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Trochleoplasty versus nontrochleoplasty procedures in treating patellar instability caused by severe trochlear dysplasia.
[trochlear dysplasia]
The
purpose
of
this
study
was
to
compare
the
clinical
outcomes
and
postoperative
complication
rates
between
patients
who
underwent
trochleoplasty
or
nontrochleoplasty
procedures
in
treating
patellar
instability
caused
by
severe
trochlear
dysplasia
(
STD
)
.
The
PubMed
database
was
searched
using
specific
inclusion
and
exclusion
criteria
for
clinical
studies
reporting
indexed
orthopaedic
treatments
of
patellar
instability
caused
by
STD
(
Dejour
type
B
to
D
)
.
Participants
within
studies
were
classified
into
one
of
the
2
treatment
groups
:
(
1
)
the
trochleoplasty
group
(
group
T
)
and
(
2
)
the
nontrochleoplasty
group
(
group
N
)
.
Clinical
outcomes
and
postoperative
complications
were
analyzed
.
Seventeen
studies
were
finally
included
.
There
were
in
total
459
knees
that
underwent
the
indexed
orthopaedic
treatments
of
patellar
instability
caused
by
STD
(
Dejour
type
B
to
D
)
.
Eleven
studies
,
including
329
knees
,
formed
the
trochleoplasty
group
(
group
T
)
,
and
the
remaining
6
studies
,
including
130
knees
,
composed
the
nontrochleoplasty
group
(
group
N
)
.
All
the
clinical
outcomes
within
groups
had
improved
significantly
(
P
<
.
05
)
at
the
final
follow-up
.
No
studies
directly
compared
the
clinical
outcomes
between
the
2
groups
.
The
postoperative
complication
analysis
showed
superior
results
for
the
trochleoplasty
group
in
(
1
)
patellar
redislocation
rate
and
(
2
)
percentage
of
patellofemoral
osteoarthritis
(
Iwano
grade
2
or
greater
)
progression
findings
but
an
inferior
outcome
with
respect
to
the
range
of
motion
(
ROM
)
deficit
compared
with
the
nontrochleoplasty
group
.
This
systematic
review
showed
significant
postoperative
improvements
both
in
patients
undergoing
the
trochleoplasty
procedures
and
in
patients
undergoing
the
nontrochleoplasty
procedures
for
the
treatment
of
patellar
instability
caused
by
STD
in
all
the
included
studies
.
However
,
there
is
limited
evidence
regarding
the
comparative
advantages
toward
the
optimal
treatment
.
The
postoperative
complication
rate
has
been
considered
to
be
the
best
measurement
of
operative
success
.
To
prevent
the
patella
from
redislocating
and
patellofemoral
osteoarthritis
from
progressing
,
trochleoplasty
procedures
should
be
considered
.
Meanwhile
,
one
should
be
cautious
about
the
postoperative
ROM
deficit
before
choosing
trochleoplasty
procedures
.
Level
IV
,
systematic
review
of
Level
III
and
IV
studies
.
Diseases
Validation
Diseases presenting
"indexed orthopaedic treatments of patellar instability"
symptom
trochlear dysplasia
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