Summary

Long-term outcomes of trochleoplasties are rarely reported. Recession wedge trochleoplasty is an effective treatment for patellar instability in high-grade dysplasia. In the long term, the patellofemoral joint is always stable, the functional scores are good, and there is no significant arthritic degeneration

Abstract

Introduction

Recession wedge trochleoplasty is indicated to treat recurrent patellar instability with high-grade trochlear dysplasia (Dejour B or D). It may be combined with a procedure on the anterior tibial tuberosity (lowering and/or medialization), and with reconstruction of the medial patellofemoral ligament (MPFL). It gives good short-term functional results. However, the long-term chondroprotective effect is not known.
The purpose of this study was to analyze the clinical and radiological results of patients operated on with a sinking trochleoplasty. The hypothesis was that the clinical results are stable over time and that the rate of secondary osteoarthritis is low.

Material And Method

Fifteen patients, that means 17 knees, primarily operated on for a recession wedge trochleoplasty between 2008 and 2013 were included and reviewed at a mean follow-up of 11,2 +/-1,8 years (132 months+/-22 months). The recurrence rate and the Lille and Kujala functional scores were collected. A complete radiological assessment was performed to evaluate patellofemoral and femorotibial osteoarthritis and to measure the height of the trochlear bump.

Results

No recurrence of dislocation was observed, the mean Lille and Kujala scores were 84?9/100 and 78+/-12/100, respectively.
No significant radiological changes in osteoarthritis were observed.
Of the 15 patients who did not have radiological signs of osteoarthritis initially, 7 patients had bone remodeling (Iwano1) and 8 had no signs of osteoarthritis. 2 patients had stage 1 osteoarthritis prior to trochleoplasty, and only one had evolved to Iwano stage 2. The postoperative spur was either absent or negative in all patients except one patient.

Conclusion

Long-term outcomes of trochleoplasties are rarely reported. Recession wedge trochleoplasty is an effective treatment for patellar instability in high-grade dysplasia. In the long term, the patellofemoral joint is always stable, the functional scores are good, and there is no significant arthritic degeneration.