Trochleoplasty for patellofemoral instability: current concepts

Trochlear dysplasia is recognized as a key anatomical and biomechanical contributor to recurrent patellar instability. Trochleoplasty has re-emerged in contemporary practice as a surgical option specifically for patients with severe dysplasia leading to recurrent episodes of instability. This clinical review aims to summarise the latest evidence regarding the indications, types, surgical techniques, and clinical outcomes associated with trochleoplasty.

Trochleoplasty can be broadly categorized into three main types: lateral facet elevation, recession wedge, and sulcus-deepening procedures. Among sulcus-deepening methods, the modified Bereiter technique-often referred to as the "thin flap" approach-has gained popularity in recent years over the traditional Dejour "thick flap" technique. A more recent development is the arthroscopic variant of the Bereiter procedure, offering a minimally invasive alternative. Contrary to previous reports, recent literature demonstrates notable improvements in patient-reported outcomes, patellofemoral stability, and overall satisfaction following these procedures.

Sulcus-deepening trochleoplasty is an established surgical option for managing patients with high-grade trochlear dysplasia associated with patellofemoral instability. It has been linked to reduced recurrence rates, low complication risks, and favourable clinical outcomes. Orthopaedic surgeons treating patellofemoral disorders should be familiar with the appropriate indications and techniques for this procedure.