Solitary Trochleoplasty for Treatment of Recurrent Patellar Dislocation

Camathias, Carlo; Speth, Bernhard M.; Rutz, Erich; Schlemmer, Thomas; Papp, Kata; Vavken, Patrick; Studer, Kathrin

doi:10.2106/jbjs.st.17.00039

Cited by 9 publications

(4 citation statements)

References 5 publications

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“…Currently, trochleoplasty is the only described surgical procedure that directly addresses the dysplastic trochlea. A variety of techniques for trochleoplasty have been described [108][109][110], but the general principles of the procedure are to increase the concavity and lateralize the trochlear groove to both enhance patellofemoral bony stability during knee flexion and reduce axial malalignment. Controversy exists [111][112][113][114][115][116] regarding the indications for use of trochleoplasty and the preferred surgical approach for patients with recurrent PFI and severe trochlear dysplasia when alternative interventions to address complex instability (namely tibial tubercle osteotomy) are available.…”

Section: Trochlear Dysplasiamentioning

confidence: 99%

Radiographic Evaluation of Pediatric Patients with Patellofemoral Instability

Orellana

Batley

Lawrence

et al. 2022

Curr Rev Musculoskelet Med

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Purpose of ReviewThe purpose of this review is to highlight the radiographic assessments of utility in the evaluation of a pediatric patient with patellofemoral instability to facilitate a thorough work-up. Understanding of these measures is useful in understanding evolving research in this field, providing accurate patient risk assessment, and appropriately directing surgical decision-making. Recent Findings Recent literature has broadened the radiographic characterization of the pediatric patellar instability and its anatomic risk factors. Knee MRI can inform the assessment of skeletal maturity and novel axial alignment measurements may enhance our identification of patients at increased risk of recurrent instability. Additional improvements have been made in the objective measurement and classification of trochlear dysplasia. Summary Knee MRI-based skeletal age assessments may obviate the need for hand bone age assessments in growing children with patellofemoral instability. Novel objective measures exist in the evaluation of pediatric patellar instability both in the assessment of axial alignment and trochlear dysplasia. Future work should focus on how these measures can aid in guiding surgical decision-making.

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Section: Trochlear Dysplasiamentioning

confidence: 99%

Radiographic Evaluation of Pediatric Patients with Patellofemoral Instability

Orellana

Batley

Lawrence

et al. 2022

Curr Rev Musculoskelet Med

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“…The same surgeon treated all patients with a solitary trochleoplasty using a modified Bereiter technique in all cases [4, 6, 7]. With this, a lateral lengthening of the trochlea was performed with a triangular bone block, which previously was resected under an osteochondral flap to deepen the trochlea.…”

Section: Methodsmentioning

confidence: 99%

Trochleoplasty improves knee flexion angles and quadriceps function during gait only if performed bilaterally

Ammann

Meier

Rutz

et al. 2020

Knee Surg Sports Traumatol Arthrosc

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Purpose To investigate if a trochleoplasty increases knee flexion angles and extensor moments in the gait of patients with patellar instability and to compare postoperative gait to a healthy control group. Methods A bilateral dislocation group (6 patients) and a unilateral dislocation group (14 patients) were treated with bilateral and unilateral trochleoplasty, respectively. Kinematics and kinetics of the lower extremity were captured using 3D‐gait analysis (VICON, 12 cameras, 200 Hz, plug‐in‐gait, two force plates). The mean of six trials was computed. The gait cycles were compared pre to postoperatively for each group. The gait of the two groups was compared to each other and the gait of a healthy population (54 knees). Results After trochleoplasty, the knee flexion angles and knee extensor moments only increased in the bilateral dislocation group, whereas the gait pattern of the unilateral dislocation group remained unchanged. Compared to the healthy population, the postoperative gait pattern of the bilateral dislocation group did not differ. In contrast, knee flexion angles and extensor moments of the unilateral dislocation group were still lower. Conclusion In adolescents with bilateral recurrent patellar dislocations, trochleoplasty of both knees increases knee flexion angles and knee extensor moments comparable to normal gait. Unilateral symptomatic patients undergoing a unilateral trochleoplasty did not achieve normal walking. These findings point out that patellar instability should be considered as a bilateral problem, even in patients with unilateral dislocations. Level of evidence III.

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“…Surgically, risk factors for patella dislocation can be mitigated. Anatomical abnormalities, such as trochlear or patellar dysplasia, patella alta, can be corrected [2, 5, 9, 10, 12, 14, 15, 23]. Ligamentous insufficiency can be reconstructed [34, 39, 40, 44].…”

Section: Introductionmentioning

confidence: 99%

Recurrent patellar dislocations in adolescents result in decreased knee flexion during the entire gait cycle

Camathias

Ammann

Meier

et al. 2020

Knee Surg Sports Traumatol Arthrosc

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Purpose To evaluate the kinematics/kinetics of the ankle, knee, hip in the sagittal plane in adolescents with recurrent patellar dislocation in comparison to a healthy control. Methods Case-control study. Eighty-eight knees (67 patients) with recurrent patellar dislocation (mean age 14.8 years ± 2.8 SD) were compared to 54 healthy knees (27 individuals, 14.9 years ± 2.4 SD). Kinematics/kinetics of ankle, knee, hip, and pelvis were captured using 3D-gait analysis (VICON, 12 cameras, 200 Hz, Plug-in-Gait, two force plates). One cycle (100%) consisted of 51 data-points. The mean of six trials was computed. ResultsThe loading-response increased by 0.02 s ± 0.01SE (10.8%) with dislocations (0.98% of total gait, P < 0.01). The mid-stance-phase decreased equally (P < 0.01). Dislocation decreased knee flexion during the entire gait cycle (P < 0.01), with the largest difference during mid-stance (9.0° ± 7.2 SD vs. 18.5° ± 6.7 SD). Dislocation increased plantar-flexion during loading response 4.1° ± 0.4 SE with (P < 0.01), afterward, the dorsal-extension decreased 3.2° ± 0.3 SE, (P < 0.01). Dislocation decreased hip flexion during all phases (P < 0.01). Maximal difference: 7.5° ± 0.5 SE during mid-stance. 80% of all patients developed this gait pattern. Internal moments of the ankle increased, of the knee and hip decreased during the first part of stance. Conclusion Recurrent patellar dislocation decreases knee flexion during the loading-response and mid-stance phase. A decreased hip flexion and increased plantar-flexion, while adjusting internal moments, indicate a compensation mechanism. Level of evidence III.

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Solitary Trochleoplasty for Treatment of Recurrent Patellar Dislocation

Cited by 9 publications

References 5 publications

Radiographic Evaluation of Pediatric Patients with Patellofemoral Instability

Radiographic Evaluation of Pediatric Patients with Patellofemoral Instability

Trochleoplasty improves knee flexion angles and quadriceps function during gait only if performed bilaterally

Recurrent patellar dislocations in adolescents result in decreased knee flexion during the entire gait cycle

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