Jordy van Sambeeck

Trochleoplasty procedures show complication rates similar to other patellar stabilizing procedures 7 103 Introduction Patellar dislocation occurs when the patella completely disengages from the trochlear groove. The most common recurrent symptom after patellar dislocation is patellar instability, which includes both patellar dislocation and subluxation 1 . Trochlear dysplasia has been identified as the most consistent anatomic factor present in patients with recurrent patellar dislocations 2 . Trochleoplasty is a surgical procedure designed to reshape the trochlea in patients with recurrent patellar dislocation and trochlear dysplasia. Trochleoplasty involves working directly on the patellofemoral joint, modifying the congruency between the two articulating bones and alteration of joint kinematics, with a high risk of cartilage damage. The number of trochleoplasty procedures as a primary or revision surgical treatment option in patients with recurrent patellar dislocation and trochlear dysplasia has increased over the last decade 3 . Most authors agree that trochleoplasty procedures should always be combined with soft-tissue and/or with bony procedures (e.g. medial patellofemoral ligament (MPFL) reconstruction (lowest rate of recurrence with double-limb graft configuration 4 ), tibial tubercle transposition) as indicated. Therefore, a trochleoplasty procedure could be defined as a trochleoplasty including any additional stabilizing procedure. Various techniques for trochleoplasty have been described in the past decades. Four basic trochleoplasty procedures can be distinguished: 1) the lateral-facet elevating trochleoplasty as first described by Albee 5 , 2) the sulcus-deepening trochleoplasty which was first proposed by Masse 6 and later modified by Dejour 7 , 3) the ‘Bereiter’ or ‘thin-flap’ procedure 8 , and 4) the ‘recession’ or ‘recession-wedge’ trochleoplasty 9 . Although, the outcome measures vary widely between individual studies (e.g. Kujala Knee Score, Lysholm Score, Knee Injury and Osteoarthritis Outcome Score etc.), most articles present satisfactory results of trochleoplasty procedures in creating a stable patellofemoral joint in terms of recurrence of patellar dislocation. However, complications are often not included as primary outcome measure but are only briefly described within the results or discussion section in general terms. Patellar redislocation as a complication is rarely reported 3 , however postoperative stiffness and return to the operating room for any reason are relatively frequent reported complications. Trochleoplasty is a highly complex surgical technique with a significant risk for complications 3, 10, 11 . Therefore, it is important to gain more knowledge on complications after trochleoplasty procedures. To assess the rate of complications after the various techniques used for trochleoplasty procedures a systematic review and meta-analysis of the available literature was performed. The results of this study provide clinicians with the best currently available evidence on the rate of complications after a trochleoplasty procedure. This can be helpful to properly inform the patient and to make a well-informed decision as to whether or not to perform this procedure.