Published online Dec 18, 2017. doi: 10.5312/wjo.v8.i12.935
Peer-review started: September 21, 2017
First decision: October 23, 2017
Revised: November 1, 2017
Accepted: December 3, 2017
Article in press: December 3, 2017
Published online: December 18, 2017
Processing time: 88 Days and 5.3 Hours
To evaluate our modified deepening trochleoplasty combined with a balanced medial patellofemoral ligament (MPFL) reconstruction for soft tissue alignement.
Thirty-three knees with with recurrent patellar dislocations and a trochlear dysplasia in 30 patients (m/f = 12/21, mean age 24 ± 9 years) underwent a combination of a modified deepening trochleoplasty and a balanced MPFL reconstruction for a medial soft tissue alignement. After a mean follow-up period of 29 ± 23 mo, patients’ return to sports, possible complications as well as the clinical outcomes using the Kujala, International Knee Documentation Committee (IKDC) and Lysholm scoring were evaluated. Moreover, patients’ satisfaction with the general outcome, the cosmetic outcome, the pre- and postoperative pain and a potential avoidance behaviour were assessed with additional standardized questionnaires which also included different visual analog scales.
There were no signs of a persistent instability. The Kujala score improved from a mean of 64 ± 16 points to 94 ± 9 points, the Lysholm score improved from a mean of 63 ± 17 to 95 ± 6 points and the IKDC score from 58 ± 11 to 85 ± 12 points, P < 0.0001, respectively. The assessment of pain using a visual analog scale showed a significant pain reduction from a mean of 4.8 ± 2.0 to 1.3 ± 3.4 points (P < 0.0001). Two of 26 cases (92%) who were engaged in regular physical activity before surgery did not return to full sporting activities. One patient felt that his sport was too risky for his knee and reported an ongoing avoidance behaviour. The other patient preferred to wait for surgery of her contralateral knee. Of the eight patients who were not engaged in sporting activities before surgery, three started regular sporting activities after surgery. In 31 of the 33 cases (94%), the patients were very satisfied with the clinical outcome of the surgery. Regarding the cosmetic results, no patients felt impaired in their self-confidence and in their clothing decisions.
Our technique shows a good clinical outcome in terms of the common scorings as well as in terms of pain, return to sports and patient satisfaction.
Core tip: Patients with recurrent patella dislocations typically have an insufficiency of the medial patellofemoral ligament (MPFL), which is an additional instability factor in a symptomatic trochlear dysplasia. Following a trochleoplasty, the articulation of the patella is changed to a more medial and dorsal mechanical position. As a consequence, a balanced alignment of the medial soft tissue restraints during a trochleoplasty is very reasonable to achieve an adequate stabilization. The combination of a modified Bereiter trochleoplasty and our MPFL reconstruction technique allowing a simple intra-operative tensioning shows encouraging results.