Quality-of-Life Outcomes of Patients following Patellofemoral Stabilization Surgery: The Influence of Trochlear Dysplasia

Abstract

Trochlear dysplasia is a well-described risk factor for recurrent patellofemoral instability. Despite its clear association with the incidence of patellofemoral instability, it is unclear whether the presence of high-grade trochlear dysplasia influences clinical outcome after patellofemoral stabilization. The purpose of this study was to assess whether trochlear dysplasia influenced patient-reported, disease-specific outcomes in surgically treated patellar instability patients, when risk factors were addressed in accordance with the à la carte surgical approach to the treatment of patellofemoral instability. The study design is of a case series. A total of 318 patellar stabilization procedures were performed during the study period. Of these procedures, 260 had adequate lateral radiographs and complete Banff Patellar Instability Instrument (BPII) scores available for assessment. A Pearson correlation was calculated between four characteristics of trochlear dysplasia, the BPII total and the BPII symptoms, and physical complaints scores, a mean of 24 months following patellofemoral stabilization. Independent-tests were performed between stratified trochlear dysplasia groups (no/low grade and high grade) and all BPII measures. There was a statistically significant correlation between measures of trochlear dysplasia and quality-of-life physical symptoms scores, an average of 2 years following patellofemoral stabilization surgery. The BPII symptoms and physical complaints domain score, as well as the individual weakness and stiffness questions, correlated with the classification of trochlear dysplasia as well as the presence of a trochlear bump ( < 0.05). Independent -tests demonstrated statistically significant differences between the no/low-grade and high-grade dysplasia groups for the BPII stiffness ( = 0.002), BPII weakness ( = 0.05) and BPII symptom, and physical complaints values ( = 0.04). Two additional measures-the 24-month postoperative total BPII score ( = 0.11) and BPII pain score ( = 0.07)-demonstrated trends toward statistical significance. This research has established a statistically significant correlation between trochlear dysplasia and disease-specific quality-of-life outcomes following patellofemoral stabilization surgery. There was a significant correlation between patient-reported physical symptoms after surgery and high-grade trochlear dysplasia.

Influence of Risky Pathoanatomy and Demographic Factors on Clinical Outcomes After Isolated Medial Patellofemoral Ligament Reconstruction: A Regression Analysis

“…In a further study, these authors correlated poorer quality of life, symptom scores, pain, and stiffness with the presence and grade of trochlear dysplasia in 297 patients after patellofemoral stabilization. 16 Liu et al 31 found no difference in outcomes among subgroups of high-grade dysplasia (Dejour B, C, D), but the authors did not have a sufficient number of low-grade or nondysplasia cases in the cohort to comment on whether outcomes were worse in patients with high-grade dysplasia. The previous trochlear dysplasia investigations conducted by Hiemstra et al assessed straightforward relationships using less complex analysis than the multiple variables included in the present study.…”

Geometry of Torsional Malalignment Syndrome: Trochlear Dysplasia but Not Torsion Predicts Lateral Patellar Instability

“…In addition, recent clinical observations have shown an increasing correlation between the severity of trochlear dysplasia, the clinical outcome, and the redislocation rate after isolated soft tissue patella-stabilizing procedures. 18,19 In particular, the presence of a severely dysplastic trochlea increased the likelihood of postoperative redislocation in patients who underwent MPFL reconstruction alone when compared with patients who underwent trochleoplasty plus individual extensor apparatus balancing. 2 Previous studies have also investigated a possible correlation between malalignment parameters and other anatomic factors of patellar instability.…”

Clinical and Radiological Predictors of Functional Outcome After Isolated Medial Patellofemoral Ligament Reconstruction at Midterm Follow-up

“…Several studies have assessed surgical risk factors, concluding that management of the positioning and the tension of the graft or the addition of a complementary bone procedure can lead to variability of the clinical results. 16, 30 Hiemstra et al 14 demonstrated that the clinical outcomes of patellofemoral stabilization surgery were influenced by the grade of trochlear dysplasia. In a further study, the same authors found no evidence of a correlation between the accuracy of MPFLR femoral tunnel and disease-specific quality-of-life scores.…”