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Trochleoplasty provides good clinical outcomes and an acceptable complication profile in both short and long-term follow-up

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

Abstract

Purpose

The purpose of this study is to report on the global distribution and clinical outcomes of published articles related to trochleoplasty.

Methods

The online databases OVID Medline, OVID EMBASE, and the Cochrane Library were searched for the literature assessing trochleoplasty performed for lateral patellofemoral instability (LPI). Study data were abstracted looking at global trends in the literature, as well as clinical and patient-reported outcomes following this technique.

Results

For the assessment of global distribution, 29 studies including 998 patients met the inclusion criteria. The majority of the studies were conducted in Europe (93%) and most used an open thin flap technique (52%). For the secondary analysis of clinical outcomes, 21 studies were included with significant heterogeneity in patient selection, reporting on the degree of trochlear dysplasia, and patient-reported outcomes. All trochleoplasty techniques showed statistically significant improvement in clinical outcomes at average 50 months (range 3–228 months) post-operative, with most patients being satisfied with their procedure. Re-dislocation and complication rates were low.

Conclusions

European centers have published majority of data on trochleoplasty surgery, which has been shown to be an acceptable procedure for patients with high-grade trochlear dysplasia and LPI. Trochleoplasty has demonstrated good clinical outcomes, a low re-dislocation rate, and an acceptable complication profile in both short and long-term follow-up. This study highlights the difficulty in reporting outcomes in this group of patients due to heterogeneity in patient selection, grading of trochlear dysplasia, and the lack of disease-specific outcome measures.

Level of evidence

IV.

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Abbreviations

LPI:

Lateral patellofemoral instability

MPFL:

Medial patellofemoral ligament

TTO:

Tibial tubercle osteotomy

LR:

Lateral release

PROM:

Patient-reported outcome measure

OA:

Osteoarthritis

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Funding

No funding was received for this study.

Author information

Authors and Affiliations

  1. Banff Sport Medicine, Box 1300, Banff, AB, T1L 1B3, Canada

    Laurie A. Hiemstra

  2. Department of Surgery, University of Calgary, Calgary, AB, Canada

    Laurie A. Hiemstra

  3. Division of Orthopaedic Surgery, Department Surgery, McMaster University, Hamilton, ON, Canada

    Devin Peterson & Olufemi R. Ayeni

  4. Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada

    John Soliman & Laura Banfield

  5. Faculty of Medicine, University of Toronto, Toronto, ON, Canada

    Michael Youssef

Authors
  1. Laurie A. Hiemstra
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  2. Devin Peterson
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  3. Michael Youssef
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  4. John Soliman
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  5. Laura Banfield
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  6. Olufemi R. Ayeni
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Corresponding author

Correspondence to Laurie A. Hiemstra.

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Appendix 1: Search Strategy

Appendix 1: Search Strategy

Database: OVID Medline Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE(R) Daily and Ovid MEDLINE(R) 1946 to Present

Search Strategy:

  1. 1.

    Patellar Dislocation/

  2. 2.

    ((patell* or knee or kneecap*) adj2 (dislocat* or instabl* or instabil* or laxit* or hypermobil* or hyper mobil* or subluxation* or luxation*)).mp.

  3. 3.

    1 or 2

  4. 4.

    Joint Dislocations/

  5. 5.

    joint dislocat*.mp.

  6. 6.

    joint instability/

  7. 7.

    joint instabil*.mp.

  8. 8.

    joint laxit*.mp.

  9. 9.

    joint hypermobil*.mp.

  10. 10.

    joint hyper mobil*.mp.

  11. 11.

    joint subluxation*.mp.

  12. 12.

    joint luxation*.mp.

  13. 13.

    or/4-12

  14. 14.

    Patella/

  15. 15.

    kneecap*.mp.

  16. 16.

    knee.mp.

  17. 17.

    patell*.mp.

  18. 18.

    or/14-17

  19. 19.

    13 and 18

  20. 20.

    3 or 19

  21. 21.

    trochle?plast*.mp.

  22. 22.

    Arthroscopy/

  23. 23.

    arthroscop*.mp.

  24. 24.

    Endoscopy/

  25. 25.

    endoscop*.mp.

  26. 26.

    arthroendoscop*.mp.

  27. 27.

    Orthopedics/

  28. 28.

    orthop?edic*.mp.

  29. 29.

    orthope?dic*.mp.

  30. 30.

    General Surgery/

  31. 31.

    surg*.mp.

  32. 32.

    su.fs.

  33. 33.

    or/21-32

  34. 34.

    trochlea* d?splasia*.mp.

  35. 35.

    groove d?splasia*.mp.

  36. 36.

    (femoral adj3 d?splasia*).mp.

  37. 37.

    femoral sulcus.mp.

  38. 38.

    femoral notch.mp.

  39. 39.

    femoral groove*.mp.

  40. 40.

    or/34-39

  41. 41.

    20 and 33 and 40

  42. 42.

    remove duplicates from 41

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Hiemstra, L.A., Peterson, D., Youssef, M. et al. Trochleoplasty provides good clinical outcomes and an acceptable complication profile in both short and long-term follow-up. Knee Surg Sports Traumatol Arthrosc 27, 2967–2983 (2019). https://doi.org/10.1007/s00167-018-5311-x

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