1
|
Good patient satisfaction with low complications rate after trochleoplasty in patellofemoral instability. Knee Surg Sports Traumatol Arthrosc 2022; 30:3444-3450. [PMID: 35355088 DOI: 10.1007/s00167-022-06954-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 03/18/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Trochlear dysplasia has been recognized as the most common factor in patients with patellofemoral dislocation. Trochleoplasty is a surgical procedure whose primary goal is to modify the femoral trochlea's abnormal shape in patients suffering from patellar instability, requiring good surgical skills, correct indication, and accurate patient information. METHODS The review aims to describe preoperative planning, patient selection, most common surgical techniques, and clinical results of trochleoplasty in patellar instability in a reproducible manner. RESULTS Trochleoplasty can be considered a general term to describe a group of different procedures that reduce trochlear dysplasia's impact on patellar instability, aiming to restore patella-trochlear congruency, remove the supratrochlear bump, allowed a new groove positioning and are generally associated with other procedures. Recent studies showed satisfactory long-term results with the restoration of patellar stability, improving radiological findings of patellofemoral instability. CONCLUSION Trochleoplasty is a technically demanding technique, requiring careful patient selection, detailed knowledge, and surgical skills to avoid severe complications. Good patient satisfaction with a low risk of significant complications such as patellofemoral arthritis has been revealed. In conclusion, trochleoplasty should be systematically included in the treatment of patellar dislocation, if indicated. LEVEL OF EVIDENCE V.
Collapse
|
2
|
Sasaki E, Kimura Y, Sasaki S, Yamamoto Y, Tsuda E, Ishibashi Y. Clinical outcomes of medial patellofemoral ligament reconstruction using FiberTape and knotless SwiveLock anchors. Knee 2022; 37:71-79. [PMID: 35696836 DOI: 10.1016/j.knee.2022.05.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 04/05/2022] [Accepted: 05/27/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND We aimed to prospectively investigate the clinical outcomes of medial patellofemoral ligament (MPFL) reconstruction using polyester high-strength suture tape with knotless anchors. METHOD Forty-three patients (65 knees) were followed for at least 1 year postoperatively, with 27 patients (43 knees) followed for 2 years postoperatively. All patients underwent MPFL reconstruction using polyester high-strength suture tape (FiberTape®; Arthrex) with knotless anchors (SwiveLock®; Arthrex). Repeated dislocation and residual patellar apprehension signs were recorded, and congruence and tilting angles were measured. Changes in Knee Injury and Osteoarthritis Outcome Scale (KOOS) scores and their associations with the preoperative tibial tubercle-trochlear groove (TT-TG) distance were analyzed. RESULTS No repeat dislocations (0%) were observed. One (2.4%) residual positive patellar apprehension sign was noted. The mean tilting angle decreased from 24.8° to 10.7° (P < 0.001), and the mean congruence angle decreased from 24.9° to 4.3° (P < 0.001). At 2 years follow up, all KOOS subscales had improved: pain (92.0 ± 12.9), symptoms (90.2 ± 11.9), activities of daily living (95.7 ± 7.3), sports activity (85.7 ± 16.9), quality of life (87.7 ± 12.9), and patellofemoral (89.0 ± 9.6) outcomes. KOOS subscale scores improved regardless of the preoperative TT-TG distance (21.1 ± 3.5 mm; range, 13.8-29.9 mm). CONCLUSIONS MPFL reconstruction using FiberTape and knotless SwiveLock anchors was performed without sacrificing autologous tissue. No recurrent patellar dislocation was observed during the 2-year follow up period. All KOOS subscale scores improved using FiberTape and SwiveLock anchors in MPFL reconstruction.
Collapse
Affiliation(s)
- Eiji Sasaki
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
| | - Yuka Kimura
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Shizuka Sasaki
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yuji Yamamoto
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Eiichi Tsuda
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yasuyuki Ishibashi
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| |
Collapse
|
3
|
Leclerc JT, Dartus J, Labreuche J, Martinot P, Galmiche R, Migaud H, Pasquier G, Putman S. Complications and outcomes of trochleoplasty for patellofemoral instability: A systematic review and meta-analysis of 1000 trochleoplasties. Orthop Traumatol Surg Res 2021; 107:103035. [PMID: 34365023 DOI: 10.1016/j.otsr.2021.103035] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/24/2020] [Accepted: 12/08/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Trochleoplasty is an effective patellar stabilization procedure; however, it is associated with a risk of complications that cannot be ignored. Prior systematic reviews on this topic did not include more recent studies reporting important outcomes, particularly the long-term results of lateral elevation trochleoplasty. This led us to carry out a new meta-analysis of the various trochleoplasty procedures to specify: (1) the recurrence rate of patellofemoral dislocation; (2) the complication rates and; (3) the clinical outcomes. PATIENTS AND METHODS Studies reporting complications and clinical outcomes of trochleoplasty, whether or not it was combined with other procedures for patellofemoral instability, were identified in the MEDLINE, Embase, Scopus, Cochrane Library, Web of Science databases and by searching the grey literature. The primary endpoint was the recurrence of patellofemoral dislocation while the secondary endpoints were objective patellofemoral instability without dislocation, stiffness, patellofemoral osteoarthritis, subsequent surgeries and various clinical outcome scores. The results were combined in a random-effects model (weighing factor: inverse variance) when the heterogeneity was less than 80%. RESULTS Twenty-eight studies were included: 5 featured lateral elevation trochleoplasty, 10 about the Dejour deepening trochleoplasty, 12 about the Bereiter deepening trochleoplasty and 1 about the recession wedge trochleoplasty. A total of 1000 trochleoplasty procedures were done in 890 patients who had a follow-up of 1 to 25 years. There were 24 cases of recurrent dislocation (24/994 [2.4%]; this outcome was not reported for 6 trochleoplasties). The Dejour deepening trochleoplasty was the most effective with only 1 recurrence in 349 knees (0.28%). For the other complications, residual patellar instability without dislocation occurred in 82 of 754 knees (8% [95% CI: 3-14%]), patellofemoral osteoarthritis in 117 of 431 knees (27%), stiffness in 59 of 642 knees (7% [95% CI: 3-12%]) and the need for subsequent surgery in 151 of 904 knees (17%). DISCUSSION This study found a low recurrence rate for patellofemoral dislocation and residual instability. The incidence of stiffness, patellofemoral osteoarthritis and subsequent surgery remains high but differs greatly between studies. This meta-analysis showed a very large disparity between studies for most complications, which justifies the need for randomized and comparative studies to establish the role of trochleoplasty procedures in the treatment algorithm for patellar instability. LEVEL OF EVIDENCE IV; systematic review and meta-analysis.
Collapse
Affiliation(s)
- Jean-Thomas Leclerc
- University Lille, CHU de Lille, ULR 4490, Département Universitaire de Chirurgie Orthopédique et Traumatologique, 59000 Lille, France; Centre Hospitalier Universitaire (CHU) de Lille, Service de Chirurgie Orthopédique, Hôpital Roger Salengro, 59000 Lille, France; Département de Chirurgie Orthopédique, Centre Hospitalier Universitaire (CHU) de Québec, Université Laval, Québec, QC, Canada.
| | - Julien Dartus
- University Lille, CHU de Lille, ULR 4490, Département Universitaire de Chirurgie Orthopédique et Traumatologique, 59000 Lille, France; Centre Hospitalier Universitaire (CHU) de Lille, Service de Chirurgie Orthopédique, Hôpital Roger Salengro, 59000 Lille, France
| | - Julien Labreuche
- University Lille, CHU de Lille, ULR2694 - METRICS : évaluation des technologies de santé et des pratiques médicales, 59000 Lille, France
| | - Pierre Martinot
- University Lille, CHU de Lille, ULR 4490, Département Universitaire de Chirurgie Orthopédique et Traumatologique, 59000 Lille, France; Centre Hospitalier Universitaire (CHU) de Lille, Service de Chirurgie Orthopédique, Hôpital Roger Salengro, 59000 Lille, France
| | - Romain Galmiche
- University Lille, CHU de Lille, ULR 4490, Département Universitaire de Chirurgie Orthopédique et Traumatologique, 59000 Lille, France; Centre Hospitalier Universitaire (CHU) de Lille, Service de Chirurgie Orthopédique, Hôpital Roger Salengro, 59000 Lille, France
| | - Henri Migaud
- University Lille, CHU de Lille, ULR 4490, Département Universitaire de Chirurgie Orthopédique et Traumatologique, 59000 Lille, France; Centre Hospitalier Universitaire (CHU) de Lille, Service de Chirurgie Orthopédique, Hôpital Roger Salengro, 59000 Lille, France
| | - Gilles Pasquier
- University Lille, CHU de Lille, ULR 4490, Département Universitaire de Chirurgie Orthopédique et Traumatologique, 59000 Lille, France; Centre Hospitalier Universitaire (CHU) de Lille, Service de Chirurgie Orthopédique, Hôpital Roger Salengro, 59000 Lille, France
| | - Sophie Putman
- University Lille, CHU de Lille, ULR 4490, Département Universitaire de Chirurgie Orthopédique et Traumatologique, 59000 Lille, France; Centre Hospitalier Universitaire (CHU) de Lille, Service de Chirurgie Orthopédique, Hôpital Roger Salengro, 59000 Lille, France; University Lille, CHU de Lille, ULR2694 - METRICS : évaluation des technologies de santé et des pratiques médicales, 59000 Lille, France
| |
Collapse
|