Sulcus-Deepening Trochleoplasty for Trochlear Dysplasia.

BACKGROUND

Patients who are refractory to initial management of trochlear dysplasia, which consists of bracing and physical therapy, may be candidates for trochleoplasty.

INDICATIONS

Indications for trochleoplasty include Dejour classification type B or D trochlear dysplasia, supratrochlear spur height ≥7 mm, and a positive J sign on examination.

TECHNIQUE DESCRIPTION

The thick shell sulcus-deepening trochleoplasty technique involves removing the supratrochlear spur by creating a 5-mm-thick osteochondral shell with underlying cavity, dividing the thick shell into medial and lateral leaflets, and securing the leaflets with absorbable sutures. This establishes a new trochlear groove that is flush with the anterior cortex of the femur.

RESULTS

A review of 21 studies with length of follow-up from 8.8 months to 15 years found postoperative dislocation was present in 0% to 15% of patients and the patient satisfaction ranged from 81.0% to 94.4%. A prospective study with a minimum 2-year follow-up found no cases of recurrent dislocation, no progression of radiographic arthritis, 84.8% of patients returned to sport, and the patient satisfaction was a 9.1/10.

DISCUSSION/CONCLUSION: Sulcus-deepening trochleoplasty for trochlear dysplasia provides patellar stability and excellent patient satisfaction.