|Beitragstitel||CLINIAL AND RADIOLOGICAL OUTCOMES IN PATIENTS AFTER TROCHLEOPLASTY AND MEDIAL PATELLO-FEMORAL LIGAMENT RECONSTRUCTION WITH A MINIMUM 2 YEAR FOLLOW-UP|
Trochlear dysplasia is a common risk factor predisposing to recurrent patella dislocation. This pathological morphology leads to a lack of congruence with the patella that occasionally needs to be surgically corrected by deepening the trochlear bone underneath the cartilage, the so-called trochleoplasty. The aim of our study was to evaluate the clinical and radiological outcomes after combined trochleoplasty and medial patello-femoral ligament (MPFL) reconstruction in patients with a minimum two-year follow-up.
Patients who underwent a combined trochleoplasty and MPFL reconstruction in our institution between January 2014 and July 2018 were eligible for a clinical and radiological assessement.
Clinical examination included patellar apprehension test, Kujala and Tegner score and isometric measurement of quadriceps and harmstring strength.
Radiological studies included radiographs and MRI of the operated knee.
Wilcoxon test was used for comparison of numeric values. Fisher’s exact test was used for comparison of frequencies.
Sixteen patients (16 knees) with a mean follow-up of 2.5 years (range 2.0 to 5.5 years) after the operation were available for clinical and radiological assessment. Median age at the time of the operation was 18.5 years (range 13 to 47 years) and trochleodyplasia was classified type B in 3 patients and type D in 13 patients.
Three patients presented a persistent positive patellar apprehension test, but none complained of a recurrent patella dislocation. Postoperative median Kujala and Tegner score were 85 (range 67 to 100) and 4 (range 2 to 10), respectively. Strength of the qaudriceps and hamstring of the operated leg was lower than the contralateral side (17% and 9%, respectively). However, this difference did not reach statistical significance.
Post-operative MRI did not show any chondrolysis or subchondral necrosis. However, chondropathy worsened on both patellar and trochlear side compared to pre-operative MRI.
Combined trochleoplasty and MPFL reconstruction is a safe and efficient treatment for patellar instability in patients with high grade trochlear dysplasia. However, increased cartilage deterioration of the patella and trochlea has been identified on MRI performed minimum two years after the operation.