Mini-Open Lateral Approach Trochleoplasty for Patellar Dislocation

Patellar dislocation is a common knee complaint, and anatomical patellofemoral abnormalities, especially trochlear dysplasia, increase the risk for recurrent dislocations. To stabilize the dislocating patella, trochleaplasty to correct trochlea dysplasia has become an accepted surgical management strategy. A surgical technique for a mini-open lateral approach thin-flap trochleoplasty is presented.

Trochleoplasty is the preferred surgical option for patients with severe trochlea dysplasia, characterized by a bump height >5 mm, a lateral trochlea inclination (LTI) angle of <10°, and a positive J-sign.

A mini-open lateral approach trochleoplasty is a less-invasive surgical modification of a thin-flap deepening trochleoplasty. In this technique, the trochlear cartilage remains intact, and the subchondral bone is removed from proximal to distal, under the cartilaginous flap, to an extent that allows the new trochlear shape to be formed and the sulcus groove to be located more anatomically. Importantly, the lateral condyle trochlear bone-cartilage junction remains intact, preventing loss of lateral condyle height, improving LTI angle, and optimizing trochlea flap healing.

Postoperatively, immediate free range of motion and full weightbearing allow for a fast recovery, preventing stiffness, and return to sports follows the general timeline after isolated medial patellofemoral ligament reconstruction. Cartilage healing has been reported to be good, with no significant lesions, in >5-year magnetic resonance imaging (MRI) follow-up.

Mini-open lateral approach trochleoplasty is a safe and effective procedure. Trochlea dysplasia can be corrected to a normal or nearly normal trochlea with mini-open lateral approach trochleaplasty, based on postoperative MRI analysis. A satisfying subjective long-term outcome can be expected for this surgical technique in trochleoplasty.

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