Classification of trochlear dysplasia as predictor of clinical outcome after trochleoplasty
- نوع فایل : کتاب
- زبان : انگلیسی
- مؤلف : Sandro F. Fucentese • Patrick O. Zingg • Ju¨rgen Schmitt • Christian W. A. Pfirrmann • Dominik C. Meyer • Peter P. Koch
- چاپ و سال / کشور: 2011
Description
Purpose Sulcus-deepening trochleoplasty restores the trochlear groove in patients with patellofemoral instability and underlying trochlear dysplasia. There are types of dysplasia both with (B and D) and without (A and C) a supratrochlear spur. The aim of this study was to identify influencing factors for the clinical outcome following trochleoplasty. Methods Forty-four knees in 38 patients who underwent trochleoplasty for instability (type A in 9, B in 15, C in 9 and D in 11 knees) were assessed clinically with the Kujala score and radiologically with radiographs and MRI. The median follow-up was 4 (2–7.8) years. Results At follow-up, the median Kujala score had improved from 68 (29–84) to 90 (42–100) points (P\0.001). Instability (P\0.001) and pain (P = 0.027) decreased significantly, but in 3 knees, pain was worse postoperatively. Twenty-seven knees were ranked as excellent, 10 as good, 2 as fair and 5 as poor. Overall, dysplasia types B and D benefited more from surgery than types A and C. The postoperative MRI revealed no chondrolysis or subchondral necrosis, but deterioration of cartilage on the lateral trochlear facet was identified. Conclusion Trochleoplasty is a useful and reliable surgical technique to improve patellofemoral instability in patients with a dysplastic trochlea. While improved stability is predictable, pain is less predictable and may even increase following surgery. The overall results were directly dependent on the type of the dysplasia, with a significantly better clinical outcome in type B and D. The clinical relevance of this study is that severe dysplasia can successfully be treated with trochleoplasty. Level of evidence III.
Knee Surg Sports Traumatol Arthrosc DOI 10.1007/s00167-011-1410-7 Received: 8 June 2010 / Accepted: 20 January 2011
