Thin flap trochleoplasty augments MPFL reconstruction for recurrent patellar instability
Key takeaways:
- MPFL reconstruction combined with thin flap trochleoplasty may yield positive outcomes for recurrent patellar instability.
- Researchers concluded trochleoplasty may be warranted in select, complex patients.
Published results showed medial patellofemoral ligament reconstruction combined with thin flap trochleoplasty may yield low rates of redislocation and reoperation for patients with high-grade trochlear dysplasia and recurrent instability.
“The correction of trochlear dysplasia with trochleoplasty is indicated in patients with recurrent [lateral patellar instability (LPI)] and high-grade trochlear dysplasia with a trochlear bump and a significant J-sign,” Laurie A. Hiemstra, MD, PhD, and colleagues from the Banff Sport Medicine Foundation wrote in the study.
They added, “Despite the technical challenges, based on the results of this study, this technique should be considered as a component of surgical care for patellofemoral stabilization in carefully selected patients.”
Hiemstra and colleagues analyzed 46 consecutive patients (63 knees) who underwent MPFL reconstruction combined with thin flap, sulcus deepening trochleoplasty for recurrent lateral patellar instability and high-grade trochlear dysplasia between 2013 and 2021 with a mean follow-up of 32.9 months.
Among the cohort, 46% of knees had Dejour type B dysplasia and 54% of knees had Dejour type D dysplasia. Mean trochlear bump height was 6.1 mm. Mean patient age was 22 years, and mean BMI was 23.7 kg/m2.
Outcome measures included the Banff Patellofemoral Instability Instrument 2.0 (BPII 2.0), redislocations and reoperations.
At 2-year follow-up, Hiemstra and colleagues found BPII 2.0 scores significantly increased from preoperatively (29.3) to postoperatively (71.8), and they found no limitations in postoperative range of motion for any patient. One knee had a redislocation (1.6%) and three knees required reoperation (4.8%). They noted persistent apprehension was present in 8.5% of knees and J-signs were present in 13.6% of knees.
“This trochleoplasty series, the first reported in Canada and one of the few in North America, showed that trochleoplasty, in combination with MPFL reconstruction, was both effective and reliable, with a low complication rate, in this cohort of complex patients,” Hiemstra and colleagues concluded.
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