Trochleoplasty With Combined Soft Tissue Reconstruction for Patellar Instability

Area of Science:

• Orthopedic surgery
• Sports medicine
• Biomechanical engineering

Background:

• Patellofemoral instability is a common condition with multifactorial causes, involving both soft tissue and bony structures.
• Trochlear dysplasia is a significant bony component contributing to patellofemoral instability.
• Patellar restabilization surgery aims to address these underlying issues.

Purpose of the Study:

• To describe the surgical technique of trochleoplasty for patellar instability.
• To evaluate the efficacy of trochleoplasty combined with soft tissue reconstruction in patients with trochlear dysplasia.
• To assess the postoperative outcomes and potential complications associated with trochleoplasty.

Main Methods:

• Trochleoplasty performed via open medial parapatellar arthrotomy.
• Subchondral bone undermining with osteotome and bur to deepen the trochlear sulcus.
• Plastic deformation of cartilage and fixation with interference screws.
• Combined medial patellofemoral ligament reconstruction.

Main Results:

• Postoperative arthrofibrosis occurred, necessitating manipulation at 4 weeks.
• The patient recovered uneventfully after manipulation.
• Full return to activities at 6 months with restored strength, range of motion, and minimal pain.

Conclusions:

• Trochleoplasty combined with soft tissue reconstruction is a viable treatment for recurrent patellar instability and trochlear dysplasia.
• This surgical technique is a powerful tool for indicated patients, despite potential complications.
• Optimal outcomes depend on appropriate patient selection and adherence to postoperative rehabilitation.