Long-Term Clinical Impact of Radiographic Patellofemoral Osteoarthritis After Sulcus-Deepening Trochleoplasty: A...

Sulcus-deepening trochleoplasty is an effective surgical treatment for high-grade trochlear dysplasia in patients with recurrent patellofemoral instability. However, concerns remain regarding the potential development of patellofemoral osteoarthritis (OA) over time and its effect on clinical outcomes.

To determine whether the presence of radiographic grade ≤2 OA after trochleoplasty is associated with inferior functional outcomes or patient satisfaction.

Cohort study; Level of evidence, 3.

A retrospective study was conducted on 42 patients (47 knees) who underwent thick-flap sulcus-deepening trochleoplasty. After applying inclusion and exclusion criteria, 27 patients (33 knees) with a minimum follow-up of 10 years were included. Patients were categorized into OA and non-OA groups based on radiographic assessment (Iwano classification) at final follow-up. Functional outcomes were evaluated using the International Knee Documentation Committee (IKDC) and Kujala scores, while patient satisfaction was assessed on a 10-point scale. Group comparisons were performed using Mann-Whitney U and chi-square tests.

At a mean follow-up of 14.97 years (range, 10.4-19 years), 20 knees (60.6%) demonstrated radiographic OA (Iwano grades 1-2), while 13 knees (39.4%) showed no OA. Patients in the OA group were older (37.5 ± 6.7 vs 30.5 ± 3.0 years, P < .001) and had a longer follow-up duration (15.8 vs 13.0 years, P = .037). No significant differences were observed in other baseline characteristics. All patients underwent concomitant medial patellofemoral ligament reconstruction, and 14 additionally received a tibial tubercle osteotomy. Functional outcomes did not significantly differ between groups (IKDC: 79.06 ± 14.72 vs 78.04 ± 15.11, P = .726; Kujala: 80.45 ± 12.5 vs 80.07 ± 13.88, P = .462). Range of motion was comparable between groups, and overall patient satisfaction remained high (8.4 ± 1.65).

Low-grade patellofemoral OA (Iwano ≤2) was observed in 60% of knees at a mean follow-up of 15 years, but its presence did not negatively affect long-term functional outcomes or patient satisfaction. Importantly, no patient developed grade 3 or 4 OA, and radiographic changes were more frequent in older patients and those with longer follow-up, supporting trochleoplasty as a reliable surgical option for patients with high-grade trochlear dysplasia.