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Classification of trochlear dysplasia as predictor of clinical outcome after trochleoplasty

Fucentese, Sandro ; Zingg, Patrick ; Schmitt, Jürgen ; Pfirrmann, Christian ; Meyer, Dominik ; Koch, Peter

In: Knee Surgery, Sports Traumatology, Arthroscopy, 2011, vol. 19, no. 10, p. 1655-1661

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    Title
    • Classification of trochlear dysplasia as predictor of clinical outcome after trochleoplasty
    Author
    • Fucentese, Sandro. Department of Orthopaedic Surgery, University Hospital Balgrist, Zurich, Forchstr. 340, 8008, Zurich, Switzerland
    • Zingg, Patrick. Department of Orthopaedic Surgery, University Hospital Balgrist, Zurich, Forchstr. 340, 8008, Zurich, Switzerland
    • Schmitt, Jürgen. Department of Orthopaedic Surgery, University Hospital Balgrist, Zurich, Forchstr. 340, 8008, Zurich, Switzerland
    • Pfirrmann, Christian. Department of Radiology, University Hospital Balgrist, Zurich, Forchstr. 340, 8008, Zurich, Switzerland
    • Meyer, Dominik. Department of Orthopaedic Surgery, University Hospital Balgrist, Zurich, Forchstr. 340, 8008, Zurich, Switzerland
    • Koch, Peter. Department of Orthopaedic Surgery, University Hospital Balgrist, Zurich, Forchstr. 340, 8008, Zurich, Switzerland
    Document Type
    • Postprint
    Language
    • English
    Published in
    • Knee Surgery, Sports Traumatology, Arthroscopy, 2011, vol. 19, no. 10, p. 1655-1661. Springer-Verlag
    Other Version
    OAI-PMH Identifier
    • oai:doc.rero.ch:319243
    Summary
    Purpose: Sulcus-deepening trochleoplasty restores the trochlear groove in patients with patellofemoral instability and underlying trochlear dysplasia. There are types of dysplasia both with (B and D) and without (A and C) a supratrochlear spur. The aim of this study was to identify influencing factors for the clinical outcome following trochleoplasty. Methods: Forty-four knees in 38 patients who underwent trochleoplasty for instability (type A in 9, B in 15, C in 9 and D in 11 knees) were assessed clinically with the Kujala score and radiologically with radiographs and MRI. The median follow-up was 4 (2-7.8) years. Results: At follow-up, the median Kujala score had improved from 68 (29-84) to 90 (42-100) points (P<0.001). Instability (P<0.001) and pain (P=0.027) decreased significantly, but in 3 knees, pain was worse postoperatively. Twenty-seven knees were ranked as excellent, 10 as good, 2 as fair and 5 as poor. Overall, dysplasia types B and D benefited more from surgery than types A and C. The postoperative MRI revealed no chondrolysis or subchondral necrosis, but deterioration of cartilage on the lateral trochlear facet was identified. Conclusion: Trochleoplasty is a useful and reliable surgical technique to improve patellofemoral instability in patients with a dysplastic trochlea. While improved stability is predictable, pain is less predictable and may even increase following surgery. The overall results were directly dependent on the type of the dysplasia, with a significantly better clinical outcome in type B and D. The clinical relevance of this study is that severe dysplasia can successfully be treated with trochleoplasty. Level of evidence: III