Patellofemoral Dysfunction in Sports Trochleoplasty: Indications and Techniques

Patellofemoral instability (PFI) is a pathological knee syndrome that frequently affects young patients. The patellofemoral joint's structural morphology is the determining factor in the extent of PFI. Structural factors that play leading roles in patellofemoral stability can be classified into static (bone morphology), passive (ligamentous), and active (muscular). The predominant static factor leading to patella dislocation and thus patellofemoral dysfunction is trochlear dysplasia, which we focus on in this review. After orienting clinical examinations, MRI can provide the best information about trochlear dysplasia. This includes trochlear shape, orientation, and tibial tuberosity to trochlear groove distance. In convex trochleas or trochlea dysplasia with PFI at flexion over 30 degrees, we recommend performing a deepening trochleoplasty to correct for static pathomorphology. In this review, we will focus on the pathology of trochlea dysplasia, its role in PFI, the correct indication for trochleoplasty as a primary intervention, and the role of a simultaneous medial patellofemoral ligament reconstruction.