Summary

The Dejour trochleoplasty, performed on 24 knees in 20 patients, significantly improved functional outcomes and had a 0% re-dislocation rate, demonstrating its effectiveness in treating trochlear dysplasia and patellofemoral instability, with a complication profile comparable to the Bereiter trochleoplasty.

Abstract

Background

Trochleoplasty for trochlear dysplasia is a recognised surgical procedure to alleviate recurrent patellofemoral instability (PFI). The Bereiter trochleoplasty is commonly performed with excellent outcomes reported. The aim of this study is to report outcomes, re-dislocation, and complication profile of using a Dejour trochleoplasty within a specialist orthopaedic unit in the UK.

Methods

This is a retrospective analysis of a patellofemoral database. All operations were performed by a fellowship-trained sports-knee surgeon. The use of the pathologic double-contour sign and trochlear-shape pattern type-3 were used to diagnose trochlear dysplasia. Functional outcomes were assessed using Kujala, IKDC, EQ5D. Statistical analyses were completed using SPSS® Statistics 26.0. Postoperative scores were compared to respective published mean values for trochlear dysplasia using a one-sample t-test (p<0.05 denoted statistical significance).

Results

In all, 24 knees in 20 patients (mean age 25.6y, SD 7.01, range 16.7 to 41.8y) were treated using a Dejour trochleoplasty, between 2019-2022. An MPFL-R was performed in all cases and a tibial-tubercle distalisation in 13 cases (54%). Mean postoperative scores were, Kujala–70.9, IKDC–56.6, EQ5D–0.86 at mean follow-up of 32-months. When compared to published mean preoperative values, there was a significant improvement in Kujala (mean difference 21.83, p<0.0001), IKDC (mean difference 21.83, p<0.0001) and EQ5D (mean difference 0.344, p<0.001). Re-dislocation rate was 0%. There was no incidence of chondral necrosis, non-union, or re-operation for PFI.

Conclusion

The Dejour trochleoplasty is an effective technique to address trochlear dysplasia and alleviate symptoms of PFI, when used with additional concomitant procedures. It shares similar results and a complication profile to the Bereiter trochleoplasty but can be used in an older age group where the cartilage flap may not have plastic deformation qualities.