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Classification of trochlear dysplasia as predictor of clinical outcome after trochleoplasty

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

Abstract

Purpose

Sulcus-deepening trochleoplasty restores the trochlear groove in patients with patellofemoral instability and underlying trochlear dysplasia. There are types of dysplasia both with (B and D) and without (A and C) a supratrochlear spur. The aim of this study was to identify influencing factors for the clinical outcome following trochleoplasty.

Methods

Forty-four knees in 38 patients who underwent trochleoplasty for instability (type A in 9, B in 15, C in 9 and D in 11 knees) were assessed clinically with the Kujala score and radiologically with radiographs and MRI. The median follow-up was 4 (2–7.8) years.

Results

At follow-up, the median Kujala score had improved from 68 (29–84) to 90 (42–100) points (P < 0.001). Instability (P < 0.001) and pain (P = 0.027) decreased significantly, but in 3 knees, pain was worse postoperatively. Twenty-seven knees were ranked as excellent, 10 as good, 2 as fair and 5 as poor. Overall, dysplasia types B and D benefited more from surgery than types A and C. The postoperative MRI revealed no chondrolysis or subchondral necrosis, but deterioration of cartilage on the lateral trochlear facet was identified.

Conclusion

Trochleoplasty is a useful and reliable surgical technique to improve patellofemoral instability in patients with a dysplastic trochlea. While improved stability is predictable, pain is less predictable and may even increase following surgery. The overall results were directly dependent on the type of the dysplasia, with a significantly better clinical outcome in type B and D. The clinical relevance of this study is that severe dysplasia can successfully be treated with trochleoplasty.

Level of evidence

III.

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Acknowledgments

We would like to thank Vaughan Poutawera, MBChB, from the Department of Orthopaedics, Tauranga Hospital, Tauranga, New Zealand, for editing the manuscript. This study was funded internally using departmental funds. There was no external source of funding to bias the assessment of the data.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, University Hospital Balgrist, Zurich, Forchstr. 340, 8008, Zurich, Switzerland

    Sandro F. Fucentese, Patrick O. Zingg, Jürgen Schmitt, Dominik C. Meyer & Peter P. Koch

  2. Department of Radiology, University Hospital Balgrist, Zurich, Forchstr. 340, 8008, Zurich, Switzerland

    Christian W. A. Pfirrmann

Authors
  1. Sandro F. Fucentese
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  2. Patrick O. Zingg
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  3. Jürgen Schmitt
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  4. Christian W. A. Pfirrmann
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  5. Dominik C. Meyer
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  6. Peter P. Koch
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Corresponding author

Correspondence to Sandro F. Fucentese.

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Fucentese, S.F., Zingg, P.O., Schmitt, J. et al. Classification of trochlear dysplasia as predictor of clinical outcome after trochleoplasty. Knee Surg Sports Traumatol Arthrosc 19, 1655–1661 (2011). https://doi.org/10.1007/s00167-011-1410-7

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  • DOI: https://doi.org/10.1007/s00167-011-1410-7

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