Jordy van Sambeeck

Chapter 7 102 Abstract Purpose Trochleoplasty aims to restore patellar stability. Various techniques have been described and almost all authors report successful results. However, the procedure has a significant risk of complications. Purpose of this study was to perform a systematic review and meta-analysis of the available literature to assess the rate of complications after the various techniques used for trochleoplasty procedures. Materials and methods MEDLINE, EMBASE, Web of Science and Cochrane Library databases were searched. Studies on patients with recurrent patellar instability treated with a trochleoplasty with or without additional procedure, and reported complications were included. The primary outcome was the rate of complications per technique. A meta-analysis was performed whenever three or more studies per surgical technique could be included. Results The selection process resulted in 20 studies included for analysis. A lateral facet elevating trochlear osteotomy was reported by two studies, ten studies reported on a Bereiter trochleoplasty, five on a Dejour trochleoplasty, one on an arthroscopic technique, one on a ‘modified’ technique and one on a recession wedge trochleoplasty. Meta-analysis showed that proportion of recurrent dislocation was 0.04 (95%CI 0.02-0.07) for Bereiter trochleoplasty and 0.02 (95%CI 0-0.08) for Dejour trochleoplasty. These proportions were 0.06 (95%CI 0.02-0.13) and 0.09 (95%CI 0.03-0.27) for recurrent instability, 0.07 (95%CI 0.02-0.19) and 0.12 (95%CI 0.00- 0.91) for patellofemoral osteoarthritis and 0.08 (95%CI 0.04-0.14) and 0.20 (95%CI 0.11-0.32) for further surgery respectively. Conclusion This study demonstrates that the complications after a Bereiter and Dejour trochleoplasty including additional procedures are in the range of those of other patellar stabilizing procedures. For four other techniques, no meta-analysis could be performed. The clinical relevance of this study is that it provides clinicians with the best currently available evidence on the rate of complications after trochleoplasty procedures. This can be helpful in the process of deciding whether or not to perform such a procedure, and can be used to better inform patients about the advantages and disadvantages of different trochleoplasty procedures. Level of Evidence Level IV Key terms Patellofemoral instability, trochlear dysplasia, trochleoplasty, trochlear osteotomy, complications.