APEX Knee Navigating Pearls and Pitfalls-Trochleoplasty: When and How

Video Transcription

Video Summary

Dr. David Dedock from the University of Virginia discusses trochleoplasty, a surgical technique for treating trochlear dysplasia—a major risk factor for recurrent patellar dislocation. Trochlear dysplasia often features a supratrochlear spur and a flat or convex trochlear groove, assessed via X-ray and 3D imaging. Dr. Dedock emphasizes identifying the dysplasia type (mainly type B or D) and evaluating patella alta, patella tracking, and the jumping J sign to determine the need for surgery. Trochleoplasty involves reshaping the trochlear groove, typically via a thick shell osteotomy removing a bony spur, and stabilizing the cartilage with sutures. This technique corrects patellar tracking while preserving cartilage contour. Results show high patient satisfaction, no recurrent dislocations, and successful return to sports. Rehabilitation begins immediately post-op with physical therapy to prevent stiffness, progressing from limited weight-bearing to full activity by 5-6 months. Trochleoplasty is particularly indicated in revision cases with significant dysplasia and a convex spur affecting patellar stability.

Asset Caption

Dr. David Diduch

Keywords

trochleoplasty

trochlear dysplasia

patellar dislocation

patella tracking

surgical technique