camathias

  3. Amsler Consulting, Basel, Switzerland

    Felix Amsler

  4. Department of Orthopaedic Surgery, Sonnenhof, Berne, Switzerland

    Philipp Henle

  5. Center of Biomechanics, CMBE, University of Basel, Basel, Switzerland

    Niklaus F. Friederich

Authors
  1. Enrique Adrian Testa
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  2. Carlo Camathias
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  6. Michael Tobias Hirschmann
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Correspondence to Michael Tobias Hirschmann.

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Disclosures

This study was funded by a generous grant of the World Arthrosis Foundation, Heidelberg, Germany (P217).

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The authors declare that they have no conflict of interest.

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The manuscript does not contain clinical studies or patient data.

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Testa, E.A., Camathias, C., Amsler, F. et al. Surgical treatment of patellofemoral instability using trochleoplasty or MPFL reconstruction: a systematic review. Knee Surg Sports Traumatol Arthrosc 25, 2309–2320 (2017). https://doi.org/10.1007/s00167-015-3698-1

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Keywords

  • Patellofemoral instability
  • Trochlear dysplasia
  • Trochleoplasty
  • Medial patellofemoral ligament
  • MPFL reconstruction