In patients who suffer from recurrent dislocation of the kneecap (patella) a common contributing factor is that the groove in the femur bone in which the kneecap glides is filled up with too much bone.
In plainer English, this means that a kneecap (patella) that fails to engage in the underlying groove can slip out to the outer side of the knee as the person begins to bend the knee. As the knee continues to bend, it can either slip back into the groove or dislocate completely over the edge. In some patients this instability is due to a structural abnormality in the groove underneath the patella - which is sometimes correctable by the procedure of 'trochleoplasty' (re-fashioning the groove).
The principle of trochleoplasty is to release the cartilage from the trochlea in order to be able to remove the excessive bone underneath it. Then the groove is deepened and the overlying cartilage is fixed back in place. The fixation is done by means of resorbable bands. From a mechanical point of view the trochleoplasty procedure is the most anatomical correct operation to perform, but the surgical method is still new and few surgeons master the technique.
Long-term results after trochleoplasty looks promising compared to other methods. In cooperation with the Panum Institute in Copenhagen and my German colleague Philip Schöttle, we have developed a technique where the trochleoplasty operation can be performed with an arthroscopic technique, that is via keyhole surgery. We call the procedure the 'arthroscopic deepening trochleoplasty' The technique is based on an arthroscopic shoulder technique, using instruments from shoulder surgery in the knee. The arthroscopic technique of trochleoplasty is less traumatic for the knee and causes less pain and smaller scars than the earlier procedures, together with a more rapid rehabilitation. We have performed arthroscopic trochleoplasty routinely since 2008 without any re-dislocation to date. Arthroscopic trochleoplasty is always performed in combination with MPFL reconstruction.
To date, I have also presented "The Arthroscopic Deepening Trochleoplasty" technique in the United States, Japan, Netherlands, UK, Sweden, Norway, and Poland.
- 1. Blønd L. and Schöttle P. “The arthroscopic deepening trochleoplasty” Knee Surg Sports Traumatol Arthrosc 2010 Apr;18(4):480-5
- 2. Blønd L., & Haugegaard M. 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 2013 doi:10.1007/s00167-013-2422-2