High-level evidence supports nonoperative treatment for first-time lateral acute patellar dislocations. Surgical intervention is often indicated for recurrent dislocations. Recurrent instability is often multifactorial and can be the result of a combination of coronal limb malalignment, patella alta, malrotation secondary to internal femoral or external tibial torsion, a dysplastic trochlea, or disrupted and weakened medial soft tissue, including the medial patellofemoral ligament (MPFL) and the vastus medialis obliquus. MPFL reconstruction requires precise graft placement for restoration of anatomy and minimal graft tension. MPFL reconstruction is safe to perform in skeletally immature patients and in revision surgical settings. Distal realignment procedures should be implemented in recurrent instability associated with patella alta, increased tibial tubercle-trochlear groove distances, and lateral and distal patellar chondrosis. Groove-deepening trochleoplasty for Dejour type-B and type-D dysplasia or a lateral elevation or proximal recession trochleoplasty for Dejour type-C dysplasia may be a component of the treatment algorithm; however, clinical outcome data are lacking. In addition, trochleoplasty is technically challenging and has a risk of substantial complications.

An Algorithmic Approach to the Management of Recurrent Lateral Patellar Dislocation.

Trochlear dysplasia is characterized by abnormal trochlear morphology and a shallow groove. It is associated with recurrent patellar dislocation, but it is unclear whether the dysplasia is congenital, the result of lateral tracking and chronic instability, or caused by a combination of factors. Lateral radiographs elucidate the crossing sign and characteristic trochlear prominence. Recurrent patellofemoral instability is multifactorial, and each component must be considered in determining treatment. Managing other factors associated with recurrent instability may compensate for a deficient trochlea and provide stability. Medial patellofemoral ligament reconstruction is recommended for patellofemoral instability in the presence of trochlear dysplasia in patients without patella alta or increased tibial tubercle-trochlear groove distance. Trochleoplasty should be reserved for severe dysplasia in which patellofemoral stability cannot otherwise be obtained.

The role of trochlear dysplasia in patellofemoral instability.

Background:Although patellofemoral instability is among the most prevalent knee disorders, the management of patients with this condition is complex and remains variable, given the lack of long-ter...

Patellar Instability Management: A Survey of the International Patellofemoral Study Group.

Background:Trochlear dysplasia is one of the most consistent anatomic factors that can lead to recurrent patellar dislocations. Various trochleoplasty procedures have been described to treat patellar dislocations in high-grade dysplasia by creating a new congruent trochlea.Purpose:To present the midterm efficacy and outcome of the sulcus-deepening trochleoplasty procedure in patients with recurrent patellar dislocations due to high-grade trochlear dysplasia. The clinical evaluation results, the amount of radiological correction, and the prevalence of arthritis were recorded.Study Design:Case series; Level of evidence, 4.Methods:A total of 27 skeletally mature patients (31 knees) with recurrent patellar dislocations due to high-grade trochlear dysplasia without any previous surgery were retrospectively included from September 1993 to September 2006. All patients underwent sulcus-deepening trochleoplasty combined with a bony and/or soft tissue procedure according to concomitant etiological factors to patell...

Midterm results of comprehensive surgical reconstruction including sulcus-deepening trochleoplasty in recurrent patellar dislocations with high-grade trochlear dysplasia.

The diagnosis of and treatment for musculoskeletal disease and injuries have seen an explosion of new knowledge. More precise imaging, correlative injury anatomy, more focused physical examination features, among others, have led this upsurge of current insight. Crucial to this knowledge revolution is the expansion of international knowledge, which is aided by an adoption of a universal scientific language, electronic transfer of information, and personal communication of surgeons and scientists across national boundaries. One area where this is particularly evident is in our knowledge and treatment for patellofemoral disorders. This article will review the developments in the management of patellar dislocations by tracing their historical roots. This is not meant to be a comprehensive review, but rather to give current readers a "historical memory" upon which to judge and interpret our present-day bridge of knowledge. Level of evidence V.

Patella instability: building bridges across the ocean a historic review.

Le traitement des rotules douloureuses, sans instabilite objective, par section de l'aileron rotulien externe ou osteotomie d'avancement de la tuberosite tibiale est le plus souvent decevant a moyen terme. La persistance d'une hyperpression femoro-patellaire entrainee par une saillie trop importante des berges trochleennes (saillie superieure ou egale a 7 mm) pourrait expliquer la persistance des douleurs rotuliennes. Les auteurs proposent une trochleoplastie d'enfoncement par resection cuneiforme retro-trochleenne a base superieure qui ne modifie pas l'angle trochleen. Ils decrivent la technique operatoire et donnent les resultats obtenus a plus de deux ans de recul. L'etude retrospective porte sur 12 genoux. La trochleoplastie a ete effectuee pour traiter des rotules douloureuses. Onze genoux avaient deja ete operes pour traiter 9 fois une instabilite rotulienne objective ou potentielle et 2 fois une rotule douloureuse. Le recul a la revision etait en moyenne de 4 ans (extremes de 2 a 6 ans). Tous les genoux avaient eu un bilan radiologique pre et postoperatoire comprenant entre autre des defiles femoro-patellaires a 30° de flexion et des mesures au scanner de la TA-GT a 30° de flexion. Les resultats fonctionnels ont ete etudies en fonction de la cotation Arpege. La trochleoplastie etait realisee par une voie antero-externe. Elle etait associee a un geste de translation frontale de la tuberosite tibiale si la TA-GT preoperatoire n'etait pas en accord avec l'ouverture de l'angle trochleen. Les resultats fonctionnels se sont ameliores pendant les deux ans postoperatoires puis sont restes stables. L'amelioration des douleurs et de l'instabilite etait statistiquement reelle. Neuf fois les resultats fonctionnels ont ete bons ou tres bons. Les 2 echecs ont ete retrouves chez les operes les plus âges a genoux deja multi-operes. La saillie moyenne des berges trochleennes a ete ramenee de 8 mm en preoperatoire a 3 mm en postoperatoire. Toutes les trochleoplasties avaient consolide ; il n'a pas ete note de necrose de la trochlee. La trochleoplastie decrite a l'avantage sur les trochleoplasties classiques d'enfoncement de ne pas modifier l'angle trochleen et d'etre quantifiable. Elle est plus logique sur le plan biomecanique que l'avancement de la tuberosite tibiale anterieure. Elle ramene, en postoperatoire, la saillie des berges trochleennes a 3 mm. Associee a une correction des anomalies de la mecanique frontale femoro-patellaire, elle est capable d'ameliorer les douleurs rotuliennes meme s'il s'agit de douleurs persistantes sur des genoux anterieurement operes pour traiter une instabilite rotulienne objective ou potentielle ou pour traiter une rotule douloureuse banale.

[Retro-trochlear wedge reduction trochleoplasty for the treatment of painful patella syndrome with protruding trochleae. Technical note and early results].

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[Retro-trochlear wedge reduction trochleoplasty for the treatment of painful patella syndrome with protruding trochleae. Technical note and early results].