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. 2022 Dec 26;5(1):e239-e247.
doi: 10.1016/j.asmr.2022.11.020. eCollection 2023 Feb.

Grooveplasty Compared With Trochleoplasty for the Treatment of Trochlear Dysplasia in the Setting of Patellar Instability

Anna K Reinholz  1 , Sara E Till  1 , Matthew M Crowe  2 , Mario Hevesi  1 , Daniel B F Saris  1 , Michael J Stuart  1 , Aaron J Krych  1
Affiliations

Grooveplasty Compared With Trochleoplasty for the Treatment of Trochlear Dysplasia in the Setting of Patellar Instability

Anna K Reinholz et al. Arthrosc Sports Med Rehabil. .

Abstract

Purpose: To compare the clinical efficacy in the resolution of patellar instability, patient-reported outcomes (PROs), and complication and reoperation rates between patients who underwent grooveplasty (proximal trochleoplasty) and patients who underwent trochleoplasty as part of a combined patellofemoral stabilization procedure.

Methods: A retrospective chart review was performed to identify a cohort of patients who underwent grooveplasty and a cohort who underwent trochleoplasty at the time of patellar stabilization. Complications, reoperations, and PRO scores (Tegner, Kujala, and International Knee Documentation Committee scores) were collected at final follow-up. The Kruskal-Wallis test and Fisher exact test were performed when appropriate, and P < .05 was considered significant.

Results: Overall, 17 grooveplasty patients (18 knees) and 15 trochleoplasty patients (15 knees) were included. Seventy-nine percent of patients were female, and the average follow-up period was 3.9 years. The mean age at first dislocation was 11.8 years overall; most patients (65%) had more than 10 lifetime instability events and 76% of patients underwent prior knee-stabilizing procedures. Trochlear dysplasia (Dejour classification) was similar between cohorts. Patients who underwent grooveplasty had a higher activity level (P = .007) and a higher degree of patellar facet chondromalacia (P = .008) at baseline. At final follow-up, no patients had recurrent symptomatic instability after grooveplasty compared with 5 patients in the trochleoplasty cohort (P = .013). There were no differences in postoperative International Knee Documentation Committee scores (P = .870), Kujala scores (P = .059), or Tegner scores (P = .052). Additionally, there were no differences in complication rates (17% in grooveplasty cohort vs 13% in trochleoplasty cohort, P > .999) or reoperation rates (22% vs 13%, P = .665).

Conclusions: Proximal trochlear reshaping and removal of the supratrochlear spur (grooveplasty) in patients with severe trochlear dysplasia may offer an alternative strategy to complete trochleoplasty for the treatment of trochlear dysplasia in complex cases of patellofemoral instability. Grooveplasty patients showed less recurrent instability and similar PROs and reoperation rates compared with trochleoplasty patients.

Level of evidence: Level III, retrospective comparative study.

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Figures

Fig 1
Fig 1
Grooveplasty technique in left knee. (A) View of trochlea showing supratrochlear spur, center of trochlear groove marked with sterile pen, and lateral trochlea with large chondral injury. (B) Elevation and retraction of synovium with grooveplasty to reshape trochlear groove entry (arrow). (C) Final view after suturing of synovium (white arrowheads).
Fig 2
Fig 2
(A) Severe type of trochlear dysplasia with supratrochlear spur in left knee preoperatively. (B) Intraoperative imaging showing spur removal after open proximal trochleoplasty (grooveplasty) in left knee.
See this image and copyright information in PMC

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