Dataset Information

Trochleoplasty, Medial Patellofemoral Ligament Reconstruction, and Open Lateral Lengthening for Patellar Instability in the Setting of High-Grade Trochlear Dysplasia.

ABSTRACT: Trochlear dysplasia is the most commonly encountered pathoanatomy in patients who present with patellar instability. Outcomes of trochleoplasty procedures have shown low rates of recurrent instability and high patient-reported outcome scores. This article describes a "thin-flap" groove-deepening trochleoplasty combined with medial patellofemoral ligament reconstruction with a gracilis allograft and lateral retinacular lengthening to treat recurrent patellar instability due to high-grade trochlear dysplasia. This technique can obviate tibial tubercle osteotomy by normalizing the position of the trochlear groove and, subsequently, decreasing the tibial tubercle-to-trochlear groove distance.

SUBMITTER: Vogel LA

PROVIDER: S-EPMC6819741 | biostudies-literature |

REPOSITORIES: biostudies-literature

ACCESS DATA

Similar Datasets

Project description:PurposeTo highlight the indications and outcomes for sulcus-deepening trochleoplasty, when used as an isolated procedure as well as in combination with other stabilization techniques for patellar instability.MethodsWe performed a systematic review focused on outcomes and complications following trochleoplasty performed either as an isolated procedure or in combination with other procedures to address patellar instability. Inclusion criteria included studies in English that reported on outcomes following primary open trochleoplasty, including Kujala scores and recurrent instability or dislocation events.ResultsTwelve papers including 702 patients who underwent sulcus-deepening trochleoplasty were included. A total of 504 patients underwent isolated sulcus-deepening trochleoplasty, whereas 198 patients underwent trochleoplasty in combination with 1 or more additional stabilization procedures. In total, 67% of patients were female compared with 33% male. The procedure was done was a primary surgical intervention 74% of the time. Postoperative Kujala scores for isolated trochleoplasty ranged from 80 to 92, whereas those for combined stabilization procedures ranged from 76 to 95. The dislocation rate among the studies ranged from 0 to 8%. There was a persistent J-sign in 0 to 12% of treated knees among all studies, and a persistent apprehension test in 0 to 29% of treated knees. Return to play ranged from 65% to 83% in studies in which this was reported as an outcome.ConclusionsSulcus-deepening trochleoplasty performed for recurrent patellar instability in the setting of trochlear dysplasia results in improved Kujala scores and a low redislocation rate, when performed as an isolated procedure or in combination with other stabilization procedures. Greater-level evidence is needed to better evaluate the overall efficacy of this procedure in addressing patellar instability.Level of evidenceLevel of Evidence, IV; Systematic review of level III and IV studies.

Project description:Medial patellofemoral ligament (MPFL) reconstruction is a common procedure to address MPFL deficiency. Various techniques have been reported, with the best method still being pursued. Previous studies have revealed the advantage of internal bracing and possible advantage of wide patellar insertion in MPFL reconstruction. Thus, we would like to introduce a technique that combines the internal bracing and wide patellar insertion in MPFL reconstruction, in which the critical points are proper location of the patellar and femoral tunnels and proper tensioning of the augmenting sutures and the whole graft complex. Our clinical experience indicates that the proper application of this technique can lead to satisfactory clinical outcome. We consider the introduction of this technique will provide more insight to MPFL reconstruction. Technique Video Video 1 Wide patellar insertion medial patellofemoral ligament reconstruction with internal bracing. This procedure is performed in the left leg. The anterior half of the peroneus longus tendon is harvested. Both ends of the tendon are braided with nonabsorbable sutures. All parts of the knee are examined and debrided. The MPJ point on the medial edge of the patella is defined. A medial patellar incision is made over the MPJ (junction of the medial and proximal one-third). Two tunnels are created from the medial edge of the patella to the midline of the anterior surface of the patella. A longitudinal incision is made over the medial femoral epicondyle and the adductor tubercle. The femoral tunnel is located and created. Two guide sutures are passed though the patellar tunnels. The graft tendon along with 2 augmenting sutures are passed through the proximal tunnel and pulled back through the distal tunnel. Lateral retinaculum release is performed as indicated. The tendon and the augmenting sutures are pulled subcutaneously out of the medial incision. A cortical suspensory fixation device with an adjustable loop is passed through the femoral tunnel from the medial to the lateral side. Each tendon end, as well as the augmenting sutures are tied to the adjustable loop. A lateral incision is made. The sutures from the adjustable loop are pulled through the soft-tissue fissure resulting from the lateral retinaculum release out of the lateral incision. The cortical fixation device is pulled through the femoral tunnel till the tendon ends are pulled into the femoral tunnel. The arthroscope is placed to the lateral gutter of the knee though the anterolateral portal. The adjustable loop is reduced until the cortical fixation button is pulled back against the lateral orifice of the femoral tunnel. At 30? flexion of the knee, lateral displacement of the patella is checked to make sure that the medial stability of the patella is restored. (MPJ, medial–proximal junction.)

Dataset Information

Trochleoplasty, Medial Patellofemoral Ligament Reconstruction, and Open Lateral Lengthening for Patellar Instability in the Setting of High-Grade Trochlear Dysplasia.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure