J Knee Surg 2015; 28(04): 297-302
DOI: 10.1055/s-0034-1398374
Special Focus Section
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Patellofemoral Dysfunction in Sports Trochleoplasty: Indications and Techniques

Don-Felix Ryzek
1   Clinic of Orthopedics, Sports Medicine, and Trauma Surgery, Isar Klinikum München, Munich, Germany
,
Philip Schöttle
1   Clinic of Orthopedics, Sports Medicine, and Trauma Surgery, Isar Klinikum München, Munich, Germany
› Author Affiliations
Further Information

Publication History

20 October 2014

17 November 2014

Publication Date:
12 January 2015 (online)

Abstract

Patellofemoral instability (PFI) is a pathological knee syndrome that frequently affects young patients. The patellofemoral joint's structural morphology is the determining factor in the extent of PFI. Structural factors that play leading roles in patellofemoral stability can be classified into static (bone morphology), passive (ligamentous), and active (muscular). The predominant static factor leading to patella dislocation and thus patellofemoral dysfunction is trochlear dysplasia, which we focus on in this review. After orienting clinical examinations, MRI can provide the best information about trochlear dysplasia. This includes trochlear shape, orientation, and tibial tuberosity to trochlear groove distance. In convex trochleas or trochlea dysplasia with PFI at flexion over 30 degrees, we recommend performing a deepening trochleoplasty to correct for static pathomorphology. In this review, we will focus on the pathology of trochlea dysplasia, its role in PFI, the correct indication for trochleoplasty as a primary intervention, and the role of a simultaneous medial patellofemoral ligament reconstruction.

 
  • References

  • 1 Meidinger G, Schöttle P. Pathogenese und Diagnostik der patellofemoralen Arthrose. Arthroskopie 2010; 23: 201-207
  • 2 Dejour H, Walch G, Neyret P , et al. Dysplasia of the femoral trochlea. Rev Chir Orthop Repar Appar Mot 1990; 76: 45-54
  • 3 Malghem J, Maldague B. Depth insufficiency of the proximal trochlear groove on lateral radiographs of the knee: relation to patellar dislocation. Radiology 1989; 170 (2) 507-510
  • 4 Merchant AC, Mercer RL, Jacobsen RH, Cool CR. Roentgenographic analysis of patellofemoral congruence. J Bone Joint Surg Am 1974; 56 (7) 1391-1396
  • 5 Senavongse W, Amis AA. The effects of articular, retinacular, or muscular deficiencies on patellofemoral joint stability: a biomechanical study in vitro. J Bone Joint Surg Br 2005; 87 (4) 577-582
  • 6 Heegaard J, Leyvraz PF, Curnier A, Rakotomanana L, Huiskes R. The biomechanics of the human patella during passive knee flexion. J Biomech 1995; 28 (11) 1265-1279
  • 7 Fithian DC, Meier SW. The case for advancement and repair of the medial patellofemoral ligament in patients with recurrent patellar instability. Oper Tech Sports Med 1999; 7 (2) 81-89
  • 8 Fithian DC, Mishra DK, Balen PF, Stone ML, Daniel DM. Instrumented measurement of patellar mobility. Am J Sports Med 1995; 23 (5) 607-615
  • 9 Hautamaa PV, Fithian DC, Kaufman KR, Daniel DM, Pohlmeyer AM. Medial soft tissue restraints in lateral patellar instability and repair. Clin Orthop Relat Res 1998; (349) 174-182
  • 10 Teitge RA, Faerber WW, Des Madryl P, Matelic TM. Stress radiographs of the patellofemoral joint. J Bone Joint Surg Am 1996; 78 (2) 193-203
  • 11 Burks RT, Desio SM, Bachus KN, Tyson L, Springer K. Biomechanical evaluation of lateral patellar dislocations. Am J Knee Surg 1998; 11 (1) 24-31
  • 12 Conlan T, Garth Jr WP, Lemons JE. Evaluation of the medial soft-tissue restraints of the extensor mechanism of the knee. J Bone Joint Surg Am 1993; 75 (5) 682-693
  • 13 Desio SM, Burks RT, Bachus KN. Soft tissue restraints to lateral patellar translation in the human knee. Am J Sports Med 1998; 26 (1) 59-65
  • 14 Sandmeier RH, Burks RT, Bachus KN, Billings A. The effect of reconstruction of the medial patellofemoral ligament on patellar tracking. Am J Sports Med 2000; 28 (3) 345-349
  • 15 Ahmed AM, Duncan NA. Correlation of patellar tracking pattern with trochlear and retropatellar surface topographies. J Biomech Eng 2000; 122 (6) 652-660
  • 16 Farahmand F, Tahmasbi MN, Amis AA. Lateral force-displacement behaviour of the human patella and its variation with knee flexion—a biomechanical study in vitro. J Biomech 1998; 31 (12) 1147-1152
  • 17 Heegaard J, Leyvraz PF, Van Kampen A, Rakotomanana L, Rubin PJ, Blankevoort L. Influence of soft structures on patellar three-dimensional tracking. Clin Orthop Relat Res 1994; (299) 235-243
  • 18 Dejour H, Walch G, Nove-Josserand L, Guier C. Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc 1994; 2 (1) 19-26
  • 19 Tardieu C, Dupont JY. The origin of femoral trochlear dysplasia: comparative anatomy, evolution, and growth of the patellofemoral joint. Rev Chir Orthop Repar Appar Mot 2001; 87: 373-383
  • 20 Dejour D, Reynaud P, Lecoultre B. Douleurs et instabilité rotulienne. Essai de classification. Med Hyg (Geneve) 1998; 56: 1466-1471
  • 21 Senavongse W, Farahmand F, Jones J, Andersen H, Bull AM, Amis AA. Quantitative measurement of patellofemoral joint stability: force-displacement behavior of the human patella in vitro. J Orthop Res 2003; 21 (5) 780-786
  • 22 Kang HJ, Wang F, Chen BC, Zhang YZ, Ma L. Non-surgical treatment for acute patellar dislocation with special emphasis on the MPFL injury patterns. Knee Surg Sports Traumatol Arthrosc 2013; 21 (2) 325-331
  • 23 Banke IJ, Kohn LM, Meidinger G , et al. Combined trochleoplasty and MPFL reconstruction for treatment of chronic patellofemoral instability: a prospective minimum 2-year follow-up study. Knee Surg Sports Traumatol Arthrosc 2014; 22 (11) 2591-2598
  • 24 Goutallier D, Bernageau J, Lecudonnec B. The measurement of the tibial tuberosity. Patella groove distanced technique and results (author's transl) [in French]. Rev Chir Orthop Repar Appar Mot 1978; 64: 423-428
  • 25 Beaconsfield T, Pintore E, Maffulli N, Petri GJ. Radiological measurements in patellofemoral disorders. A review. Clin Orthop Relat Res 1994; (308) 18-28
  • 26 Hunt P, Unterhauser FN, Strobel MJ, Weiler A. Development of a perforated biodegradable interference screw. Arthroscopy 2005; 21 (3) 258-265
  • 27 Shih Y-F, Bull AMJ, Amis AA. The cartilaginous and osseous geometry of the femoral trochlear groove. Knee Surg Sports Traumatol Arthrosc 2004; 12 (4) 300-306
  • 28 Schoettle PB, Werner CML, Romero J. Reconstruction of the medial patellofemoral ligament for painful patellar subluxation in distal torsional malalignment: a case report. Arch Orthop Trauma Surg 2005; 125 (9) 644-648
  • 29 Seitlinger G, Scheurecker G, Högler R, Labey L, Innocenti B, Hofmann S. The position of the tibia tubercle in 0°-90° flexion: comparing patients with patella dislocation to healthy volunteers. Knee Surg Sports Traumatol Arthrosc 2014; 22 (10) 2396-2400
  • 30 Salzmann GM, Weber TS, Spang JT, Imhoff AB, Schöttle PB. Comparison of native axial radiographs with axial MR imaging for determination of the trochlear morphology in patients with trochlear dysplasia. Arch Orthop Trauma Surg 2010; 130 (3) 335-340
  • 31 Schoettle PB, Zanetti M, Seifert B, Pfirrmann CW, Fucentese SF, Romero J. The tibial tuberosity-trochlear groove distance; a comparative study between CT and MRI scanning. Knee 2006; 13 (1) 26-31
  • 32 Fucentese SF, Schöttle PB, Pfirrmann CWA, Romero J. CT changes after trochleoplasty for symptomatic trochlear dysplasia. Knee Surg Sports Traumatol Arthrosc 2007; 15 (2) 168-174
  • 33 Fucentese SF, von Roll A, Koch PP, Epari DR, Fuchs B, Schottle PB. The patella morphology in trochlear dysplasia—a comparative MRI study. Knee 2006; 13 (2) 145-150
  • 34 Masse Y. Trochleoplasty. Restoration of the intercondylar groove in subluxations and dislocations of the patella. Rev Chir Orthop Repar Appar Mot 1978; 64: 3-17
  • 35 Pagenstert G, Wolf N, Bachmann M , et al. Open lateral patellar retinacular lengthening versus open retinacular release in lateral patellar hypercompression syndrome: a prospective double-blinded comparative study on complications and outcome. Arthroscopy 2012; 28 (6) 788-797