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. 2024 Jan 1;13(2):102848.
doi: 10.1016/j.eats.2023.09.023. eCollection 2024 Feb.

Medial Closing-Wedge Patellar Osteotomy in Patients With Patellofemoral Instability

David H Dejour  1 , Tomas Pineda  1 , Amedeo Guarino  1 , Michael J Dan  1 , Edoardo Giovannetti de Sanctis  1
Affiliations

Medial Closing-Wedge Patellar Osteotomy in Patients With Patellofemoral Instability

David H Dejour et al. Arthrosc Tech. .

Abstract

Trochlear dysplasia is the main anatomical risk factor for objective patellar instability. Surgical correction of trochlea dysplasia via a trochleoplasty has been described with good clinical results reported. Concerns remain for who have abnormal patellofemoral tracking post a trochleoplasty due to incongruence between the two articulating surfaces. We described a medial closing wedge patellar osteotomy to improve congruency of the patellofemoral joint post-trochleoplasty.

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Conflict of interest statement

The authors report the following potential conflicts of interest or sources of funding: D.H.D. reports royalties from Arthrex. All other authors (T.P., A.G., M.J.D., E.G.d.S.) declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Full ICMJE author disclosure forms are available for this article online, as supplementary material.

Figures

Fig 1
Fig 1
Patient position. The patient is placed in a supine position on the operating table. Two supports, lateral and distal, are used to keep the right knee in flexion. A high thigh tourniquet is placed to optimize the knee exposure during surgery. The knee is positioned at 90° of flexion.
Fig 2
Fig 2
The sulcus deepening trochleoplasty is performed first.
Fig 3
Fig 3
Medial patellar soft-tissue release is performed to expose the cortical bone.
Fig 4
Fig 4
A sterile marking pen is used to draw 2 dashed lines to set the thickness of the bone wedge to be removed (left). Another dashed line is drawn on the articular surface indicating the desired articular ridge (right).
Fig 5
Fig 5
With an oscillating saw the first osteotomy is performed at least 5 mm anterior and parallel to the articular surface to avoid any damages to the cartilage (left). A second, more anterior osteotomy, converging medially with the first cut at the level of the planned new articular ridge is then made (right).
Fig 6
Fig 6
The cortical wedge of bone is removed.
Fig 7
Fig 7
The osteotomy is closed with a grasper.
Fig 8
Fig 8
A 1.7-mm drill is used to create 2 anterior-to-posterior transosseous holes through the patella, slightly lateral to the medial patellar edge (A-B). Two no. 2 VICRYL sutures (Ethicon, Somerville, NJ) are driven from anterior to posterior through the first hole and then with an opposite direction through the second hole (B-C).
Fig 9
Fig 9
A knot is then carried out on the anterior patellar bone surface using the 4 ends of the suture
See this image and copyright information in PMC

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  • Patellar instability: current approach.
    Dejour DH, Mazy D, Pineda T, Cance N, Dan MJ, Giovannetti de Sanctis E. Dejour DH, et al. EFORT Open Rev. 2025 Jun 2;10(6):378-387. doi: 10.1530/EOR-2025-0051. EFORT Open Rev. 2025. PMID: 40459157 Free PMC article.

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