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P.G. Ntagiopoulos, P. Byn, D. Dejour
196
in the development of arthritis is poorly
understood [28]. On one hand, trochlear
dysplasia can predispose to patellofemoral
arthritis and on the other hand, trochleoplasty
can be an additional factor for arthritis as with
any other corrective surgery for patellar
dislocation [27, 29]. But the main goal of
trochleoplasty remains to correct recurrent
dislocation and not to prevent arthritic changes.
An additional difficulty in estimating the risks
of arthritis from trochleoplasty is the presence
of severe cartilage lesions before surgery. The
only available long-term data so far, show the
presence of arthritic findings in 30% of patients
after 8 years of trochleoplasty, but the authors
recorded the presence of such degeneration in
most of the cases at the time of surgery and
attributed it to previous patellar dislocation
[11]. In the present study, there were no cases
of post-operative patellofemoral arthritis during
the last follow-up, even for the cases with
severe cartilage damage at the time of surgery.
In conclusion, sulcus-deepening trochleoplasty
is a good option for the primary surgical
treatment of carefully selected patients with
recurrent patellar dislocation and high-grade
trochlear dysplasia of type B or D. Concomitant
etiologic factors must also be cautiously
assessed. Trochleoplasty remains an important
revision option in the case of previously
operated patients with persistent patellar
dislocation and undiagnosed or underestimated
trochlear dysplasia, in whom neglect of
dysplasia and conventional surgery is probably
ill-fated. Combination of the procedure with
soft-tissue surgery, such as MPFL recons
truction, is necessary to achieve normal
patellar kinematics. The effects of such
procedures are difficult to compare and there
is need for agreement on the choice of the
right candidate for trochleoplasty, the surgical
technique, the rehabilitation protocol, and the
post-operative parameters that must be
corrected. Mid-term follow-up showed
satisfactory restoration of patellar stability
and functional knee scores, good to excellent
patient satisfaction with no major compli
cations of subsequent arthritis or deterioration
of patellofemoral function.
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