Jordy van Sambeeck

Twelve year follow-up of a stand-alone lateral condyle elevating trochlear osteotomy 6 93 Location Classification Pre-operative No of knees (%) 2 year FU No of knees (%) 12 year FU No of knees (%) Iwano Patellofemoral None 14 (93.3) 13 (86.6) 3 (20) Stage 1 1 (6.7) 1 (6.7) 8 (53.3) Stage 2 0 (0) 1 (6.7) 4 (26.7) Total 15 (100%) 15 (100%) 15 (100%) Note In addition to these 15 knees, one patient underwent a patellofemoral arthroplasty 3 years post trochlear osteotomy. Table 4. Radiological evaluation of patellofemoral and tibiofemoral osteoarthritis. Discussion This study shows that the clinical results of this lateral condyle elevating osteotomy do not significantly deteriorate over time. However, a high percentage of patients reported residual patellofemoral instabilitywithobjectiveand subjective symptoms of instability requiring additional surgery. Patellofemoral osteoarthritis was generally confined to the lower grades on the Iwano scale. We conclude that this procedure has acceptable clinical results and does not lead to rapidly progressive osteoarthritis. It can have a place in the arsenal of treatments for patellofemoral instability, but it should not be performed as a stand-alone procedure since it is not sufficient in guaranteeing patellar stability. This is the largest study on the results of this type of osteotomy, with the longest follow up. We found only two previous studies of poor methodologic quality which reported on the results of this type of osteotomy. In 2003 Badhe et al reported on four patients with a follow up of just one year 13 . They performed a lateral condyle elevating trochleoplasty in combination with an osteotomy of the patella and a tibial tuberosity transfer. They found no instability but all patients had a loss of flexion and residual patellofemoral pain. In 1997 Weiker and Black reviewed five patients (six knees) with an average follow up of 7 years 14 . All patients had a deficient lateral condyle and 3.8 previous surgical procedures on average, including 2 complete patellectomies. They found persistent symptoms in all 6 knees; 4 with sport activities, 1 with activities in daily living, and one knee was eventually converted to an arthrodesis. In 2 out of 4 knees in which radiographic follow up was available, osteophytes were present. When compared to our study these results appear worse both clinically and radiographically. The VAS-pain, Lysholm and WOMAC scores in our study all showed improvement from pre-operative to final evaluation and the mean Kujala score at final follow up was 76. Most authors describe the results at short- or mid-term follow up. In a recent systemic review by Balcarek et al. 5 , results of a sulcus deepening