Skip to main content
SpringerLink
Log in

Patellofemoral Instability: Proximal Realignment and Trochleoplasty

  • Chapter
  • First Online:
Disorders of the Patellofemoral Joint

  • 603 Accesses

Abstract

Patellar instability is multifactorial. Proximal femoral derotation osteotomies and trochleoplasty allow direct correction of morphological abnormalities which produce instability and can be used alone or in combination with other procedures such a distal realignment or soft tissue procedures including medial patellofemoral ligament (MPFL) reconstruction or a lateral release. Where trochlear dysplasia, excessive femoral anteversion or torsion are not recognised and addressed, surgery to treat recurrent patella instability has worse outcomes. When clinical examination suggests abnormal trochlear morphology, version or torsion, cross-sectional imaging is indicated. Rotational osteotomies and trochleoplasty, has a robust and growing evidence base, and with careful planning and execution, both can be highly effective in treating recurrent instability. Proximal realignment procedures to the quadriceps are performed less frequently but may prove valuable in selected cases, in particular skeletally immature patients.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 49.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 64.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 89.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Lee TQ, Anzel SH, Bennett KA, Pang D, Kim WC. The influence of fixed rotational deformities of the femur on the patellofemoral contact pressures in human cadaver knees. Clin Orthop Relat Res. 1994;302:69–74.

    Google Scholar 

  2. Diederichs G, Kohlitz T, Kornaropoulos E, Heller MO, Vollnberg B, Scheffler S. Magnetic resonance imaging analysis of rotational alignment in patients with patellar dislocations. Am J Sports Med. 2013;41:51–7.

    Article  Google Scholar 

  3. James SL, Bates BT, Osternig LR. Injuries to runners. Am J Sports Med. 1978;6:40–50.

    Article  CAS  Google Scholar 

  4. Georgiadis AG, Siegal DS, Scher CE, Zaltz I. Can femoral rotation be localized and quantified using standard CT measures? Clin Orthop Relat Res. 2015;473:1309–14.

    Article  Google Scholar 

  5. Nelitz M. Femoral Derotational osteotomies. Curr Rev Musculoskelet Med. 2018;11:272–9.

    Article  Google Scholar 

  6. Kaiser P, Schmoelz W, Schottle PB, Heinrichs C, Zwierzina M, Attal R. Isolated medial patellofemoral ligament reconstruction for patella instability is insufficient for higher degrees of internal femoral torsion. Knee Surg Sports Traumatol Arthrosc. 2019;27:758–65.

    Article  Google Scholar 

  7. Weber AE, Nathani A, Dines JS, Allen AA, Shubin-Stein BE, Arendt EA, Bedi A. An algorithmic approach to the management of recurrent lateral patellar dislocation. J Bone Joint Surg Am. 2016;98:417–27.

    Article  Google Scholar 

  8. Waisbrod G, Schiebel F, Beck M. Abnormal femoral antetorsion-a subtrochanteric deformity. J Hip Preserv Surg. 2017;4:153–8.

    Article  Google Scholar 

  9. Franciozi CE, Ambra LF, Albertoni LJ, Debieux P, Rezende FC, Oliveira MA, Ferreira MC, Luzo MV. Increased femoral anteversion influence over surgically treated recurrent patellar instability patients. Arthroscopy. 2017;33:633–40.

    Article  Google Scholar 

  10. Nelitz M, Dreyhaupt J, Williams SR, Dornacher D. Combined supracondylar femoral derotation osteotomy and patellofemoral ligament reconstruction for recurrent patellar dislocation and severe femoral anteversion syndrome: surgical technique and clinical outcome. Int Orthop. 2015;39:2355–62.

    Article  Google Scholar 

  11. Dickschas J, Harrer J, Reuter B, Schwitulla J, Strecker W. Torsional osteotomies of the femur. J Orthop Res. 2015;33:318–24.

    Article  Google Scholar 

  12. Stambough JB, Davis L, Szymanski DA, Smith JC, Schoenecker PL, Gordon JE. Knee pain and activity outcomes after femoral derotation osteotomy for excessive femoral anteversion. J Pediatr Orthop. 2018;38:503–9.

    Article  Google Scholar 

  13. Crosby EB, Insall J. Recurrent dislocation of the patella. Relation of treatment to osteoarthritis. J Bone Joint Surg Am. 1976;58:9–13.

    Article  CAS  Google Scholar 

  14. Aglietti P, Insall JN, Cerulli G. Patellar pain and incongruence. I: Measurements of incongruence. Clin Orthop Relat Res. 1983;176:217–24.

    Google Scholar 

  15. Insall JN, Aglietti P, Tria AJ Jr. Patellar pain and incongruence. II: Clinical application. Clin Orthop Relat Res. 1983;176:225–32.

    Google Scholar 

  16. Aglietti P, Buzzi R, De Biase P, Giron F. Surgical treatment of recurrent dislocation of the patella. Clin Orthop Relat Res. 1994;308:8–17.

    Google Scholar 

  17. Dejour H, Walch G, Nove-Josserand L, et al. Factors of Patella instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc. 1994;2:19–26.

    Article  CAS  Google Scholar 

  18. Heegard J, Leyvraz PF, van Kampen A, et al. Influence of soft tissue structures on patella three dimension tracking. Clin Orthop Relat Res. 1994;299:235–43.

    Google Scholar 

  19. Stephen JM, Lumpaopong P, Deehan DJ, Kader D, Amis AA. The medial patellofemoral ligament: location of femoral attachment and length change patterns resulting from anatomic and non-anatomic attachments. Am J Sports Med. 2012;40:1871–9.

    Article  Google Scholar 

  20. Dejour H, Walch G, Neyret P, Adeleine P. Dysplasia of the femoral trochlea. Rev Chir Orthop Reparatrice Appar Mot. 1990;76:45–54.

    CAS  Google Scholar 

  21. Ryzek D-F, Schottle P. Patello-femoral dysfunction in sports. Trochleoplasty: indications and techniques. J Knee Surg. 2015;28:297–302.

    Article  Google Scholar 

  22. Senavongse W, Amis AA. The effects of articular, retinacular or muscle deficiencies on patellofemoral joint stability: A biomechanical study invitro. J Bone Joint Surg Br. 2005;87:577–82.

    Article  CAS  Google Scholar 

  23. Jungmann PM, Tham SC, Liebl H, Nevitt MC, et al. Association of Trochlear dysplasia with degenerative abnormalities in the knee. Skelet Radiol. 2013;42:1383–92.

    Article  Google Scholar 

  24. Pfirrmann CW, Zanetti M, Romero J, et al. Femoral trochlear dysplasia: MR findings. Radiology. 2000;216:858–64.

    Article  CAS  Google Scholar 

  25. Dejour D, le Coultre B. Osteotomies in patello-femoral instabilities. Sports Med Arthrosc Rev. 2007;15:39–46.

    Article  Google Scholar 

  26. Nolan JE, Schottel PC, Endres NK. Trochleoplasty: indications and techniques. Curr Rev Musculoskelet Med. 2018;11:231–40.

    Article  Google Scholar 

  27. Camathias C, Studer K, Kiapour A, et al. Trochleoplasty as a solitary treatment for recurrent patella dislocation results in good clinical outcomes in adolescents. Am J Sports Med. 2016;44:2855–63.

    Article  Google Scholar 

  28. Pollard B. Old dislocation of Patella reduced with intra articular operation. Lancet. 1891;1:988.

    Google Scholar 

  29. Drew D. Dislocation of the patella (Congenital); operation; cure. Proc R Soc Med. 1908;1:11–3.

    CAS  PubMed  PubMed Central  Google Scholar 

  30. Albee FH. Bone graft wedge in the treatment of habitual dislocation of the patella. In: Albee FH, editor. Bone-graft surgery, vol. 88. New York: Med Record; 1915. p. 257–9.

    Google Scholar 

  31. Masse Y. Trochleoplasty. Restoration of the intercondylar groove in subluxations and dislocations of the patella. Rev Chir Orthop Reparatrice Appar Mot. 1978;64:3–17.

    CAS  PubMed  Google Scholar 

  32. Bereiter H, Gautier E. Die trochleaplastik als chirurgische therapie der rezidivierenden patella luxation bei trochlea dysplasie des femurs. Arthroskopie. 1994;7:281–6.

    Google Scholar 

  33. von Knoch F, Bohm T, Burgi ML, et al. Trochleoplasty for recurrent patella dislocation in association with trochlear dysplasia. A 4 to 14 year follow up study. J Bone J Surg Br. 2006;88:1331–5.

    Article  Google Scholar 

  34. Goutallier D, Raou D, Van Driessche S. 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. 2002;88:678–85.

    CAS  PubMed  Google Scholar 

  35. McNamara I, Bua N, Smith TO, Ali K, Donell ST. Deepening trochleoplasty with a thick osteochondral flap for patella instability: clinical outcomes at a mean 6- year follow up. Am J Sports Med. 2015;28:297–302.

    Google Scholar 

  36. Nelitz M, Dreyhaupt LS. Combined trochleoplasty and medial patellofemoral ligament reconstruction for recurrent patella dislocations in severe trochlear dysplasia. A minimum 2 year follow up study. Am J Sports Med. 2013;41:1005–12.

    Article  Google Scholar 

  37. Metcalfe AJ, Clarke DA, Kemp MA, Eldridge JD. Trochleoplasty with a flexible osteochondral flap: results from an 11 year series of 214 cases. Bone Joint J. 2017;99-B:344–50.

    Article  CAS  Google Scholar 

  38. Testa EA, Camathias C, Amsler F, Henle P, et al. Surgical treatment of patellofemoral instability using trochleoplasty or MPFL reconstruction: a systematic review. Knee Surg Sports Traumatol Arthrosc. 2017;25:2309–20.

    Article  Google Scholar 

  39. Longo UG, Vincenzo C, Mannering N, et al. Trochleoplasty techniques provide good clinical results in patients with trochlear dysplasia. Knee Surg Sports Traumatol Arthrosc. 2018;26:2640–58.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Joint Reconstruction Unit, Royal National Orthopaedic Hospital, Stanmore, UK

    Maureen Monda

  2. Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK

    Antony Palmer

Authors
  1. Maureen Monda
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Antony Palmer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Antony Palmer .

Editor information

Editors and Affiliations

  1. Department of Orthopaedic Surgery, La Paz University Hospital, Madrid, Spain

    E. Carlos Rodríguez-Merchán

  2. University College London Institute of Orthopaedics, London, UK

    Alexander D. Liddle

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Monda, M., Palmer, A. (2019). Patellofemoral Instability: Proximal Realignment and Trochleoplasty. In: Rodríguez-Merchán, E., Liddle, A. (eds) Disorders of the Patellofemoral Joint. Springer, Cham. https://doi.org/10.1007/978-3-030-12442-7_10

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-12442-7_10

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-12441-0

  • Online ISBN: 978-3-030-12442-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation