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Combined trochleoplasty and medial patellofemoral ligament reconstruction for recurrent patellar dislocations in severe trochlear dysplasia: a minimum 2-year follow-up study.
[trochlear dysplasia]
Trochlear
dysplasia
is
an
important
etiological
factor
for
the
development
of
patellofemoral
instability
.
Because
a
dislocation
of
the
patella
as
a
result
of
trochlear
dysplasia
results
in
a
traumatic
disruption
of
the
medial
patellofemoral
ligament
(
MPFL
)
,
a
combined
trochleoplasty
and
patellofemoral
ligament
reconstruction
appears
to
be
the
most
appropriate
procedure
to
treat
patients
with
severe
trochlear
dysplasia
.
Combined
trochleoplasty
and
anatomic
reconstruction
of
the
MPFL
will
prevent
redislocations
of
the
patella
and
will
lead
to
improved
knee
function
.
Case
series
;
Level
of
evidence
,
3
.
Twenty
-
three
consecutive
patients
(
26
knees
)
with
patellofemoral
instability
and
severe
trochlear
dysplasia
underwent
combined
trochleoplasty
and
anatomic
reconstruction
of
the
MPFL
.
Preoperative
radiographic
examination
included
anteroposterior
and
lateral
views
to
assess
patella
alta
.
Magnetic
resonance
imaging
was
performed
to
evaluate
trochlear
dysplasia
and
the
tibial
tubercle-trochlear
groove
(
TT-
TG
)
distance
.
Evaluations
included
the
detection
of
cartilage
injuries
,
preoperative
and
postoperative
physical
examinations
,
and
scores
for
the
visual
analog
scale
(
VAS
)
,
Kujala
knee
function
,
International
Knee
Documentation
Committee
(
IKDC
)
,
activity
rating
scale
(
ARS
)
,
and
Tegner
activity
scale
.
The
mean
age
at
the
time
of
operation
was
19
.
2
years
(
range
,
15
.
4
-
23
.
6
years
)
.
The
mean
follow-up
after
operation
was
2
.
5
years
after
surgery
(
range
,
2
.
0
-
3
.
5
years
)
.
No
recurrent
dislocation
occurred
postoperatively
.
Kujala
scores
improved
from
79
to
96
,
IKDC
scores
from
74
to
90
,
and
VAS
scores
from
3
to
1
.
All
improvements
were
highly
statistically
significant
(
P
<
.
01
)
.
The
activity
level
according
to
the
Tegner
activity
scale
and
the
ARS
decreased
but
was
not
statistically
significant
(
P
=
.
06
and
P
=
.
21
,
respectively
)
.
There
were
95
.
7
%
of
the
patients
who
were
satisfied
or
very
satisfied
with
the
procedure
.
Combined
anatomic
reconstruction
of
the
MPFL
and
trochleoplasty
reliably
improved
the
stability
of
the
patellofemoral
joint
in
patients
with
severe
trochlear
dysplasia
and
no
or
mild
degenerative
changes
.
In
addition
,
the
described
procedure
showed
significant
improvement
of
knee
function
and
good
patient
satisfaction
without
any
episode
of
redislocations
of
the
patella
.
Diseases
Validation
Diseases presenting
"severe trochlear dysplasia"
symptom
trochlear dysplasia
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