AANA Lab Course 913 - Advanced Knee Course-Trochleoplasty; When to Consider in 2019 Faculty Lecture

Trochleoplasty; When to Consider in 2019 Faculty Lecture_ Elizabeth Arendt, MD

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This presentation by Dr. Elizabeth A. Arendt from the University of Minnesota discusses trochleoplasty as a surgical option for patella stabilization, focusing on indications, techniques, and outcomes.<br /><br />Trochleoplasty is primarily considered in patients with high-grade trochlear dysplasia causing patellar instability and functional disability, particularly when there is a pronounced J-sign on physical exam and poor knee confidence affecting quality of life. Imaging criteria include no significant patella alta, presence of a supratrochlear spur (often central or central-lateral), a boss measuring about 7 mm, and a lateral trochlear inclination (LTI) angle around 11º.<br /><br />There are two main types of deepening trochleoplasty: (1) thick-flap osteotomy technique popularized by Dejour involving an osteotomy and a 5 mm osteochondral flap, and (2) the thin-flap arthroscopic technique by Bereiter, using a flexible 3 mm osteochondral flap without osteotomy. Dr. Arendt features both arthroscopic and open approaches using the Arthrex Trochlear Guide System.<br /><br />Patient selection involves careful history, physical exam, and advanced imaging (X-ray and CT) to classify trochlear dysplasia and cartilage wear. Trochleoplasty is contraindicated in patients with significant trochlear cartilage wear (grade IV). The surgical steps include marking the new groove, creating a subchondral bone window, undermining cartilage, shaping the groove with osteotomes or burrs, and fixing the flap with absorbable sutures, while preserving lateral trochlear wall and cartilage hydration.<br /><br />Radiographic outcomes show improved sulcus angles (average 9º deepening) and reduction/elimination of supratrochlear bumps. Postoperative arthroscopic evaluations demonstrate maintained cartilage integrity. Dr. Arendt concludes that although technically demanding, trochleoplasty can provide the best patella stabilization and improve quality of life in properly selected patients with trochlear dysplasia.

Keywords

trochleoplasty

patella stabilization

trochlear dysplasia

J-sign

supratrochlear spur

lateral trochlear inclination

thick-flap osteotomy

thin-flap arthroscopic technique

Arthrex Trochlear Guide System

patellar instability