BLOG: ‘Patellar instability showdown’ seen as a highlight of the AAOS Annual Meeting
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At the American Academy of Orthopaedic Surgeons Annual Meeting, a capacity audience enjoyed “Showdowns: Patellar instability,” an hour of lively but congenial and insightful expert debates on patellofemoral instability controversies.
The session featured four surgeons with extensive experience and passion for patellofemoral treatment. The first “showdown” debate was about trochleoplasty and featured David DeJour, MD, from the Lyon Ortho Clinic in Lyon, France, against Jason L. Koh, MD, from the University of Chicago and the North Shore Orthopaedic Institute. The second debate was about tibial tubercle osteotomy (TTO) and featured Miho J. Tanaka, MD, PhD, from Massachusetts General Hospital, against Seth Sherman, MD, from Stanford University.
In the trochleoplasty showdown, DeJour presented a strong argument for trochleoplasty, showing multiple technically complex and stellar clinical examples of highly effective trochlear-dysplasia correction from his extensive experience, with excellent long-term outcomes in patellar stability and patellofemoral joint preservation. Koh’s debate approach smartly turned DeJour’s impressive and successful trochleoplasty examples into his own supporting evidence: He praised DeJour as a surgical artist, not unlike Michelangelo, and said DeJour’s trochleoplasty results are spectacular because of his peerless artistry. But, at best, most of us are more like Bob Ross, of “The Joy of Painting” fame. In addition, medial patellofemoral ligament (MPFL) reconstruction and its variants are far more technically accessible and have demonstrated such highly successful outcomes (greater than 95%), that to strive for trochleoplasty artistry à la DeJour may be unrealistic and unnecessary for us mere mortals.
In the TTO showdown, Tanaka said her debate task was “easy” and she described multiple studies and articles demonstrating the benefits of TTO that were actually authored by her debate opponent, Sherman. She also cited the powerful versatility of TTO to medialize, anteriorize and, if necessary, distalize the tibial tubercle to personalize the tracking correction for each patient.
Tanaka’s debate opponent, Sherman, noted several factors for which TTO is a valuable treatment (severe patella alta and/or trochlear dysplasia, for example), but then argued that those instances are rare. As did Koh, Sherman also pointed to the success of MPFL reconstruction in multiple conditions and outlined his own indications for TTO: to unload lateral patellofemoral chondrosis and to distalize the tubercle in severe patella alta in addition to anteromedialization.
In summary, “showdowns” at the AAOS Annual Meeting was an entertaining and educational spotlight of current controversies, research findings and expert opinions on patellofemoral instability etiology and treatment.
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