Trochleoplasty

Illustration of a section through the upper femoral trochlea showing a shallow groove of mild trochlear dysplasia predisposing to episodes of subluxation and dislocation of the patella.

The same view after a 'sulcus-deepening' trochleoplasty, where a wedge of underlying bone is removed to help re-shape the walls of the groove and contain the patella.

Trochlear dysplasia and patellar instability

A flat or even dome-shaped upper trochlear groove (trochlear dysplasia) may fail to contain the patella when the leg is straight, and during early bending of the knee it may slip over to the side - subluxing or even dislocating.

This is particularly so when the abnormal upper trochlea is associated with a higher than normal patella - patella alta. When the situation is extreme, trochleoplasty may be offered to try to steepen the trochlear groove.

• Quote from peer-reviewed paper:

  "....trochleoplasty can reliably improve patellofemoral stability in patients with severe trochlear dysplasia, but a high percentage of patients will have pain postoperatively"

  Citation: Faruqui S, Bollier M, Wolf B, Amendola N. Outcomes after trochleoplasty. Iowa Orthop J. 2012;32:196-206. PMID: 23576941; PMCID: PMC3565402.

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How is trochleoplasty performed?

Trochleoplasty is generally only performed by specialist patellofemoral surgeons, who have good experience in managing kneecap instability.

• Quote from peer-reviewed paper:

  "...trochleoplasty is often considered a highly specialized procedure that can be technically difficult..."

  Citation: Reinholz AK, Till SE, Crowe MM, Hevesi M, Saris DBF, Stuart MJ, Krych AJ. Grooveplasty Compared With Trochleoplasty for the Treatment of Trochlear Dysplasia in the Setting of Patellar Instability. Arthrosc Sports Med Rehabil. 2022 Dec 26;5(1):e239-e247. doi: 10.1016/j.asmr.2022.11.020. PMID: 36866307; PMCID: PMC9971888.

• Quote from peer-reviewed paper:

  "....The main complications associated with trochleoplasty are superficial wound healing complications, deep vein thrombosis, and deep infection. Additionally, complications including arthritis, stiffness/ arthrofibrosis, and recurrent dislocation have been reported...."

  Citation: Nolan JE 3rd, Schottel PC, Endres NK. Trochleoplasty: Indications and Technique. Curr Rev Musculoskelet Med. 2018 Jun;11(2):231-240. doi: 10.1007/s12178-018-9478-z. PMID: 29744697; PMCID: PMC5970113.

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Forum discussions

• Laura's trochleoplasty and TTO

  Diary of a patient whose surgery was a combination of trochleoplasty and tibial tubercle osteotomy.

• TROCHLEOPLASTY - what do people think?!

  A discussion about rehab after trochleoplasty.

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