Jordy van Sambeeck

Chapter 7 114 Included in the major complications but not included in the meta-analysis is a pulmonary embolus in one patient in the study of McNamara et al. 13 Minor complications not included in the meta-analysis are a superficial wound infection in two patients in the study of Utting 28 and in four patients in the study of McNamara 13 , a deep venous thrombosis in two patients 2, 13 , a complication related to anesthesia in two patients 17, 28 , a wound healing problem in one patient 17 , a complex regional pain syndrome in two patients 8, 17 and a postoperative bleeding in one patient 8 . Fifty-eight patients had unchanged or increased pain not requiring reoperation, ninety-five patients have some residual symptoms such as clicking, swelling or pain. Six patients kept complaints of crepitus without further surgical treatment and fourteen patients kept complaints of swelling. Complications and miscellaneous results of techniques not included in the meta- analysis Two studies reported on a lateral facet elevating trochlear osteotomy, one study reported an arthroscopic deepening trochleoplasty, one a modified deepening trochleoplasty, and one a recession wedge trochleoplasty (Table 1). Discussion The most important finding of this study was that Bereiter and Dejour trochleoplasty procedures show complication rates similar to other patellar stabilizing procedures. The rates of reoperation after a Bereiter and Dejour trochleoplasty (0.08 (95%CI 0.04;0.14) and 0.20 (95%CI 0.11;0.32)) are comparable with those found in other systematic reviews of patellar stabilizing procedures (4.1% after MPFL-reconstruction 32 , 18% after tibial tubercle osteotomy 33 and 25% after trochleoplasty vs. 7% after MPFL-reconstruction 34 ). Decreased range of motion and recurrence of instability were the two most frequent reasons for further surgery. The study of McNamara et al. 13 largely contributed (23 patients) to the number of patients returning to the OR after a Dejour trochleoplasty. Ten of these patients underwent an additional MPFL reconstruction and eight underwent arthrolysis. Seven of the eight patients undergoing arthrolysis were from their early cohort of patients before continuous passive motion was introduced. This study of McNamara et al. might therefore confound the rate of reoperation after a Dejour trochleoplasty. The proportion of recurrent dislocation after a Bereiter or Dejour trochleoplasty (0.04 (95%CI 0.02 - 0.07) and 0.02 (95%CI 0 - 0.08)) was lower than or equal with previous results in literature 32, 35, 36 . In their systematic review, Smith et al. 1 found 13% recurrent patellar dislocations after 2 to 5 years follow-up after surgical intervention for patellar dislocation. Meta-analysis showed that the proportion of recurrence of instability (sensation of instability or subluxation) was low for Bereiter (0.06 (95%CI 0.02-0.13)) and Dejour (0.09 (95%CI 0.03-0.27)) trochleoplasty.