Sulcus-deepening trochleoplasty may address instability in skeletally immature patients
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Key takeaways:
- Sulcus-deepening trochleoplasty may address patellar instability for skeletally immature patients with open distal femoral physes.
- Most patients had postoperative satisfaction scores of 9 or 10.
According to published results, thick-shell sulcus-deepening trochleoplasty may yield clinical improvements and high satisfaction for skeletally immature patients with patellar instability and open distal femoral physes.
Neil P. Blanchard, MD, orthopedic surgeon from the department of orthopedic surgery at University of Virginia Health System, and colleagues analyzed 21 knees from 17 adolescents with less than 2 years of growth remaining who had trochlear dysplasia and open distal femoral physes. All patients underwent thick-shell sulcus-deepening trochleoplasty at a single institution. Mean postoperative follow-up was 64 months.
At the time of surgery, male patients (n = 5 patients; n = 5 knees) had a chronological age of 15.6 years and a bone age of 15.2 years, while female patients (n = 12 patients; n = 16 knees) had a chronological age of 15.2 years and a bone age of 14.3 years.
Blanchard and colleagues found mean change in anatomic lateral distal femoral angle was 0.73° and mean change in Blumensaat angle was 0.88°. They found median IKDC scores improved from 57.3 preoperatively to 90.9 postoperatively, while median Kujala scores improved from 55 preoperatively to 95 postoperatively.
Overall, one patient had recurrent patellar instability, which required revision. However, all other patients reported satisfaction scores of 9 or 10, with a mean satisfaction score of 9.26 out of 10. Blanchard and colleagues noted all distal femoral physes were closed at final follow-up and found no evidence of leg length discrepancies or rotational abnormalities on radiographs at final follow-up.
“The findings of the present study contribute to the limited, but growing, body of evidence surrounding the use of trochleoplasty to address recurrent patellar instability,” Blanchard and colleagues wrote in the study. “The outcomes of this study are also particularly notable, as current consensus recommendations caution against trochleoplasty in skeletally immature patients due to the concern of potential injury to the distal femoral physis.”
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