- https://www.arthroscopytechniques.org/cms/asset/0a26e389-ecf5-4d5c-bcab-16a05fa34b5f/mmc1.mp4Loading ...
Indications for Surgery
|The quadriceps tendon autograft should be partial thickness.||The cartilage flap should not be too thick because this creates difficulty in securing down the newly contoured trochlea.|
|An arthroscope should be used to scrutinize the underside of the trochleoplasty flap.||Removed bone should be saved to build up the lateral column if too much has been removed with the burr.|
|Tibial tubercle osteotomy should be performed before trochleoplasty to allow better visualization during trochleoplasty.||The quadriceps tendon in smaller individuals may be of insufficient length to reconstruct the MPFL.|
|When quadriceps tendon is used, Q-Fix anchors can be used instead of tunnels.||A suture-held reduction of the trochlear flap can be difficult during fixation; holding manual reduction minimizes cut-through or under-reduction.|
Patient Positioning and Anesthesia
|The quadriceps tendon is already anchored on the patella, making for a strong construct.||Sulcus-deepening trochleoplasty is technically more difficult than alternatives such as lateral facet–elevating trochleoplasty.|
|Use of Q-Fix anchors to secure the quadriceps tendon to the femur minimizes tunnel drilling and minimizes the need to find the Schöttle point on fluoroscopy.||Risks include trochlear flap necrosis and loss of cartilage fixation.|
|Sulcus-deepening trochleoplasty addresses a shallow sulcus and centralizes the patellar tracking area.||Trochleoplasty is not suitable for patients who already have advanced osteoarthritis.|
|Trochleoplasty can also address patellar tilt—and even height to some extent.||Patellar instability often presents at a young age, but trochleoplasty is contraindicated in patients with open physes.|
- Goutallier D.
- Raou D.
- Van Driessche S.
The patient is examined under anesthesia and found to have a positive J-sign, dislocating laterally and remaining so until 60° of flexion, consistent with severe trochlear dysplasia. An anterior arthrotomy is made, and partial-thickness quadriceps tendon graft is harvested. Q-Fix anchors are placed at the adductor tubercle. A tibial tubercle osteotomy is performed with a drill, osteotomes, and a small anterior cruciate ligament saw, and the tibia, 12 mm distally, is prepared for reattachment. A medial parapatellar arthrotomy is next incised, and the trochlear groove is outlined. The periosteum is elevated with a scalpel, and a burr and osteotomes are used to create the new trochlear shape, with an arthroscope passed beneath the osteochondral flap to help clear the undersurface. Four guide pins are placed and screws are used to keep the cartilage flap reduced. The tibial tubercle osteotomy is completed by reattaching the tubercle to its new distal position with cannulated screws and washers. The arthrotomy is closed, and medial patellofemoral ligament reconstruction is completed by passing the folded quadriceps graft, attached at the superior pole of the patella with a Q-Fix anchor, through the retinacular channel and affixing it to the adductor tubercle with 2 Q-Fix anchors. Once patellar stability is ensured through range of motion, the incision is closed.
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The authors report the following potential conflicts of interest or sources of funding: R.F.L. is a consultant for Arthrex , Smith & Nephew, Ossur, and Linvatec, outside the submitted work; receives royalties from Arthrex, Smith & Nephew, and Ossur, outside the submitted work; and is an editorial board member of American Journal of Sports Medicine, Knee Surgery, Sports Traumatology, Arthroscopy, and Journal of Experimental Orthopaedics. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
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