Thin flap sulcus-deepening trochleoplasty in patellar instability yields good functional outcomes without progressive cartilage deterioration in the short-term follow-up-A retrospective single-surgeon cohort study.
Jannik Frings, Eva Janssen, Matthias Krause, Karl-Heinz Frosch, Eik Vettorazzi, Andreas Weiler, Arno Schmeling
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引用次数: 0
Abstract
Purpose: Sulcus-deepening trochleoplasty (TP) effectively treats patellofemoral (PF) instability (PFI) caused by high-grade trochlear dysplasia (TD), but current evidence is based on small case series. We hypothesised, that TP would result in significant functional improvements and a low re-dislocation rate but would not accelerate the progression of PF cartilage deterioration.
Methods: We retrospectively reviewed all TP cases performed by a single surgeon between 2015 and 2021. Inclusion criteria were postoperative Magnetic resonance imaging (MRI) >6 and >12 months and a clinical follow-up >12 months. Patients with simultaneous cartilage repair, open physes or incomplete records were excluded. Clinical outcomes were assessed using pre- and postoperative scores, postoperative Banff Patellofemoral Instability Instrument (BPII) 2.0 and Knee Injury and Osteoarthritis Outcome Score (KOOS), re-dislocation rate and patient satisfaction. PF cartilage was evaluated via Area Measurement and Depth & Underlying Structures (AMADEUS) scores preoperatively, at 6 months and at the final follow-up.
Results: We included 113 patients (25.8 ± 8.3 years) with high-grade TD (Dejour B-D; mean lateral inclination angle: -2.9 ± 9.1°), 85% of whom had advanced cartilage lesions. All underwent TP, lateral retinacular lengthening (LRL) and medial patellofemoral ligament reconstruction (MPFL-R). After 34.8 ± 20.9 months, function, pain levels and Tegner scores improved significantly (p < 0.001). KOOS dimensions were: symptoms 79.9 ± 13.5, pain 86.4 ± 12.1, activity 91.9 ± 8.3, sports 71.7 ± 22.2 and quality-of-life 58.1 ± 23.8. BPII 2.0 was 64.3 ± 31.4. Preoperative AMADEUS scores (55.2 ± 17.4) remained stable at 6 months (p = 0.343) but improved to 58.4 ± 16.0 at 28.6 (12-89) months (p = 0.004). Complication and re-dislocation rates were 5.3% and 1.8%, with 93% patient satisfaction.
Conclusion: Sulcus-deepening TP with MPFL-R and LRL yields good to excellent short-term results without progressive chondral deterioration, enabling patients to return to their prior or higher activity levels despite advanced preoperative chondral lesions. TP can be considered a safe, joint-preserving technique for PF stabilisation.
Level of evidence: Level III, retrospective cohort study.
期刊介绍：
Few other areas of orthopedic surgery and traumatology have undergone such a dramatic evolution in the last 10 years as knee surgery, arthroscopy and sports traumatology. Ranked among the top 33% of journals in both Orthopedics and Sports Sciences, the goal of this European journal is to publish papers about innovative knee surgery, sports trauma surgery and arthroscopy. Each issue features a series of peer-reviewed articles that deal with diagnosis and management and with basic research. Each issue also contains at least one review article about an important clinical problem. Case presentations or short notes about technical innovations are also accepted for publication.
The articles cover all aspects of knee surgery and all types of sports trauma; in addition, epidemiology, diagnosis, treatment and prevention, and all types of arthroscopy (not only the knee but also the shoulder, elbow, wrist, hip, ankle, etc.) are addressed. Articles on new diagnostic techniques such as MRI and ultrasound and high-quality articles about the biomechanics of joints, muscles and tendons are included. Although this is largely a clinical journal, it is also open to basic research with clinical relevance.
Because the journal is supported by a distinguished European Editorial Board, assisted by an international Advisory Board, you can be assured that the journal maintains the highest standards.
Official Clinical Journal of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA).
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