Trochleoplasty and a Medial Patellofemoral Ligament Reconstruction Using a Quadriceps Tendon Graft

By Iain Mcnamara

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March 20, 2020

A surgical technique of a deepening Trochleoplasty and a Medial Patellofemoral Ligament reconstruction using a ...
read more ↘ Quadriceps tendon graft

Professor Iain McNamara
Consultant Orthopaedic Surgeon
Honorary Professor at the University of East Anglia

Summary:
For patients with significant trochlear dysplasia and recurrent patella instability despite conservative treatment, a trochleoplasty and medial patellofemoral ligament reconstruction is an operation that can give good results.
Here we demonstrate a deepening trochleoplasty using an offset burr and arthroscopic assistance before undertaking a medial patellofemoral ligament reconstruction using a quadriceps tendon graft.

Full text:
Patellar instability is a problem that regularly presenting to Orthopaedic surgeons. Despite the frequency of presentation, the need to operate on the unstable patella is unusual.
Many patients with patella instability have anatomical abnormalities that predispose them to patella maltracking and dislocation. Should the patient have persistent patella instability, despite physiotherapy then operative intervention should be considered.
The decision to undergo a trochleoplasty depends on the circumstances of the patient, and not just on radiographic measurements. For those patients that have significant trochlear dysplasia then a deepening trochleoplasty should be considered particularly as other soft tissue and bony realignment procedures can fail or leave the patient with persistent symptoms. In general, a trochleoplasty works best when performed as the first stabilization procedure.
The principle of the deepening trochleoplasty is to remove the excess subchondral bone at the dysplasia and then depress the articular cartilage to form a groove. Additional soft tissue or bony procedures can be undertaken at the same time depending upon anatomical features and the static position and dynamic tracking of the patellofemoral joint.
Here we demonstrate a deepening trochleoplasty using an offset burr and arthroscopic assistance before undertaking a medial patellofemoral ligament reconstruction using a quadriceps tendon graft.
Good results can be obtained from a deepening trochleoplasty including a return to sporting activity, but is a demanding procedure and should be performed by surgeons who have expertise with the technique.
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Trochleoplasty and a Medial Patellofemoral Ligament Reconstruction Using a Quadriceps Tendon Graft

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