Trochleaplasty for patellar instability due to trochlear dysplasia

Schöttle, Philip B.; Fucentese, Sandro F.; Pfirrmann, Christian W. A.; Bereiter, H.; Roméro, J.

doi:10.1080/17453670510041781

Cited by 174 publications

(120 citation statements)

References 12 publications

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“…This leads to an increased risk of patellofemoral tracking disorder, instability, dislocation, and ultimately cartilage injury [27]. One study found an association between increased sulcus angle and increased medial and lateral cartilage injury in patients with osteoarthritis.…”

Section: Discussionmentioning

confidence: 99%

Investigation of the Relationship between Anterior Knee Pain and Chondromalacia Patellae and Patellofemoral Malalignment

et al. 2018

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Objective:The study aimed to investigate whether there is any association of anterior knee pain and knee function with chondromalacia stage and patellofemoral alignment in patients with anterior knee pain for over a month and with chondromalacia patellae (CMP) detected by magnetic resonance imaging (MRI). Materials and Methods: We reviewed the medical records of 38 patients who underwent a knee MRI examination and were diagnosed with chondromalacia based on the MRI. Knee MRI images were evaluated by a radiologist for chondromalacia staging. Patients were divided into two groups as early stage (stage 1-2) and advanced stage (stage 3-4) chondromalacia. Patients' demographical data (age, sex, and occupation), clinical features, physical examination findings and patellofemoral pain severity scale, kujala patellofemoral scoring system, and functional index questionnaire scores were obtained from their medical records. Trochlear sulcus angle, sulcus depth, lateral patellofemoral angle, patellar translation, and Insall-Salvati index were measured using the MRI images. Results: The mean patient age was higher in the advanced stage CMP group compared to the early stage CMP group (p=0.038). There was no statistically significant difference regarding other demographical data (p>0.05). MRI measurement parameters did not show difference between the groups (p>0.05). Patients in the advanced stage CMP group had higher patellofemoral pain severity score, lower kujala patellofemoral score, and lower functional index questionnaire score compared to the early stage CMP group. The differences were statistically significant (p=0.008, p=0.012, and p=0.026, respectively). Conclusion: As chondromalacia stage advances, the symptom severity worsens and knee functions decline; however, MRI measurements do not show difference between early and advanced stage CMP patients.

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Section: Discussionmentioning

confidence: 99%

Investigation of the Relationship between Anterior Knee Pain and Chondromalacia Patellae and Patellofemoral Malalignment

et al. 2018

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“…In clinical studies, no redislocation or subluxation occurred [5,32], but exact evaluation of the morphological changes after trochleoplasty is missing. Until today radiographic outcome after trochleoplasty was determined on plain radiographs only [32,39].…”

Section: Discussionmentioning

confidence: 99%

“…In the clinical examination, the patients presented a positive apprehension sign [32]. All patients had radiological signs of trochlear dysplasia (positive crossing sign, decreased trochlear depth, positive translation) [11].…”

Section: Patientsmentioning

confidence: 99%

“…The cartilage bony fragment is now pressed into the newly formed bony groove and fixed with two absorbable transosseous sutures (Vicryl-Tape, Ethicon, Norderstedt, Germany). The insertion of the vastus medialis obliquus muscle at the patella is tightened with one absorbable suture (Vicryl 2-0, Ethicon, Norderstedt, Germany), while the lateral retinaculum is left open [5,32].…”

Section: Surgical Techniquementioning

confidence: 99%

“…Trochlear dysplasia is commonly associated with recurrent patellar dislocation with atraumatic onset [6,9,11,12,25,32]. A positive crossing sign, a decreased trochlear depth, and an anterior translation on a straight lateral X-ray [11] are radiological signs of trochlear dysplasia.…”

Section: Introductionmentioning

confidence: 99%

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CT changes after trochleoplasty for symptomatic trochlear dysplasia

Fucentese

Schöttle

Pfirrmann

et al. 2006

Knee Surg Sports Traumatol Arthrosc

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Trochlear dysplasia is an important risk factor for patellar instability. Because of a decreased trochlear depth in combination with a low lateral femoral condyle, the patella cannot engage properly in the trochlea. Trochleoplasty is a surgical procedure, which strives to correct such bony abnormalities. The aim of this study was to describe morphological features of trochlear dysplasia and the corrective changes after trochleoplasty on CT scan. The study group consists of 17 knees with trochlear dysplasia having undergone trochleoplasty for recurrent patellofemoral dislocation at a mean age of 22.4 years. The evaluation consisted in pre-and postoperative measurements on the proximal and distal trochlea on transverse CT scans in order to determine the morphological features. We measured the transverse position and depth of the trochlear groove, the transverse position of the patella, the ratio between the posterior patellar edge and the trochlear groove, the lateral patellar inclination angle, the sulcus angle, and the lateral trochlear slope. The trochlear groove lateralised a mean of 6.1 mm in the proximal aspect and 2.5 mm in the distal aspect of the trochlea, while the patella medialised a mean of 5 mm. Preoperatively the patella was lateral in relation to the trochlear groove in 13 cases, neutral in two cases, and medial in two cases. Postoperatively it was lateral in four cases, in neutral position in seven cases, and medialised in six cases, referenced to the trochlear groove. The trochlear depth increased from 0 to 5.9 mm postoperatively in the proximal aspect of the trochlea, and from 5.5 to 8.3 mm postoperatively in the distal trochlea. The lateral patellar inclination angle decreased from a mean of 21.9°to a mean of 7.8°. The sulcus angle decreased from a mean of 172.1°to a mean of 133°in the proximal trochlea and from a mean of 141.9°to a mean of 121.7°in the distal trochlea. The lateral trochlear slope changed from 2.8°to 22.7°in the proximal and from 14.9°to 26.9°in the distal part of the trochlea. In the CT scan patients with trochlear dysplasia demonstrated a poor depth, or even a flat or convex trochlea with a greater sulcus and lateral trochlear slope angle, a lateralised patella to the trochlear groove with poor congruency, and a greater lateral patellar inclination angle. Trochleoplasty can correct the pathological features of trochlear dysplasia by surgically creating more normal anatomy. The goal of this surgical procedure is to steepen and lateralise the trochlear groove for a better engagement of the patella.

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Association between measures of trochlear morphology and structural features of patellofemoral joint osteoarthritis on MRI: The MOST study

Stefanik

Roemer

Zumwalt

et al. 2011

Journal Orthopaedic Research

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The sulcus angle has been widely used in the literature as a measure of trochlear morphology. Recently, lateral trochlear inclination and trochlear angle have been reported as alternatives. The purpose of this study was to determine the association between measures of trochlear morphology and patellofemoral joint (PFJ) cartilage damage and bone marrow lesions (BMLs). 907 knees were selected from the Multicenter Osteoarthritis Study, a cohort study of persons aged 50-79 years with or at risk for knee OA. Trochlear morphology was measured using lateral trochlear inclination, trochlear angle, and sulcus angle on axial MRI images; cartilage damage and BMLs were graded on MRI. We determined the association between quartiles of each trochlear morphology level with the presence or absence of cartilage damage and BMLs in the PFJ using logistic regression. The strongest associations were seen with lateral trochlear inclination and lateral PFJ cartilage damage and BMLs, with knees in the lowest quartile (flattened lateral trochlea) having more than two times the odds of lateral cartilage damage and BMLs compared to those in the highest quartile (p<0.0001). Lateral trochlear inclination may be the best method for assessment of trochlear morphology as it was strongly association with structural damage in the PFJ.

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Trochleaplasty for patellar instability due to trochlear dysplasia

Abstract: Patellofemoral instability with underlying trochlear dysplasia can be treated successfully by trochleaplasty.

Cited by 174 publications

References 12 publications

Investigation of the Relationship between Anterior Knee Pain and Chondromalacia Patellae and Patellofemoral Malalignment

Investigation of the Relationship between Anterior Knee Pain and Chondromalacia Patellae and Patellofemoral Malalignment

CT changes after trochleoplasty for symptomatic trochlear dysplasia

Association between measures of trochlear morphology and structural features of patellofemoral joint osteoarthritis on MRI: The MOST study

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