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Author Topic: Deepening trochleoplasty?  (Read 1018 times)

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Offline northerner

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Deepening trochleoplasty?
« on: June 29, 2017, 12:01:22 PM »
I'm new here, so first of all; hello, fellow sufferes  ;)

I've just had an MRI that showed a loose object in my left knee (I knew it was there) and trochlear dysplasia, type D. I was told that doing a Fulkerson procedure probably wouldn't be enough and that a deepening trochleoplasty would be necessary as well.

Can anyone tell me about their experiences with that? I'm thinking recovery time, rehabilitation, pain, outcome aso. I know this is individual both from patient to patient but also the procedure in itself. I know why it's done, but never had one, so anything is helpful really.
• trochlear dysplasia (types B+D)
• cartilage damage (grades III + IV)
• recurrent patellar subluxations
• 2005: unsuccessful arthroscopy to remove loose body (L)
• 2012: fulkerson osteotomy (R)
• 2017: arthroscopy to remove loose body (L)
• 2017: deepening trochleoplasty + fulkerson osteotomy (L)

Offline tinydinosaur

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Re: Deepening trochleoplasty?
« Reply #1 on: June 29, 2017, 12:28:55 PM »
i had one done, separately from an MPFL (had the MPFL several years prior). i was told that as it's becoming more common the MPFL + trochleoplasty is being offered to patients with high grade trochlear dysplasia for greater success rates.

recovery time - i was told for 'healthy' patients 3-6 months, full recovery at around a year as with most major surgeries. for me it's pretty complicated because i've had so many prior surgeries, i also still have fairly noticeable muscle wasting on that leg which skews how i recover and rehab. at about 3 weeks, when i had the staples out i could already bend it pretty far. i was in one of those lockable braces, just for safety (because of my small quads).

rehab -  recovered ROM really quickly, which was incredibly nice. one of the pains from other surgeries has been having to work so hard to regain range just so the leg in general is comfortable. my kneecap was still catching and locking after surgery as it had done before, but the pressure from bending my knee was gone. i could go full bend before but it was incredibly uncomfortable to do so and until my knee started degenerating again recently i could do it without any discomfort after the surgical pain had subsided. it was such a weird feeling!

pain - again skewed because of all the surgeries i've had, i don't think this would be too bad a surgery as long as you keep on the cold packs or cryo cuff. i've had a scope done and it's been painful (from surgery) for up to three months - where back in the day a scope would be sore for a week to maybe a month, but minimally painful - so i struggled quite a bit with pain after this one - but even with that i would say the MPFL and OATS surgeries i had were more painful and more difficult to recover from. from what my surgeon told me it seems like this is true for other patients as well.

outcome - the good thing from this surgery is that knee pressure is gone, which is not something i knew i wasn't supposed to be feeling until this surgery. also, the muscle dysfunction i get from chronic pain + knee dysfunction is not nearly as bad. when my knee would get bad from the weather or activity prior my leg muscles would 'wind up' and stay like that almost all of the time, and my whole entire leg would ache. since having this done my muscles seem to function a lot better, perhaps because (while still dysfunctional due to catching) the kneecap has a proper groove to slide in so the muscles are functioning more like they are supposed to. because they function better and are in turn more healthy they respond a lot more to manual treatment and even a heatpack, which is honestly super nice. my knee still gives me hell but it's a lot better than my entire leg feeling this way :)

questions you can ask is what type of trochleoplasty is this? what restrictions will you have after surgery, what are their rehab protocols like - should give you a good idea of what their technique is and how their patients recover (and how quickly).

Offline northerner

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Re: Deepening trochleoplasty?
« Reply #2 on: June 29, 2017, 12:40:58 PM »
Thank you so much for your reply. Sounds like you've had quite some work done  :(

To be honest, I'm not sure whether they'll do an MPFL or "just" the Fulkerson and trochleoplasty. I don't know what is normally done, I guess it depends on various factores.

Anyways. You mention that you kneecap was and is still catching and locking. Do you know why? How often does it happen? Mine does too but only maybe 2 times in 12 months and then it stays locked for days or weeks and somehow unlatches on it's own. I'm hoping the arthroscopy to remove the loose object will eliminate that.
• trochlear dysplasia (types B+D)
• cartilage damage (grades III + IV)
• recurrent patellar subluxations
• 2005: unsuccessful arthroscopy to remove loose body (L)
• 2012: fulkerson osteotomy (R)
• 2017: arthroscopy to remove loose body (L)
• 2017: deepening trochleoplasty + fulkerson osteotomy (L)

Offline tinydinosaur

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Re: Deepening trochleoplasty?
« Reply #3 on: June 30, 2017, 08:13:47 AM »
yeah i think it depends on the surgeon, some surgeons are comfortable with TTT some would rather do MPFL based on what their outcomes for their patients have been, also depends on how bad the misalignment is.


before trochleoplasty it felt like the kneecap was catching on something all the time, every step i took felt like it was scraping against something, with occasional locking. post surgery it seems like my kneecap gets stuck up to the inside and is out of place when i try to bend it, as well as there being something that catches when the kneecap is mobilized medial and lateral. having a scope done in a few months time to see what's going on, if it's soft tissue or more joint degeneration. i don't walk very much but if i sit for a period and get up and walk that's when it locks the most, or if i have my leg out straight and attempt to bend it - i can either straighten it and try to bend it again or gently push my kneecap over so i'm able to bend it. get a lot of pain when it locks in the middle of bending.

Offline leahjg-90

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Re: Deepening trochleoplasty?
« Reply #4 on: December 23, 2017, 02:07:39 PM »
Not sure if this thread is still read - but I am looking to talk to anyone who has experienced a trochleoplasty.

My consultant has referred me to have a trochleoplasty and I am a little anxious!

Offline nathigut

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Re: Deepening trochleoplasty?
« Reply #5 on: January 18, 2018, 02:40:47 PM »
@leahjg-90:

I just had a Trochleoplasty done on December 13th 2017. So far I'm happy with the results although it is hard to really judge the situation at this point.

The surgery itself wasn't too big of a deal - two hours. I stayed at the hospital for three nights and other than having some "worse" pain during the first night, everything went really well. There was some throbbing pain during the first week but I was allowed to put full weight on it from the very beginning as long as I was wearing my brace. However, they told me it might be good to use crutches during the first week for my own psychological comfort. 

I was told that I would be off work for about 6 weeks but I since I have a desk job, I started working from home after about 3.5 and started working (physically going to the office) for half days after about 4.5 weeks. It's going really well!

Right now I'm at the point where my physiotherapist says I can walk around at home without a brace and through that I'm automatically getting some bend back into my knee. I'm also already doing squats (without weights!!), one-legged stands, light lunges to the front and side as well as walking on my heels and toes.

One of the craziest things before surgery was how loud my knees were when I put weight on them in any way (walking up stairs, lunges, squats...)... I'm 24 years old so I was pretty worried about that... but after my surgery my knee is completely quiet!!

All in all, I'm very happy with the results so far. Obviously I haven't been able to put it to the real test during intense sports but I have a good feeling!

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Offline leahjg-90

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Re: Deepening trochleoplasty?
« Reply #6 on: January 20, 2018, 11:35:21 AM »
@nathigut

Thanks so much for your response. It sounds really successful for you - and helps reduce my anxiety! Where did you have it done?

I’ve had numerous dislocations, each getting worse. Now my new cracks, grinds and moves with every bend. Looking forward to stability.

You sound like you’ve done really well so far with your recovery. That’s quicker than my recovery from my last dislocation!! Hopefully it keeps going well for you 😊

Offline nathigut

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Re: Deepening trochleoplasty?
« Reply #7 on: January 21, 2018, 03:39:08 PM »
@leahjg-90

I had the trochleoplasty done here in Luzern, Switzerland where I live currently.

I should mention that I also had a previous surgeries on both my knees when I was about 18 years old. I had a Roux-Goldthwait procedure done in Canada as I was experiencing frequent dislocations on both knees during stop/go sports, snowboarding, running as well as any uncontrolled movement where the knee muscles should have contracted to hold my patella in place.

The surgery helped to stabalize the knees significantly but the main problem with the bones having grown wrong wasn't solved.

My doctor here in Switzerland believes this was an outdated procedure and he would have done the Trochleoplasty from the get-go. The Roux Glodthwait procedure basically just holds the knee cap in place but the problem was that with the surgery the patella was rubbing on the bone even more causing the arthritis to build even faster.

Oh well, can't change things now and I really believe the Trochleoplasty was the right way to go! As I mentioned (and this seems to be a problem for you too..), my non-operated, "old" knee still cracks and grinds with every bend as well and my "new" one is totally silent. I hope that keeps up!















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