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P.G. Ntagiopoulos, P. Byn, D. Dejour

194

5-7, 10-12]. Trochleoplasty procedures are

often performed with different techniques and,

most important, with various rehabilitation

protocols, which make the comparison of their

results challenging. Last, evaluating the

efficacy of trochleoplasty as a single procedure

is very difficult to do in a patient population

that usually presents with other concomitant

anomalies that also need correction, and

especially since trochleoplasty is almost always

performed in combination with soft-tissue

procedures, such as MPFL reconstruction [2, 3,

5-7, 11, 12, 14, 18, 20].

The mid-term clinical results from its

application have been also reported. Fucentese

et al.

reported the results from its application in

44 cases after an average of 4 years [6]. Kujala

score improved from 68 to 90 points (p<0.001),

and instability (p<0.001) and pain (p=0.027)

decreased significantly with no major

complications, like chondrolysis or subchondral

necrosis, except for deterioration of the

cartilage on the lateral trochlear facet. Donell

et al.

reported their data after performing

sulcus-deepening osteotomy in 17 cases after

an average of 1 year [7]. Eleven cases had

normal patellar tracking post-operatively,

Kujala score improved from a mean of 48 to 75

(p<0.05) and only 8 patients required a re-

operation (i.e. arthrolysis). Verdonk

et al.

also

reported their results in 14 cases after a mean

follow-up of 18 months [10]. In that study,

patients were assessed using the Larsen-

Lauridsen score on pain, stiffness, crepitus, and

loss of function. Seven scored poorly, three

fairly well and four well. On a subjective

scoring system 77% of patients found the

procedure satisfactory: six patients rated the

result as very good, four as good, and one as

satisfactory with only two patients rating the

result as inadequate. All these authors conclude

that sulcus-deepening trochleoplasty requires

careful attention to detail [10]. It is a technically-

demanding procedure that addresses a rare

condition with satisfactory results and

acceptable level of complications [7]. Sulcus-

deepening trochleoplasty is more suitable for

severe cases of type B and D of dysplasia,

where the presence of trochlear prominence is

amenable to correction with this technique [6].

In this study, the primary surgical treatment of

patients with recurrent patellar instability and

trochlear dysplasia included the sulcus-

deepening trochleoplasty that was also

combined with other procedures. The results of

performing additional soft-tissue or bone

surgery to trochleoplasty were satisfactory,

IKDC score improved significantly and there

was only one case of positive lateral glide test

without patellar dislocation. Other authors

report equal success rates from 90% to 100%

[5, 7, 10-12, 20].

Except for the patellar height, all radiographic

findings were significantly corrected post-

operatively, with emphasis to the lateral patellar

tilt. This can be attributed to both the trochleo­

plasty and the concomitant soft-tissue procedure

(VMO plasty or MPFL reconstruction, respec­

tively). Another interesting finding was the

significant decrease of the TT-TG distance,

caused by the position of the new groove in a

more lateral position. This can be helpful in

eliminating the need for an additional procedure

(medial transfer of the tuberosity), since in

cases of excessive TT-TG distance, re-

positioning the trochlea, instead of the

tuberosity, can reduce it.

Trochleoplasty procedures are a very appealing

revision option in cases of previously operated

patients with persistent patellar instability and

an undiagnosed or underestimated underlying

trochlear dysplasia [3, 5-7, 11-13, 20]. The

satisfying results that are recorded in these

patients after trochleoplasty, probably show the

need for the early recognition of a group of

patients with trochlear dysplasia in whom the

benign neglect of the dysplasia and the

application of conventional surgery for the

treatment of patella dislocation (i.e. medial

reefing, lateral release) is doomed to failure. In

the present study, patients were also classified

according to having previous surgery or not.

All patients with previous patellofemoral

surgery and persistent patellar dislocation had

associated high-grade trochlear dysplasia (type

B and D). In every case, trochleoplasty was

combined with a soft-tissue procedure.

Restoration of patellar stability, correction of

lateral tilt, functional score and patient