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Trochleoplasty in major trochlear dysplasia: current concepts.
[trochlear dysplasia]
Trochleoplasty
is
the
theoretical
solution
to
persistent
symptoms
(
pain
and
/
or
instability
)
related
to
trochlear
dysplasia
where
there
is
not
only
a
trochlear
flatness
but
also
a
trochlear
prominence
.
The
threshold
of
prominence
indicating
surgical
intervention
has
as
yet
not
been
determined
.
A
bump
of
5
mm
is
generally
accepted
as
the
inferior
limit
.
Given
the
interventional
nature
of
this
demanding
procedure
,
it
should
be
proposed
in
selected
cases
after
considerable
discussion
with
the
patient
.
Trochleoplasty
is
indicated
as
a
primary
procedure
for
major
trochlear
dysplasia
with
a
prominence
>
5
mm
.
Stabilization
is
obtained
in
most
of
the
cases
with
the
risk
of
residual
mild
anterior
knee
pain
.
It
is
also
indicated
as
a
salvage
procedure
when
a
previous
surgery
failed
.
Despite
the
reputation
of
the
procedure
,
the
published
results
are
encouraging
in
terms
of
prevention
of
re
-
dislocation
,
satisfaction
index
,
and
radiological
outcomes
.
Post-operative
stiffness
is
the
main
complication
,
which
may
require
manipulation
under
anaesthesia
or
arthroscopic
arthrolysis
.
There
are
few
other
complications
reported
and
to
date
secondary
necrosis
of
the
trochlea
has
not
been
reported
.
Technically
speaking
,
the
deepening
trochleoplasty
is
a
difficult
procedure
without
reliable
landmarks
.
We
propose
a
recession
wedge
trochleoplasty
which
is
an
easier
procedure
.
It
is
never
undertaken
as
an
isolated
procedure
,
but
always
in
conjunction
with
other
realignment
procedures
of
the
extensor
apparatus
according
to
the
"
a
la
carte
"
surgery
concept
.