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WHAT IS THE EVIDENCE OF TROCHLEOPLASTY IN TREATMENT OF PATELLOFEMORAL INSTABILITY? A SYSTEMATIC REVIEW AND COMPARISON WITH MPFL RECONSTRUCTION OUTCOMES
  1. Enrique Adrian Testa1,
  2. Felix Amsler2,
  3. Carlo Camathias3,
  4. Philipp Henle4,
  5. Niklaus Friederich1,
  6. Michael Tobias Hirschmann1
  1. 1 Orthopaedic and Nuclear Medicine Research Department, Kantonsspital Baselland standort Bruderholz, Switzerland
  2. 2 Amsler Consulting, Basel, Switzerland
  3. 3 UKBB, Basel, Switzerland
  4. 4 Sonnenhofklinik, Bern, Switzerland

Abstract

Introduction Trochleoplasty and reconstruction of the medial patellofemoral ligament (MPFL) are the most commonly used surgical treatment in patients with patellofemoral instability. Although there is an increasing number of publications dealing with treatment of patellofemoral instability, the clinical evidence about outcomes and in particular the question when to use which method is still scarce. It was our purpose to perform a systematic review on trochleoplasty in the treatment of patients with patellofemoral instability and compare the outcomes with those seen in patients treated by reconstruction of the MPFL.

Methods Two independent orthopaedic surgeons performed a standardized search on Pubmed and other literature search engines and reviewed the obtained abstracts. All observational and experimental studies (case reports excluded) were then obtained in fulltext and again reviewed in a consensus meeting. 15 articles were included and analysed using the PEDro appraisal scoring system to assess its methodological quality. As comparison group the same process was done for MPFL reconstruction. 25 studies on MPFL reconstruction were obtained for comparison. The clinical and radiological outcomes of all papers was reviewed and compared. The studies investigated use a great variety of different outcome scoring instruments. Seven outcome variables were found consistently in most of the studies. Descriptive statistics was used for comparison of Kujala score, Lysholm score, patella tilt angle (PTA), sulcus angle (SA), apprehension test, redislocation and instability rates.

Results There was no statistical significant difference in outcomes between both groups investigated. The MPFL reconstruction group showed a trend to better clinical outcomes. Mean postoperative Kujala score and Lysholm score increased significantly in both groups when compared to preoperatively (Kujala:61.4 to 80.8 and 46.9 to 88.8; Lysholm:55.5 to 78.5 and 59.9 to 91.1). Postoperatively a positive apprehension test was found in 8% of the MPFL group and in 20% of Trochleoplasty group. No difference in redislocation (2%) and instability (5–6%) rates between both groups. Mean PTA and SA showed a decrease in the trochleoplasty group (PTA: 30° to 15.9° and 12.6° to 8.1°, SA: 145.5° to 135.7° and 149° to 145.6°).

Conclusion Considering all limitations this systematic review showed that trochleoplasty and MPFL reconstruction are able to deliver good clinical outcomes with stable patellofemoral joints. The minor differences in outcomes seem to be related to different patient populations and surgical techniques.

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