title: Midterm results of comprehensive surgical reconstruction including sulcus-deepening trochleoplasty in recurrent patellar dislocations with high-grade trochlear dysplasia.
abstract: BACKGROUND
  Trochlear dysplasia is one of the most consistent anatomic factors that can lead to recurrent patellar dislocations. Various trochleoplasty procedures have been described to treat patellar dislocations in high-grade dysplasia by creating a new congruent trochlea.
  
  
  OBJECTIVE
  To present the midterm efficacy and outcome of the sulcus-deepening trochleoplasty procedure in patients with recurrent patellar dislocations due to high-grade trochlear dysplasia. The clinical evaluation results, the amount of radiological correction, and the prevalence of arthritis were recorded.
  
  
  METHODS
  Case series; Level of evidence, 4.
  
  
  METHODS
  A total of 27 skeletally mature patients (31 knees) with recurrent patellar dislocations due to high-grade trochlear dysplasia without any previous surgery were retrospectively included from September 1993 to September 2006. All patients underwent sulcus-deepening trochleoplasty combined with a bony and/or soft tissue procedure according to concomitant etiological factors to patellar dislocations: medial patellofemoral ligament reconstruction (16.1%), vastus medialis obliquus plasty (83.8%), tibial tuberosity distalization (51.6%), tibial tuberosity medialization (67.7%), and lateral retinaculum release (67.6%). Mean follow-up was 7 years (range, 2-9 years).
  
  
  RESULTS
  The mean sulcus angle decreased significantly (P < .01) from 152° ± 16° preoperatively to 141° ± 9° postoperatively, tibial tuberosity-trochlear groove distance decreased significantly (P < .001) from 19 ± 4 mm to 12 ± 5 mm, and patellar tilt decreased significantly (P < .001) from 37° ± 7° to 15° ± 8°. No recurrence was observed, and there was no case of stiffness. Apprehension signs remained positive in 19.3% of the cases, patellar tracking was normal in all cases, and the lateral patellar glide test finding was negative in 96.8%. The mean preoperative International Knee Documentation Committee (IKDC) score was 51 (range, 25-80), and the mean postoperative IKDC score was 82 (range, 40-100) (P < .001), while the mean Kujala score improved from a preoperative 59 (range, 28-81) to 87 (range, 49-100) postoperatively (P < .001). There was no radiographic evidence of patellofemoral arthritis at the latest follow-up.
  
  
  CONCLUSIONS
  Sulcus-deepening trochleoplasty is a valid option for the primary surgical treatment of carefully selected patients with recurrent patellar dislocations with high-grade trochlear dysplasia type B and D. Concomitant etiological factors must be cautiously corrected in an associated procedure. Midterm follow-up showed satisfactory restoration of patellar stability and improvement of knee scores with no complication of subsequent arthritis.
authors.affiliation: Lyon-Ortho-Clinic, Clinique de la Sauvegarde, 8 Avenue Ben Gourion, Lyon, 69009 France.
authors.forename: Panagiotis G
authors.initials: PG
authors.lastname: Ntagiopoulos
authors.forename: Pieter
authors.initials: P
authors.lastname: Byn
authors.forename: David
authors.initials: D
authors.lastname: Dejour
mesh_terms: D000293:Adolescent; D000328:Adult; D001178:Arthroplasty / Q000379:methods*; D001848:Bone Diseases, Developmental / Q000150:complications / Q000473:pathology / Q000601:surgery*; D002358:Cartilage, Articular / Q000473:pathology; D005260:Female; D005269:Femur / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D007719:Knee Joint / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D031222:Patellar Dislocation / Q000209:etiology / Q000517:prevention & control / Q000601:surgery*; D012189:Retrospective Studies; D055502:Secondary Prevention; D012720:Severity of Illness Index; D055815:Young Adult
keywords: recurrent patellar dislocation; trochlear dysplasia; trochleoplasty