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Midterm results of comprehensive surgical reconstruction including sulcus-deepening trochleoplasty in recurrent patellar dislocations with high-grade trochlear dysplasia.
[trochlear dysplasia]
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
.
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
.
Case
series
;
Level
of
evidence
,
4
.
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
)
.
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
.
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
.
Diseases
Validation
Diseases presenting
"improvement of knee scores with no complication of subsequent arthritis"
symptom
trochlear dysplasia
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