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Patellar instability with and without trochlear dysplasia: new arthroscopic medial soft tissue plication with pullout technique.
[trochlear dysplasia]
The
aim
of
this
study
was
to
analyze
clinical
and
radiologic
results
of
an
arthroscopic
medial
plication
with
the
pullout
technique
and
to
define
indications
and
limitations
of
this
procedure
for
patellar
instability
.
Records
of
45
patients
treated
for
patellar
instability
with
arthroscopic
medial
plication
with
the
pullout
technique
were
reviewed
.
The
mean
patient
age
was
22
.
8
±
8
.
3
years
.
The
tibial
tuberosity-trochlear
groove
distance
,
trochlear
depth
(
TD
)
,
and
Insall-
Salvati
ratio
were
measured
using
magnetic
resonance
imaging
taken
preoperatively
.
Patients
were
evaluated
clinically
by
the
Insall
and
Kujala
score
and
radiographically
by
measuring
the
congruence
angle
,
lateral
patellofemoral
angle
,
and
lateral
patellar
translation
pre-
and
postoperatively
.
Patients
were
classified
into
2
groups
:
group
1
comprised
23
patients
with
TD
greater
than
or
equal
to
3
.
0
mm
and
group
2
comprised
22
patients
with
TD
less
than
3
.
0
mm
.
A
significant
improvement
(
P
=
.
007
)
in
postoperative
clinical
scores
compared
with
preoperative
values
was
observed
.
The
congruence
angle
improved
to
11
.
0
°
±
20
.
6
°
(
P
=
.
006
)
,
the
lateral
patellofemoral
angle
improved
to
-
1
.
6
°
±
7
.
7
°
(
P
≤
.
0001
)
,
and
the
lateral
patellar
translation
improved
to
8
.
7
±
5
.
3
mm
(
P
≤
.
0001
)
postoperatively
.
There
were
5
(
11
%
)
failure
cases
.
No
significant
difference
existed
in
the
number
of
failure
cases
and
clinical
scores
between
the
2
groups
.
This
arthroscopic
medial
soft
tissue
pullout
technique
showed
good
clinical
and
radiologic
results
for
patellar
instability
even
in
the
presence
of
mild
to
moderate
trochlear
dysplasia
.
However
,
the
technique
showed
limited
success
in
severe
trochlear
dysplasia
cases
.
