Sulcus-deepening trochleoplasty and medial patellofemoral ligament reconstruction provide good clinical outcomes in addressing patellar instability at mid-term follow-up: A retrospective case series

Abstract

Purpose

This study aimed to update previously published clinical and radiographic outcomes of Dejour sulcus-deepening trochleoplasty and medial patellofemoral ligament reconstruction (MPFL-R) at mid-term follow-up and monitor trends in patient-reported outcome scores and satisfaction.

Methods

Using the same cohort of patients from our previously published short-term series of 2-year follow-up, an interval follow-up was performed on 67 patients (76 knees) with severe trochlear dysplasia and recurrent patellar instability who were prospectively enrolled and underwent Dejour sulcus-deepening trochleoplasty and MPFL-R combined with other patellar stabilization procedures. Patients with less than 2 years of follow-up were excluded. Evaluation involved radiographic analysis, physical examination, clinical follow-up, and patient-reported outcome scores.

Results

A total of 37 patients (45 knees) were included in the current study, with a mean follow-up of 6.1 years postoperatively (standard deviation: 2.7 years). Two interval reoperations were performed (arthroscopic lysis of adhesions; hardware removal and arthroscopic shaving chondroplasty). There remained no occurrences of reoperation for recurrent patellar instability. Patient-reported outcomes were largely stable from early (mean: 3.6 years) to mid-term (mean: 6.1 years) follow-up, with no statistically significant difference between early and mid-term International Knee Documentation Committee (IKDC) (P ​= ​0.75), Kujala (P ​= ​0.47), or visual analog scale (VAS) pain (P ​= ​0.06) scores. Compared to preoperative knee scores, there was a significant difference in IKDC (49.3 vs 82.0, P ​< ​0.001, d ​= ​1.85), Kujala (56.5 vs 89.3, P ​< ​0.001, d ​= ​2.03), and VAS pain (3.8 vs 1.9, P ​= ​0.003, d ​= ​0.33) scores at mid-term follow-up (mean: 6.1 years). Mean Kellgren-Lawrence grading of patellofemoral arthritis showed no statistically significant change from 0.56 to 0.52 (P ​= ​0.511) on sunrise radiographs at the most recent follow-up.

Conclusions

At the mid-term follow-up, Dejour sulcus-deepening trochleoplasty and MPFL-R, combined with other patellar stabilization procedures, achieves durable resolution of patellar instability with maintained patient-reported outcome scores and satisfaction rates and is without interval evidence of clinical or radiographic progression of patellofemoral arthritis.

Level of evidence

IV, Case Series.