Kneecap (patella) dislocation is a common condition often caused by the improper development of the femoral groove (trochlea), otherwise known as ‘trochlear dysplasia.’ Trochleoplasty is a surgical procedure designed to correct trochlear dysplasia and restore the groove shape to help prevent patellar dislocation. Currently, few surgeons are experienced in this procedure, and opinions vary on who should use it and when.
Researchers at Children’s Hospital of Philadelphia today announced results from the first ever international survey of trochleoplasty experts, which they hope will help guide current practice and future research regarding this procedure. The findings were reported in the Orthopaedic Journal of Sports Medicine.
In the study, which was distributed to experienced international orthopedic surgeons, researchers developed a cross-sectional survey to assess the current indications for use, surgical techniques, postoperative rehabilitation practices, and observed complication profile for trochleoplasty in the management of patellofemoral instability. Thirty-two surgeons with an average of 14 years in practice responded.
Overall, researchers found significant variation in the surgical techniques, postoperative management and observed complications in patients treated with trochleoplasty. Surgeons with more trochleoplasty experience tended to differ in their imaging and age-specific approaches compared with their less experienced colleagues. Arthrofibrosis, a condition characterized by the formation of scar tissue within a joint, was cited as the most frequently observed complication of trochleoplasty.
Additionally, surgeons reported different reasons for performing trochleoplasty. Most saw the procedure as appropriate for patients with any degree of trochlear dysplasia (a shallow, flat or convex trochlea) without arthritis in their kneecap or limb deformity. Others said the procedure should be used more selectively, such as only in those with severe dysplasia or those who have failed other surgical treatments. Although many surgeons expressed concerns regarding the potential for trochleoplasty to lead to premature osteoarthritis, few of the experienced trochleoplasty surgeons reported this as an observed complication.
In the realm of pediatric patients, some respondents were uncertain about whether the procedure was appropriate for developing adolescents who are not fully grown due to concerns regarding its impact on growth plates. However, recent research highlighted the safety of this technique in adolescent patients with less than two years of growth remaining, citing no evidence of growth disturbance.
“Given the known risks of recurrent instability in the setting of trochlear dysplasia, further understanding of appropriate indications for trochleoplasty and the safety of this procedure is critical,” said Brendan A. Williams, MD, an attending pediatric orthopedic surgeon with the Orthopedic Center and the Sports Medicine and Performance Center at CHOP. “Our findings shed light on important directions for future research.”
Williams et al. “Trochleoplasty Utilization in the Management of Patellofemoral Instability - An International Survey of Surgeons.” Orthopaedic Journal of Sports Medicine. Online January 13, 2025. DOI:10.1177/23259671241303147.
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Kneecap (patella) dislocation is a common condition often caused by the improper development of the femoral groove (trochlea), otherwise known as ‘trochlear dysplasia.’ Trochleoplasty is a surgical procedure designed to correct trochlear dysplasia and restore the groove shape to help prevent patellar dislocation. Currently, few surgeons are experienced in this procedure, and opinions vary on who should use it and when.
Researchers at Children’s Hospital of Philadelphia today announced results from the first ever international survey of trochleoplasty experts, which they hope will help guide current practice and future research regarding this procedure. The findings were reported in the Orthopaedic Journal of Sports Medicine.
In the study, which was distributed to experienced international orthopedic surgeons, researchers developed a cross-sectional survey to assess the current indications for use, surgical techniques, postoperative rehabilitation practices, and observed complication profile for trochleoplasty in the management of patellofemoral instability. Thirty-two surgeons with an average of 14 years in practice responded.
Overall, researchers found significant variation in the surgical techniques, postoperative management and observed complications in patients treated with trochleoplasty. Surgeons with more trochleoplasty experience tended to differ in their imaging and age-specific approaches compared with their less experienced colleagues. Arthrofibrosis, a condition characterized by the formation of scar tissue within a joint, was cited as the most frequently observed complication of trochleoplasty.
Additionally, surgeons reported different reasons for performing trochleoplasty. Most saw the procedure as appropriate for patients with any degree of trochlear dysplasia (a shallow, flat or convex trochlea) without arthritis in their kneecap or limb deformity. Others said the procedure should be used more selectively, such as only in those with severe dysplasia or those who have failed other surgical treatments. Although many surgeons expressed concerns regarding the potential for trochleoplasty to lead to premature osteoarthritis, few of the experienced trochleoplasty surgeons reported this as an observed complication.
In the realm of pediatric patients, some respondents were uncertain about whether the procedure was appropriate for developing adolescents who are not fully grown due to concerns regarding its impact on growth plates. However, recent research highlighted the safety of this technique in adolescent patients with less than two years of growth remaining, citing no evidence of growth disturbance.
“Given the known risks of recurrent instability in the setting of trochlear dysplasia, further understanding of appropriate indications for trochleoplasty and the safety of this procedure is critical,” said Brendan A. Williams, MD, an attending pediatric orthopedic surgeon with the Orthopedic Center and the Sports Medicine and Performance Center at CHOP. “Our findings shed light on important directions for future research.”
Williams et al. “Trochleoplasty Utilization in the Management of Patellofemoral Instability - An International Survey of Surgeons.” Orthopaedic Journal of Sports Medicine. Online January 13, 2025. DOI:10.1177/23259671241303147.
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