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Study notes stable postoperative pain scores, indications for trochleoplasty
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ORLANDO, Fla. — Results from a prospective study of patients who underwent a patella-stabilizing procedure that included trochleoplasty for the treatment of recurrent lateral patella dislocation showed most patients reported poor preoperative quality of life and had stable postoperative pain scores.
“Trochleoplasty remains a rare surgical procedure for patients with recurrent lateral patella recurrent dislocation,” Elizabeth A. Arendt, MD, said during her presentation here. “Preoperatively, they are copers. They manage ADLs [activities of daily living], but they have poor quality of life, and postoperative pain subscales remain stable. In the short-term, these are my surgical indications: high-grade trochlea dysplasia, satisfactory trochlea cartilage surfaces and a positive ‘j-sign.’”
Arendt presented her results with the procedure performed in 22 patients (28 knees), which represented 9% of her patella population between 2006 and 2013. Patients had an average age of 24 years.
Elizabeth A. Arendt
Arendt’s indications for trochleoplasty included recurrent lateral patella dislocation with failed conservative treatment; symptoms of instability, but not pain, as the primary complaint; a disabling ‘j-sign’ on physical examination; Dejour classification of B or D; no patella alta; and no full-thickness cartilage wear on the articulating trochlear cartilage.
Six patient underwent bilateral staged procedures performed 6 months to 22 months apart, and overall, 75% of patients had previous patellofemoral surgery. Arendt noted some patients who underwent the procedure had patella alta and some had patella cartilage wear. Preoperatively, measures of TT-TG and tilt varied widely.
Eleven patients had concomitant tibial tubercle osteotomies. In addition, 17 knees had medial patellofemoral ligament (MPFL) reconstructions.
“Earlier in my cohort, I did not do MPFL reconstructions. I do now favor that,” Arendt said.
All patients in the study required retinacular lengthening based on interoperate criteria. Six patients had second-look arthroscopies: three at the time of the staged procedure and three for postoperative stiffness. None of the patients had cartilage breakdown or softening. Additionally, all of the patients had an improved sulcus angle at 20°, and all had a reduction in the supra-trochlear bump.
Arendt noted baseline KOOS scores showed patients “had little disabilities in ADLs, but they had poor quality of life and low sporting activities, and these were the two categories that they most improved in.” – by Gina Brockenbrough, MA
Reference:
Arendt EA. Paper #10. Presented at: American Orthopaedic Society for Sports Medicine Annual Meeting; July 9-12, 2015; Orlando, Fla.
Disclosure: Arendt reports no relevant financial disclosures.