Thin Flap Trochleoplasty for High-Grade Trochlear Dysplasia

Area of Science:

• Orthopedic Surgery
• Biomechanical Engineering

Background:

• Lateral patellofemoral instability is often associated with trochlear dysplasia, a condition where the trochlear groove is abnormally shaped.
• Trochleoplasty aims to correct this by deepening the trochlear groove, thereby improving patellofemoral tracking.

Purpose of the Study:

• To describe the thin-flap trochleoplasty technique for treating high-grade trochlear dysplasia with lateral patellofemoral instability.
• To evaluate the efficacy and safety of this surgical approach.

Main Methods:

• The thin-flap trochleoplasty involves elevating the trochlear cartilage, removing subchondral bone to create a deeper groove, and repositioning the cartilage flap.
• The corrected cartilage is secured using bioabsorbable nails.
• This procedure is recommended to be performed in conjunction with a stabilizing procedure, such as medial patellofemoral ligament reconstruction.

Main Results:

• Thin-flap trochleoplasty demonstrates low redislocation rates (3%-4%) in carefully selected patients.
• Postoperative outcomes show good patient-reported scores, high satisfaction rates, and successful return to work and sports (>85%).
• Potential complications include patellofemoral osteoarthritis (7%-18%) and knee stiffness, with complication risks similar to alternative patellar stabilization methods.

Conclusions:

• Thin-flap trochleoplasty is a safe, reliable, and effective surgical option for patients with high-grade trochlear dysplasia and lateral patellofemoral instability.
• While technically demanding, the procedure yields favorable outcomes and high patient satisfaction when performed on appropriately selected individuals.