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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
.
Diseases
Validation
Diseases presenting
"pain"
symptom
achondroplasia
acute rheumatic fever
adrenal incidentaloma
adrenomyeloneuropathy
aniridia
aromatase deficiency
carcinoma of the gallbladder
cholangiocarcinoma
coats disease
congenital diaphragmatic hernia
congenital toxoplasmosis
cushing syndrome
cutaneous mastocytosis
cystinuria
dedifferentiated liposarcoma
dentin dysplasia
dracunculiasis
dystrophic epidermolysis bullosa
epidermolysis bullosa simplex
erdheim-chester disease
erythropoietic protoporphyria
esophageal adenocarcinoma
esophageal carcinoma
esophageal squamous cell carcinoma
fabry disease
familial mediterranean fever
focal myositis
hirschsprung disease
hodgkin lymphoma, classical
holt-oram syndrome
junctional epidermolysis bullosa
kabuki syndrome
kindler syndrome
lamellar ichthyosis
liposarcoma
locked-in syndrome
lymphangioleiomyomatosis
malignant atrophic papulosis
neuralgic amyotrophy
oligodontia
oral submucous fibrosis
papillon-lefèvre syndrome
phenylketonuria
pleomorphic liposarcoma
primary hyperoxaluria type 1
proteus syndrome
pyomyositis
scrub typhus
sneddon syndrome
systemic capillary leak syndrome
thoracic outlet syndrome
trochlear dysplasia
typhoid
von hippel-lindau disease
waldenström macroglobulinemia
well-differentiated liposarcoma
wolf-hirschhorn syndrome
This symptom has already been validated