Midterm results of comprehensive surgical reconstruction including sulcus-deepening trochleoplasty in recurrent patellar dislocations with high-grade trochlear dysplasia

Am J Sports Med. 2013 May;41(5):998-1004. doi: 10.1177/0363546513482302. Epub 2013 Apr 15.


Background: Trochlear dysplasia is one of the most consistent anatomic factors that can lead to recurrent patellar dislocations. Various trochleoplasty procedures have been described to treat patellar dislocations in high-grade dysplasia by creating a new congruent trochlea.

Purpose: To present the midterm efficacy and outcome of the sulcus-deepening trochleoplasty procedure in patients with recurrent patellar dislocations due to high-grade trochlear dysplasia. The clinical evaluation results, the amount of radiological correction, and the prevalence of arthritis were recorded.

Study design: Case series; Level of evidence, 4.

Methods: A total of 27 skeletally mature patients (31 knees) with recurrent patellar dislocations due to high-grade trochlear dysplasia without any previous surgery were retrospectively included from September 1993 to September 2006. All patients underwent sulcus-deepening trochleoplasty combined with a bony and/or soft tissue procedure according to concomitant etiological factors to patellar dislocations: medial patellofemoral ligament reconstruction (16.1%), vastus medialis obliquus plasty (83.8%), tibial tuberosity distalization (51.6%), tibial tuberosity medialization (67.7%), and lateral retinaculum release (67.6%). Mean follow-up was 7 years (range, 2-9 years).

Results: The mean sulcus angle decreased significantly (P < .01) from 152° ± 16° preoperatively to 141° ± 9° postoperatively, tibial tuberosity-trochlear groove distance decreased significantly (P < .001) from 19 ± 4 mm to 12 ± 5 mm, and patellar tilt decreased significantly (P < .001) from 37° ± 7° to 15° ± 8°. No recurrence was observed, and there was no case of stiffness. Apprehension signs remained positive in 19.3% of the cases, patellar tracking was normal in all cases, and the lateral patellar glide test finding was negative in 96.8%. The mean preoperative International Knee Documentation Committee (IKDC) score was 51 (range, 25-80), and the mean postoperative IKDC score was 82 (range, 40-100) (P < .001), while the mean Kujala score improved from a preoperative 59 (range, 28-81) to 87 (range, 49-100) postoperatively (P < .001). There was no radiographic evidence of patellofemoral arthritis at the latest follow-up.

Conclusion: Sulcus-deepening trochleoplasty is a valid option for the primary surgical treatment of carefully selected patients with recurrent patellar dislocations with high-grade trochlear dysplasia type B and D. Concomitant etiological factors must be cautiously corrected in an associated procedure. Midterm follow-up showed satisfactory restoration of patellar stability and improvement of knee scores with no complication of subsequent arthritis.

Keywords: recurrent patellar dislocation; trochlear dysplasia; trochleoplasty.

MeSH terms

  • Adolescent
  • Adult
  • Arthroplasty / methods*
  • Bone Diseases, Developmental / complications
  • Bone Diseases, Developmental / pathology
  • Bone Diseases, Developmental / surgery*
  • Cartilage, Articular / pathology
  • Female
  • Femur / surgery
  • Follow-Up Studies
  • Humans
  • Knee Joint / pathology
  • Knee Joint / surgery*
  • Male
  • Middle Aged
  • Patellar Dislocation / etiology
  • Patellar Dislocation / prevention & control
  • Patellar Dislocation / surgery*
  • Retrospective Studies
  • Secondary Prevention
  • Severity of Illness Index
  • Young Adult