LIVRE JDG 2012

P.R.F. Saggin, P.G. Ntagiopoulos, P. Ferrua, D. Dejour

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The cartilage-bone flap should sit flush on the

underlying bone bed. The bone bed should be

deepened in its central portion to recreate and

adequate the groove. Once the flap is

adequately modeled over the bone bed and the

trochlear conformation is satisfactory, fixation

is performed.

Fixation

Absorbable vycril sutures are used to fix the

cartilage-bone flap to the underlying bone bed.

One suture is passed from each facet and tied

over the respective medial and lateral gutters;

this allows pulling down the new groove with

similar pressure of both facets on the cancellous

bone, promoting a perfect healing (fig. 5).

The synovium that was formerly dissected

away from the osteochondral margin is sutured

back to it. This protects the patellar cartilage

from the femoral bone and minimizes blood

loss through the exposed cancellous bone.

Patellar tracking check-up:

After satisfactory

trochlear shape is achieved, the associated

planned procedures are performed. We

routinely perform an associated medial

patellofemoral ligament reconstruction. After

the complete procedure is done, patellar

tracking and stability are checked.

Closure

Closure of the medial retinaculum is the final

step. No drains are installed.

Post-op protocol

Immobilization or weight restriction are not

necessary. Early mobilization on a continuous

passive motion device improves cartilage

nutrition and helps further trochlear modeling

by the patella. Immediate weight bearing is

allowed with an extension brace and flexion

must be regained without forced or painful

postures. Early rehabilitation goals are pain

and edema reduction and range of motion

recovery. The brace is removed when the

quadriceps strength allows the patient to walk.

Quadriceps strengthening with weights on the

foot or the tibial tubercle is prohibited in the

initial phase. After 45 days, cycling with weak

resistance and weight bearing proprioceptive

exercises may be initiated. From the 4

to the

month, running can be reinitiated and

quadriceps reinforcement with open kinetic

chain exercises between 0 and 60 degrees and

minor loads are allowed. Sports return is

allowed after the 6

month.

Control X-rays are obtained postoperatively

immediately and at 6 weeks. Six months after

the procedure, a CT scan is performed to

document the obtained correction.

Fig. 4 : The bone from the undersurface of the

trochlea has been removed. All bone that projects

beyond the anterior cortex of the femur must be

resected in order to eliminate the bump.

Fig. 5 : After fixation, trochlear anatomy resembles

that of normal knees.