Trochleoplasty in major trochlear dysplasia: Current concepts

被引：43
作者：
Philippe Beaufils
Mathieu Thaunat
Nicolas Pujol
Sven Scheffler
Roberto Rossi
Mike Carmont
机构：
[1] Orthopaedic Surgery Department, Centre Hospitalier de Versailles, Versailles
[2] Versailles Saint Quentin University, Versailles
[3] Chirurgisch, Orthopädischer PraxisVerbund, Sports Medicine and Arthroscopy Service, Berlin
[4] Department of Orthopaedics and Traumatology, University of Torino, Turin
[5] Princess Royal Hospital, Shropshire and Sheffield University Teaching Hospitals NHS Foundation Trust, Sheffield
来源：
Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology | / 4卷 / 1期
关键词：
Patellar instability; Patello femoral dysplasia; Trochlea; Trochleoplasty;
D O I：
10.1186/1758-2555-4-7
中图分类号：
学科分类号：
摘要：
Trochleoplasty is the theoretical solution to persistent symptoms (pain and/or instability) related to trochlear dysplasia where there is not only a trochlear flatness but also a trochlear prominence. The threshold of prominence indicating surgical intervention has as yet not been determined. A bump of 5 mm is generally accepted as the inferior limit. Given the interventional nature of this demanding procedure, it should be proposed in selected cases after considerable discussion with the patient. Trochleoplasty is indicated as a primary procedure for major trochlear dysplasia with a prominence > 5 mm. Stabilization is obtained in most of the cases with the risk of residual mild anterior knee pain. It is also indicated as a salvage procedure when a previous surgery failed. Despite the reputation of the procedure, the published results are encouraging in terms of prevention of re-dislocation, satisfaction index, and radiological outcomes. Post-operative stiffness is the main complication, which may require manipulation under anaesthesia or arthroscopic arthrolysis. There are few other complications reported and to date secondary necrosis of the trochlea has not been reported. Technically speaking, the deepening trochleoplasty is a difficult procedure without reliable landmarks. We propose a recession wedge trochleoplasty which is an easier procedure. It is never undertaken as an isolated procedure, but always in conjunction with other realignment procedures of the extensor apparatus according to the a la carte" surgery concept. © 2012 Beaufils et al; licensee BioMed Central Ltd."
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  • [1] Dejour H., Walch G., Neyret P., Adeleine P., Dysplasia of the femoral trochlea, Rev Chir Orthop, 76, pp. 45-54, (1990)
  • [2] Dejour D., Saggin P., The sulcus deepening trochleoplasty-The Lyon's procedure, Int Orthop, 34, pp. 311-316, (2010)
  • [3] Albee F., The bone graft wedge in the treatment of habitual dislocation of the patella, Med Rec, 88, pp. 257-259, (1915)
  • [4] Masse Y., Trochleoplasty. Restoration of the intercondylar groove in subluxations and dislocations of the patella, Rev Chir Orthop, 64, pp. 3-17, (1978)
  • [5] Von-Knoch F., Bohm T., Burgi M.L., Von-Knoch M., Bereiter H., Trochleaplasty for recurrent patellar dislocation in association with trochlear dysplasia. A 4- to 14-year follow-up study, J Bone Joint Surg Br, 88, pp. 1331-1335, (2006)
  • [6] Blond L., Schottle P.B., The arthroscopic deepening trochleoplasty, Knee Surg Sports Traumatol Arthrosc, 18, pp. 480-485, (2010)
  • [7] Dejour D., Le-Coultre B., Osteotomies in patello-femoral instabilities, Sports Med Arthrosc, 15, pp. 39-46, (2007)
  • [8] Donell S.T., Joseph G., Hing C.B., Marshall T.J., Modified Dejour trochleoplasty for severe dysplasia: operative technique and early clinical results, Knee, 13, pp. 266-273, (2006)
  • [9] Gougeon F., Vanovermeire P., Migaud H., Debroucker M.J., Spiers A., Duquennoy A., Résultats après 3 ans de recul de 51 trochléoplasties pour instabilité frontale fémoropatellaire, Rev Chir Orthop, 87, 2, pp. 85-86, (1996)
  • [10] Reynaud P., Les trochleoplasties -creusement, 8emes Journees Lyonnaises de chirurgie de genou, pp. 176-190, (1995)
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