Tarchala Magdalena, Kerslake Sarah, Hiemstra Laurie A
The Hospital for Sick Children, University of Toronto, Toronto, Canada.
Banff Sport Medicine Foundation, Box 1300, Banff, AB, T1L 1B3, Canada.
Curr Rev Musculoskelet Med. 2023 Nov;16(11):538-549. doi: 10.1007/s12178-023-09868-6. Epub 2023 Sep 12.
The most common and biomechanically influential pathoanatomic risk factor for recurrent patellofemoral instability is trochlear dysplasia. Sulcus-deepening trochleoplasty is a procedure developed to address high-grade trochlear dysplasia in the setting of patellofemoral instability. The purpose of this paper is to outline the current classification and surgical management of trochlear dysplasia as well as to review the current literature on the clinical outcomes and complications of sulcus-deepening trochleoplasty.
This review outlines the most recent literature reporting evidence behind the decision-making to perform a trochleoplasty in the setting of patellofemoral instability and high-grade trochlear dysplasia. Critical parameters include grade of trochlear dysplasia, severity of symptoms, pertinent physical examination findings, surgical techniques, modifications for skeletally immature patients, and considerations for the revision setting. Historic studies have elicited concerns regarding high reported complication rates for trochleoplasty; however, recent studies consistently report good clinical outcomes and acceptable complication rates, similar to those of other patellar stabilizing procedures. The addition of a trochleoplasty in patients with high-grade dysplasia results in a lower re-dislocation rate, significant improvements in patient-reported outcome measures (PROMs) as well as high levels of patient satisfaction and return to sport. The use of sulcus-deepening trochleoplasty for the treatment of high-grade dysplasia and recurrent patellofemoral instability is a well-established technique with good outcomes and an acceptable complication profile. In patients with high-grade dysplasia, trochleoplasty results in lower re-dislocation rates, high patient satisfaction scores, and good clinical and functional outcomes. An understanding of trochleoplasty and its indications should be in the armamentarium of surgeons treating patellofemoral instability.
复发性髌股关节不稳最常见且在生物力学上具有重要影响的病理解剖学危险因素是滑车发育不良。沟加深滑车成形术是为解决髌股关节不稳情况下的高级别滑车发育不良而开发的一种手术。本文的目的是概述滑车发育不良的当前分类和手术治疗方法，并回顾有关沟加深滑车成形术临床结果和并发症的当前文献。
本综述概述了最新文献，这些文献报道了在髌股关节不稳和高级别滑车发育不良情况下进行滑车成形术决策背后的证据。关键参数包括滑车发育不良的分级、症状的严重程度、相关的体格检查结果、手术技术、对骨骼未成熟患者的改良以及翻修情况的考虑因素。既往研究引发了对滑车成形术报道的高并发症发生率的担忧；然而，最近的研究一致报告了良好的临床结果和可接受的并发症发生率，与其他髌骨稳定手术相似。在高级别发育不良患者中增加滑车成形术可降低再脱位率，显著改善患者报告的结局指标（PROMs），以及提高患者满意度和恢复运动的水平。使用沟加深滑车成形术治疗高级别发育不良和复发性髌股关节不稳是一种成熟的技术，具有良好的结果和可接受的并发症情况。在高级别发育不良患者中，滑车成形术可降低再脱位率，提高患者满意度评分，并取得良好的临床和功能结果。对于治疗髌股关节不稳的外科医生来说，了解滑车成形术及其适应证应是其技能储备的一部分。
