2025 ISAKOS Biennial Congress ePoster
Thin Flap Trochleoplasty for Recurrent Patellofemoral Instability with High-Grade Trochlear Dysplasia is Safe and Effective: A Series of 63 Consecutive Cases
Laurie A. Hiemstra, MD, PhD, FRCSC, Dead Man's Flats, AB CANADA
Mark R Lafave, PhD, Calgary, Alberta CANADA
Sarah Kerslake, BPhty, MSc, Banff, Alberta CANADA
Banff Sport Medicine, Banff, ALBERTA, CANADA
FDA Status Not Applicable
Summary
Thin-flap trochleoplasty combined with an MPFL reconstruction in patients with recurrent LPI and high-grade trochlear dysplasia resulted in a low redislocation and reoperation rate at a mean of 33 months, and statistically signficantly improved QOL scores.
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Abstract
Background
Trochlear dysplasia (TD) is present in 68-85% of patients with recurrent lateral patellofemoral instability (LPI), compared to 3-6% in healthy controls. TD has been associated with medial patellofemoral ligament (MPFL) graft failure and lower quality-of-life (QOL) outcome scores. Correction of TD with trochleoplasty is indicated in patients with recurrent LPI and high-grade trochlear dysplasia with a large supra-trochlear spur and a significant J-sign.
Purpose
The purpose of this study was to assess the clinical and patient-reported outcomes after patellar stabilizing surgery, including a thin-flap sulcus deepening trochleoplasty. A secondary purpose was to explore the influence of pathoanatomic variables on the post-operative QOL scores in patients who have undergone patellar stabilization, including trochleoplasty.
Study Design - Consecutive case-series
Methods
63 consecutive knees in 47 patients with recurrent LPI and high-grade trochlear dysplasia who underwent an MPFL reconstruction with trochleoplasty were followed for 2 years postoperatively. Clinical outcomes and Banff Patellofemoral Instability Instrument (BPII) 2.0 scores were collected prospectively. T-tests were used to determine change in quality of life. A multiple linear regression was calculated to significant pathoanatomic variables that reflct multiple aspects of outcome for MPFL reconstruction.
Results
Sixty-three knees had a mean follow-up of 32.9 months (SD 17; range 12-84). All patients had pre-operative high-grade trochlear dysplasia (Dejour B = 46%; Dejour D = 54%), with a mean supra-trochlear bump of 6.1mm (SD 1.8; range 3.2-10.5). BPII scores increased significantly after surgery (p <.001) with a large effect size Cohen’s d = -2.41. There was one re-dislocation (1.5%) and three re-operations (4.6%). Persistent apprehension and J-sign were reduced in all patients but remained discernible in 8.6% and 13.6% of the knees, respectively. The multiple regression analysis determined no statistically significant relationships between the 24-month post-operative BPII scores and the pre-operative BPII scores, through knee rotation, bump size, or Beighton score (R = 0.47, R2 = 0.22, F = 5.23, P = 0.13).
Conclusions
Thin-flap trochleoplasty combined with an MPFL reconstruction in patients with recurrent LPI and high-grade trochlear dysplasia resulted in a low redislocation and reoperation rate at a mean of 33 months. Quality of life scores were statistically significantly improved from pre- to post-operative.