Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 26, Issue 9, pp 2640–2658 | Cite as

Trochleoplasty techniques provide good clinical results in patients with trochlear dysplasia

  • Umile Giuseppe LongoEmail author
  • Candela Vincenzo
  • Nicholas Mannering
  • Mauro Ciuffreda
  • Giuseppe Salvatore
  • Alessandra Berton
  • Vincenzo Denaro



The aim of this systematic review is to compare the clinical outcomes of patients treated with different trochleoplasty procedures, the rate of complications and recurrence of patellar dislocation.


A systematic review of the literature was performed, in accord with the PRISMA guidelines. PubMed, MEDLINE, CINAHL, Cochrane, EMBASE and Google Scholar databases were comprehensively searched using the keyword combinations, “Dejour trochleoplasty”, “Bereiter Trochleoplasty”, “Albee Trochleoplasty”, “Recession Trochleoplasty”, “Trochlear Dysplasia”, “Instability”, “Adult”, “Clinical Outcome” and “Surgery”.


Three-hundred and ninety-two knees in 371 patients were included. Bereiter U-shaped deepening trochleoplasty was the most commonly used technique for the treatment of trochlear dysplasia in the included studies with the lowest rate of recurrence and post-operative ROM deficiency. On the other hand, Dejour V-shaped deepening trochleoplasty showed the highest mean post-operative value of Kujala score with 79.3 (SD 8.4) points. Statistical differences were found in terms of redislocation rate between Goutallier procedure and Bereiter trochleoplasty (p < 0.05) and in terms of post-operative osteoarthritis between Bereiter and Dejour procedures (p < 0.05).


Bereiter trochleoplasty seems to be the most efficiency procedure in terms of post-operative patellar redislocation, post-operative osteoarthritis and ROM, but the highest mean post-operative Kujala score is obtained by Dejour procedure. Therefore, none of the surgical techniques analysed highlighted a real superiority. Randomised clinical trials are needed to establish whether of available surgical technique is the best to treat patient with trochlear dysplasia. The clinical relevance of this paper is that the three most popular trochleoplasty techniques are associated with significantly improved stability and function, showing a relatively low rate of osteoarthritis and pain, and a moderate rate of complications.

Level of evidence

Systematic review, Level IV.


Trochleoplasty Trochlear dysplasia Patellar instability Knee Patellofemoral 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.


No external source of funding was used.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

No informed consent was necessary for this study.


  1. 1.
    Albee F (1915) Bone graft wedge in the treatment of habitual dislocation of the patella. Med Rec 88:257–259Google Scholar
  2. 2.
    Altman DG, Schulz KF, Moher D, Egger M, Davidoff F, Elbourne D et al (2001) The revised CONSORT statement for reporting randomized trials: explanation and elaboration. Ann Intern Med 134:663–694CrossRefPubMedGoogle Scholar
  3. 3.
    Arendt E (2009) MPFL reconstruction for PF instability: the soft (tissue) approach. Orthop Traumatol Surg Res 95:S97–S100CrossRefPubMedGoogle Scholar
  4. 4.
    Banke IJ, Kohn LM, Meidinger G, Otto A, Hensler D, Beitzel K, Imhoff AB, Schöttle PB (2014) Combined trochleoplasty and MPFL reconstruction for treatment of chronic patellofemoral instability: a prospective minimum 2-year follow-up study. Knee Surg Sports Traumatol Arthrosc 22:2591–2598CrossRefPubMedGoogle Scholar
  5. 5.
    Bereiter H, Gautier E (1994) Die trochleaplastik als chirurgische Therapie der rezidivierenden Patellaluxation bei Trochleadysplasie des Femurs. Arthroskopie 7:281–286Google Scholar
  6. 6.
    Blønd L, Haugegaard M (2014) Combined arthroscopic deepening trochleoplasty and reconstruction of the medial patellofemoral ligament for patients with recurrent patella dislocation and trochlear dysplasia. Knee Surg Sports Traumatol Arthrosc 22:2484–2490CrossRefPubMedGoogle Scholar
  7. 7.
    Carofino BC, Fulkerson JP (2008) Anteromedialization of the tibial tubercle for patellofemoral arthritis in patients > 50 years. J Knee Surg 21:101–105CrossRefPubMedGoogle Scholar
  8. 8.
    Crossley KM, Bennell KL, Cowan SM, Green S (2004) Analysis of outcome measures for persons with patellofemoral pain: which are reliable and valid? Arch Phys Med Rehabil 85:815–822CrossRefPubMedGoogle Scholar
  9. 9.
    Dejour D, Byn P, Ntagiopoulos PG (2013) The Lyon’s sulcus-deepening trochleoplasty in previous unsuccessful patellofemoral surgery. Int Orthop 37:433–439CrossRefPubMedGoogle Scholar
  10. 10.
    Dejour D, Le Coultre B (2007) Osteotomies in patello-femoral instabilities. Sports Med Arthrosc 15:39–46CrossRefPubMedGoogle Scholar
  11. 11.
    Dejour D, Saggin P (2010) The sulcus deepening trochleoplasty: the Lyon’s procedure. Int Orthop 34:311–316CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Dejour H, Walch G, Neyret P, Adeleine P (1990) Dysplasia of the femoral trochlea. Rev Chir Orthop Reparatrice Appar Mot 76:45–54 (in French) PubMedGoogle Scholar
  13. 13.
    Dejour H, Walch G, Nove-Josserand L, Guier C (1994) Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc 2:19–26CrossRefPubMedGoogle Scholar
  14. 14.
    Donell ST, Joseph G, Hing CB, Marshall TJ (2006) Modified Dejour trochleoplasty for severe dysplasia: operative technique and early clinical results. Knee 13:266–273CrossRefPubMedGoogle Scholar
  15. 15.
    Fucentese SF, Zingg PO, Schmitt J, Pfirrmann CW, Meyer DC, Koch PP (2011) Classification of trochlear dysplasia as predictor of clinical outcome after trochleoplasty. Knee Surg Sports Traumatol Arthrosc 19:1655–1661CrossRefPubMedGoogle Scholar
  16. 16.
    Goutallier D, Raou D, Van-Driessche S (2002) Retro-trochlear wedge reduction trochleoplasty for the treatment of painful patella syndrome with protruding trochleae. Technical note and early results. Rev Chir Orthop Reparatrice Appar Mot 88:678–685PubMedGoogle Scholar
  17. 17.
    Kujala UM, Jaakkola LH, Koskinen SK, Taimela S, Hurme M, Nelimarkka O (1993) Scoring of patellofemoral disorders. Arthroscopy 9:159–163CrossRefPubMedGoogle Scholar
  18. 18.
    Longo UG, Loppini M, Berton A, Marinozzi A, Maffulli N, Denaro V (2012) The FIFA 11 + program is effective in preventing injuries in elite male basketball players: a cluster randomized controlled trial. Am J Sports Med 40:996–1005CrossRefPubMedGoogle Scholar
  19. 19.
    Longo UG, Rizzello G, Ciuffreda M, Loppini M, Baldari A, Maffulli N et al (2016) Elmslie–Trillat, Maquet, Fulkerson, Roux Goldthwait, and Other Distal Realignment Procedures for the Management of Patellar Dislocation: systematic review and quantitative synthesis of the literature. Arthroscopy 32:929–943. doi: 10.1016/j.arthro.2015.10.019 CrossRefPubMedGoogle Scholar
  20. 20.
    Maffulli N, Longo UG, Gougoulias N, Caine D, Denaro V (2011) Sport injuries: a review of outcomes. Br Med Bull 97:47–80CrossRefPubMedGoogle Scholar
  21. 21.
    Maffulli N, Longo UG, Gougoulias N, Loppini M, Denaro V (2010) Long-term health outcomes of youth sports injuries. Br J Sports Med 44:21–25CrossRefPubMedGoogle Scholar
  22. 22.
    Maffulli N, Longo UG, Spiezia F, Denaro V (2011) Aetiology and prevention of injuries in elite young athletes. Med Sport Sci 56:187–200CrossRefPubMedGoogle Scholar
  23. 23.
    Maffulli N, Longo UG, Spiezia F, Denaro V (2010) Sports injuries in young athletes: long-term outcome and prevention strategies. Phys Sportsmed 38:29–34CrossRefPubMedGoogle Scholar
  24. 24.
    Marcacci M, Zaffagnini S, Lo Presti M, Vascellari A, Iacono F, Russo A (2004) Treatment of chronic patellar dislocation with a modified Elmslie–Trillat procedure. Arch Orthop Trauma Surg 124:250–257CrossRefPubMedGoogle Scholar
  25. 25.
    Masse Y (1978) Trochleoplasty. Restoration of the intercondylar groove in subluxations and dislocations of the patella. Rev Chir Orthop Reparatrice Appar Mot 64:3–17PubMedGoogle Scholar
  26. 26.
    Nakagawa K, Wada Y, Minamide M, Tsuchiya A, Moriya H (2002) Deterioration of long-term clinical results after the Elmslie–Trillat procedure for dislocation of the patella. J Bone Joint Surg Br 84:861–864CrossRefPubMedGoogle Scholar
  27. 27.
    Naranja RJ Jr, Reilly PJ, Kuhlman JR, Haut E, Torg JS (1996) Long-term evaluation of the Elmslie–Trillat–Maquet procedure for patellofemoral dysfunction. Am J Sports Med 24:779–784CrossRefPubMedGoogle Scholar
  28. 28.
    Nelitz M, Dreyhaupt J, Lippacher S (2013) Combined trochleoplasty and medial patellofemoral ligament reconstruction for recurrent patellar dislocations in severe trochlear dysplasia: a minimum 2-year follow-up study. Am J Sports Med 41:1005–1012CrossRefPubMedGoogle Scholar
  29. 29.
    Ntagiopolous PG, Dejour D (2014) Current concepts on trochleopalasty procedures for the surgical treatment of trochlear dysplasia. Knee Surg Sports Traumatol Arthrosc 22:2531–2539CrossRefGoogle Scholar
  30. 30.
    Ntagiopoulos PG, Byn P, Dejour D (2013) Midterm results of comprehensive surgical reconstruction including sulcus-deepening trochleoplasty in recurrent patellar dislocations with high-grade trochlear dysplasia. Am J Sports Med 41:998–1004CrossRefPubMedGoogle Scholar
  31. 31.
    Oliva F, Ronga M, Longo UG, Testa V, Capasso G, Maffulli N (2009) The 3-in-1 procedure for recurrent dislocation of the patella in skeletally immature children and adolescents. Am J Sports Med 37:1814–1820CrossRefPubMedGoogle Scholar
  32. 32.
    Placella G, Speziali A, Sebastiani E, Morello S, Tei MM, Cerulli G (2016) Biomechanical evaluation of medial patello-femoral ligament reconstruction: comparison between a double-bundle converging tunnels technique versus a single-bundle technique. Musculoskelet Surg 100(2):103–107CrossRefPubMedGoogle Scholar
  33. 33.
    Placella G, Tei M, Sebastiani E, Speziali A, Antinolfi P, Delcogliano M et al (2015) Anatomy of the Medial Patello–Femoral Ligament: a systematic review of the last 20 years literature. Musculoskelet Surg 99:93–103CrossRefPubMedGoogle Scholar
  34. 34.
    Ronga M, Oliva F, Longo UG, Testa V, Capasso G, Maffulli N (2009) Isolated medial patellofemoral ligament reconstruction for recurrent patellar dislocation. Am J Sports Med 37:1735–1742CrossRefPubMedGoogle Scholar
  35. 35.
    Rouanet T, Gougeon F, Fayard JM, Remy F, Migaud H, Pasquier G (2015) Sulcus deepening trochleoplasty for patellofemoral instability: a series of 34 cases after 15 years postoperative follow-up. Orthop Traumatol Surg Res 101:443–447CrossRefPubMedGoogle Scholar
  36. 36.
    Roux C (1979) The classic. Recurrent dislocation of the patella: operative treatment. Clin Orthop Relat Res 144:4–8Google Scholar
  37. 37.
    Schöttle PBFS, Pfirrmann C, Bereiter H, Romero J (2005) Trochleaplasty for patellar instability due to trochlear dysplasia: a minimum 2-year clinical and radiological follow-up of 19 knees. Acta Orthop 76(5):693–698CrossRefPubMedGoogle Scholar
  38. 38.
    Shah JN, Howard JS, Flanigan DC, Brophy RH, Carey JL, Lattermann C (2012) A systematic review of complications and failures associated with medial patellofemoral ligament reconstruction for recurrent patellar dislocation. Am J Sports Med 40:1916–1923CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Thaunat M, Bessiere C, Pujol N, Boisrenoult P, Beaufils P (2011) Recession wedge trochleoplasty as an additional procedure in the surgical treatment of patellar instability with major trochlear dysplasia: early results. Orthop Traumatol Surg Res 97:833–845CrossRefPubMedGoogle Scholar
  40. 40.
    Tsuda E, Ishibashi Y, Yamamoto Y, Maeda S (2012) Incidence and radiologic predictor of postoperative patellar instability after Fulkerson procedure of the tibial tuberosity for recurrent patellar dislocation. Knee Surg Sports Traumatol Arthrosc 20:2062–2070CrossRefPubMedGoogle Scholar
  41. 41.
    Utting MR, Mulford JS, Eldridge JD (2008) A prospective evaluation of trochleoplasty for the treatment of patellofemoral dislocation and instability. J Bone Joint Surg Br 90:180–185CrossRefPubMedGoogle Scholar
  42. 42.
    Verdonk R, Jansegers E, Stuyts B (2005) Trochleoplasty in dysplastic knee trochlea. Knee Surg Sports Traumatol Arthrosc 13:529–533CrossRefPubMedGoogle Scholar
  43. 43.
    von Knoch F, Böhm T, Bürgi ML, von Knoch M, Bereiter H (2006) Trochleaplasty for recurrent patellar dislocation in association with trochlear dysplasia; a 4- to 14- year follow up-study. J Bone Joint Surg Br 88:1331–1335CrossRefGoogle Scholar
  44. 44.
    Wagner D, Pfalzer F, Hingelbaum S, Huth J, Mauch F, Bauer G (2013) The influence of risk factors on clinical outcomes following anatomical medial patellofemoral ligament (MPFL) reconstruction using the gracilis tendon. Knee Surg Sports Traumatol Arthrosc 21:318–324CrossRefPubMedGoogle Scholar
  45. 45.
    Zaffagnini S, Grassi A, Marcheggiani Muccioli GM, Luetzow WF, Vaccari V, Benzi A, Marcacci M (2014) Medial patellotibial ligament (MPTL) reconstruction for patellar instability. Knee Surg Sports Traumatol Arthrosc 22:2491–2498CrossRefPubMedGoogle Scholar

Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2017

Authors and Affiliations

  • Umile Giuseppe Longo
    • 1
    Email author
  • Candela Vincenzo
    • 1
  • Nicholas Mannering
    • 1
    • 2
  • Mauro Ciuffreda
    • 1
  • Giuseppe Salvatore
    • 1
  • Alessandra Berton
    • 1
  • Vincenzo Denaro
    • 1
  1. 1.Department of Orthopaedic and Trauma SurgeryCampus Bio-Medico UniversityTrigoriaItaly
  2. 2.Melbourne Medical SchoolUniversity of MelbourneMelbourneAustralia

Personalised recommendations