Thin Flap Trochleoplasty With Medial Patellofemoral Ligament Reconstruction for Recurrent Patellofemoral Instability With High-Grade Trochlear Dysplasia: A Series of 63 Consecutive Cases

Abstract

Background:

Trochlear dysplasia is present in 68% to 85% of patients with recurrent lateral patellofemoral instability (LPI) compared with 3% to 6% of healthy controls. Trochlear dysplasia has been associated with medial patellofemoral ligament (MPFL) graft failure and lower quality-of-life (QOL) outcome scores. The correction of trochlear dysplasia with trochleoplasty is indicated in patients with recurrent LPI and high-grade trochlear dysplasia with a trochlear bump and a significant J-sign.

Purpose:

To assess the clinical and patient-reported outcomes after patella-stabilizing surgery, including thin flap sulcus deepening trochleoplasty, and to explore the influence of pathoanatomic variables on postoperative QOL scores in patients who have undergone patellar stabilization, including trochleoplasty.

Study Design:

Case series; Level of evidence, 4.

Methods:

A total of 63 consecutive knees in 46 patients with recurrent LPI and high-grade trochlear dysplasia who underwent MPFL reconstruction with thin flap trochleoplasty were followed for 2 years postoperatively. Clinical outcomes and Banff Patellofemoral Instability Instrument (BPII) 2.0 scores were collected prospectively. The t test was used to determine changes in QOL. Multiple linear regression was conducted to determine significant pathoanatomic variables that affected outcomes after MPFL reconstruction.

Results:

Overall, 63 knees with a mean follow-up of 32.9 ± 17.0 months (range, 12-84 months) were included. All patients had preoperative high-grade trochlear dysplasia (Dejour type B: 46%; Dejour type D: 54%), with a mean trochlear bump height of 6.1 ± 1.8 mm (range, 3.2-10.5 mm). The BPII 2.0 score increased significantly from preoperatively (29.3 ± 12.4) to postoperatively (71.8 ± 17.4) (P < .001), with a large effect size (Cohen d = −2.41). There was 1 redislocation (1.6%) and 3 reoperations (4.8%). Persistent apprehension and the J-sign were present in 8.5% and 13.6% of the knees, respectively. Multiple linear regression analysis demonstrated no statistically significant predictive relationship between the 24-month postoperative BPII 2.0 score and the preoperative BPII 2.0 score, tibiofemoral rotation, the Beighton score, or trochlear bump height (R = 0.47; R² = 0.22; F = 5.23; P = .13).

Conclusion:

Thin flap trochleoplasty combined with MPFL reconstruction in patients with recurrent LPI and high-grade trochlear dysplasia resulted in low redislocation and reoperation rates at a mean of 33 months. Disease-specific QOL scores were statistically significantly improved from preoperatively to postoperatively.