Jordy van Sambeeck

Twelve year follow-up of a stand-alone lateral condyle elevating trochlear osteotomy 6 89 surgeries. None of the patients had a previous MPFL-reconstruction as it was not an often performed procedure at that time. After the trochlear osteotomy, 1 patient had multiple surgeries (including an MPFL- reconstruction), 1 patient had a tibial tubercle distalisation and 1 patient had a tibial tubercle distalisation and medialisation 2 months post-operative (all patients unilateral), because of persistent instability. None of the patients with additional procedures post trochlear osteotomy had persisting instability afterwards. Twelve knees (9 patients) did not have any further surgeries. Where possible, results were compared to the pre-operative values and the results at 2 years follow-up. Operative technique 16 After the skin incision, a lateral parapatellar incision is made and extended distally along the lateral femoral condyle. To visualize the osteotomy, two Kirschner wires are placed in the direction of the osteotomy till they are visible through the cartilage (halfway between the medial and lateral femoral facet). A curved incomplete osteotomy with small osteotomes from the beginning of the trochlea proximally to the subchondral bone of the sulcus terminalis distally is performed. The lateral articular surface of the trochlea is levered 6–8 mm, and the osteotomy is secured with a wedge shaped autograft taken from the ipsilateral iliac crest (Figure 1). Fixation of the osteotomy with osteosynthesis material is not necessary. The synovium is closed over the previously performed osteotomy, the lateral retinaculum is left open (i.e. a lateral release). This was done in order not to over tighten the lateral structures after the lateral condyle was raised. Postoperatively, patients were placed on a continuous passive motion device (CPM) to stimulate a passive range of motion until knee flexion was at least 60 degrees. Patients were advised partial weight bearing without flexion limitation for the first 6 weeks postoperatively.