Trochleoplasty is a Viable Option for Patellar Instability in Patients with Severe Trochlear Dysplasia: a Minimum 1-year Follow-Up Prospective Study

Objectives: Patellar instability caused by trochlear dysplasia may be addressed by sulcus-deepening trochleoplasty. A paucity of data exists from the United States regarding this procedure and no long term follow up. The purpose of this study was to evaluate the outcome data of patients undergoing sulcus-deepening trochleoplasty for high-grade trochlear dysplasia at our institution. Methods: Sixty-four patients (71 knees) with severe trochlear dysplasia were prospectively enrolled and underwent sulcus-deepening trochleoplasty using the Dejour method from 2011-2018. Thirty-six of 71 knees (50.6%) had prior surgery and failed prior surgical management for patellar instability. Concomitant procedures during trochleoplasty were performed at varying rates. Radiographic analysis, physical examination, and clinical follow-up were obtained for all patients. At enrollment, patients completed preoperative visual analog scores (VAS), international knee documentation committee (IKDC) and Kujala scores, which were repeated at their 6 month, 1 year, 2 year, 3 year, and 4 year follow-up visits. Preoperatively, the patellotrochlear index (PTI), trochlear spur height, and trochlear depth were all measured. The patient’s sulcus angle was measured preoperatively and postoperatively on sunrise (merchant) view xray. Of the entire cohort, 43 patients (49 knees) had at least one year complete follow-up including xrays, physical exam, and patient-reported outcome measures and were included in the study. Results: The majority of patients were female (81.6%) with a mean age of 19.6 (+/- 6.8y). Follow-up ranged from 12 months to 78.4 months (mean 27.7 +/- 15.4). At the time of enrollment, mean BMI was 27.1 kg/m2 (+/-6.3) with one current smoker and one diabetic patient. Mean duration of symptoms prior to surgery was 75.2 months (+/- 72.5; r: 4-370mos). All knees were either Dejour B (81.3%) or D (18.8%) with a mean Caton-Deschamps index (CDI) of 1.20 (+/-0.2). Mean spur height preoperatively was 7.41 mm (+/1.84 mm) with a mean trochlear depth -0.18 (+/-2.71). Mean patellotrochlear index (PTI) was 0.41 (+/0.41). There were zero episodes of recurrent instability. All patients reported clinically significant improvements compared with baseline preoperative outcome scores. The mean preoperative IKDC score was 49.99, which improved to 79.86 (p&lt0.001), and the mean preoperative Kujala score was 55.88, which improved to 85.80 (p&lt0.001). Patients reported high satisfaction rates (9.5 +/-1.6 out of 10). All but 1 patient (96.9%) returned to work while 88.2% of patients were able to return to sport. Ten knees (20.4%) developed arthrofibrosis and required manipulation under anesthesia while eight of which underwent simultaneous arthroscopic lysis of adhesions. At the latest follow-up, mean knee range of motion was 132.4 +/- 13.2 degrees. Preoperative VAS was 3.31 (right) and 4.16 (left) while postoperative was 1.31 (right) and 1.76 (left) (p=0.007 R, 0.002 L). Radiographic analysis of the sulcus angle demonstrated a significant decrease from 148.86 degrees (+/-11.42) preoperatively to 135.11 degrees (+/-8.85) postoperatively (p<0.001). Conclusion: In the setting of severe trochlear dysplasia, sulcus-deepening trochleoplasty can provide a reliable and successful surgical solution to recurrent patellar instability. At a minimum of one year follow-up, the majority of patients were satisfied with their outcome corroborated by their subjective, validated outcome measures.

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Trochlear dysplasia - congenital anomaly or biomechanical development

Medicinski pregled ◽

10.2298/mpns1804096t ◽

2018 ◽

Vol 71 (3-4) ◽

pp. 96-99

Author(s):

Zlatko Temelkovski ◽

Zoran Bozinovski ◽

Alan Andonovski ◽

Biljana Andonovska

Keyword(s):

Knee Flexion ◽

Patellar Instability ◽

Trochlear Dysplasia ◽

Breech Presentation ◽

Trochlear Groove ◽

Mechanical Theory ◽

Predisposing Factor ◽

Sulcus Angle ◽

Pathologic Findings ◽

The Mean

Introduction. The aim of this study was to investigate the appearance of the trochlear groove in infants and to present the possible causes for the development of trochlear dysplasia as one of the most severe pathologic findings in patients with patellar instability. Material and Methods. Knee ultrasonography was performed in 200 infants, 3 to 6 months of age. The measurements were made at 30 and 60 degrees of knee flexion, in order to measure the trochlear bone and cartilaginous sulcus angle on the patellar surface of the femur and to determine the degree of trochlear dysplasia. A 7-megahertz probe was used for measurements, which was tangentially placed with the reference to the posterior femoral joint. Results. A completely flat trochlear bony sulcus angle was registered in all infants aged 3 to 6 months. The mean cartilaginous sulcus angle was between 149 ? 5.4? and 19 infants had a sulcus angle over 159?. Eleven infants with trochlear dysplasia were in breech presentation at birth. Conclusion. Our study showed that the cartilaginous part of the trochlear groove was already well developed at birth. Breech presentation of the fetus could be a predisposing factor for dysplasia of the cartilaginous part of the trochlear groove. The bony part of the trochlear groove is dysplastic in infants and it gradually gets deeper, later getting a shape of the overlying articular cartilage. The influence of the Delpech law, with lower pressure in the trochlear groove, could be the possible mechanical theory explaining the development of the trochlear dysplasia in the later stage of the childhood.

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Isolated Medial Patellofemoral Ligament Reconstruction for Patellar Instability Regardless of the Tibial Tubercle Trochlear Groove Distance: Outcomes at 1 and 2 Years

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967118s00078 ◽

2018 ◽

Vol 6 (7_suppl4) ◽

pp. 2325967118S0007

Author(s):

Brandon J. Erickson ◽

Joseph Nguyen ◽

Katelyn Gasik ◽

Jacqueline Brady ◽

Beth E. Shubin Stein

Keyword(s):

Patellar Instability ◽

Medial Patellofemoral Ligament ◽

Trochlear Dysplasia ◽

Patellar Height ◽

Mpfl Reconstruction ◽

Tibial Tubercle ◽

Trochlear Groove ◽

One Year ◽

Recurrent Patellar Instability

Background: Several surgical options exist for treatment of recurrent patellar instability. The treatments can be divided into ligamentous and bony procedures. It is currently unclear which patients require a bony procedure in addition to a soft tissue reconstruction. Purpose: To report the one and two-year outcomes of patients following medial patellofemoral ligament (MPFL) reconstruction performed in isolation regardless of the patellar height, tibial tubercle trochlear groove distance (TT-TG) or trochlear dysplasia. Hypothesis:: Patients will have <5% re-dislocation rate and significant improvements in patient reported outcome measures (PROMs) following isolated MPFL reconstruction. Methods: All patients with recurrent patellar instability and without significant unloadable chondral defects, failed previous surgery or pain greater than or equal to 50% as their chief complaint, were prospectively enrolled beginning March of 2014. All patients underwent a primary, unilateral, isolated MPFL reconstruction regardless of concomitant bony pathology for treatment of recurrent patellar instability. Patients were followed at standard intervals. PROMs were collected at one year and two year follow up visits. Information on recurrent subjective instability, dislocations, and ability to return to sport (RTS) was recorded. TT-TG and patellar height (using the Caton-Deschamps index) were measured on magnetic resonance images. Results: Overall, 90 patients (77% female; average age 19.4 +/- 5.6 years) underwent a MPFL reconstruction from March 2014 to August 2017; 63 (70%) of whom reached one year follow up, and 35 of these patients (39%) reached 2-year follow-up. No patient experienced a redislocation; 96% of patients at one year and 100% of patients at two years had no subjective patellofemoral instability. RTS rates at one and two years were 59% and 75% respectively. No patient experienced a complication at one year. All patients had a clinically and statistically significant improvement from baseline to 1-year follow-up in the following PROMs: Knee injury and Osteoarthritis Outcome Score Quality of Life (KOOS QOL) (32.7 to 72.0; p<0.001), International Knee Documentation Committee (IKDC) (51.4 to 82.6; p<0.001) Kujala (62.2 to 89.5; p<0.001), and all general health PROM. No clinically and statistically significant change was seen between 1- and 2-year follow-ups in all outcome scores (all p>0.05). A non-statistically significant increase was seen in sporting activity of the Pediatric Functional Activity Brief Scale (Pedi-FABS) (13.9 to 16.7 p=0.292) at 2 years. Average patient satisfaction was 9.3 of 10 (10 being most satisfied) at 1- and 2-year follow-up. Average TT-TG was 15.1 +/- 4.0. Average patellar height was 1.25 +/- 0.17. Conclusion: Isolated MPFL reconstruction is an effective treatment for patellar instability and provides significant improvements in PROMs with a low redislocation/instability rate at early 1 and 2 year follow up, regardless of bony pathologies including TT-TG, Caton-Deschamps Index and trochlear dysplasia. The goal of this ongoing prospective study is to follow these patients out for 5 to 10 years to assess what radiologic and physical examination factors predict failure of isolated MPFL reconstruction.

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Clinical Outcomes and Predictive Factors for Failure With Isolated MPFL Reconstruction for Recurrent Patellar Instability: A Series of 211 Reconstructions With a Minimum Follow-up of 3 Years

The American Journal of Sports Medicine ◽

10.1177/0363546519838405 ◽

2019 ◽

Vol 47 (6) ◽

pp. 1323-1330 ◽

Cited By ~ 22

Author(s):

Elliot Sappey-Marinier ◽

Bertrand Sonnery-Cottet ◽

Padhraig O’Loughlin ◽

Herve Ouanezar ◽

Levi Reina Fernandes ◽

...

Keyword(s):

Patellar Instability ◽

Trochlear Dysplasia ◽

Patella Alta ◽

Mpfl Reconstruction ◽

Tibial Tubercle ◽

Trochlear Groove ◽

Kujala Score ◽

The Mean ◽

Recurrent Patellar Instability

Background: Reconstruction of the medial patellofemoral ligament (MPFL) is widely acknowledged as an integral part of the current therapeutic armamentarium for recurrent patellar instability. The procedure is often performed with concomitant bony procedures, such as distalization of the tibial tuberosity or trochleoplasty in the case of patella alta or high-grade trochlear dysplasia, respectively. At the present time, few studies have evaluated the clinical effectiveness of MPFL reconstruction as an isolated intervention. Purpose: To report the clinical outcomes of isolated MPFL reconstruction in cases of patellar instability and to identify predictive factors for failure. Study Design: Case series; Level of evidence, 4. Methods: A retrospective analysis of prospectively collected data was performed, including all patients who had undergone isolated MPFL reconstruction between January 2008 and January 2014. Preoperative assessment included the Kujala score, assessment of patellar tracking (“J-sign”), and radiographic features, such as trochlear dysplasia according to Dejour classification, patellar height with the Caton-Deschamps index (CDI), tibial tubercle–trochlear groove distance, and patellar tilt. The Kujala score was assessed postoperatively. Failure was defined by a postoperative patellar dislocation or surgical revision for recurrent patellar instability. Results: A total of 239 MPFL reconstructions were included; 28 patients (11.7%) were uncontactable and considered lost to follow-up. Thus, 211 reconstructions were analyzed with a mean follow-up of 5.8 years (range, 3-9.3 years). The mean age at surgery was 20.6 years (range, 12-48 years), and 55% of patients were male. Twenty-seven percent of patients had a preoperative positive J-sign, and 93% of patients had trochlear dysplasia (A, 47%; B, 25%; C, 15%; D, 6%). The mean CDI was 1.2 (range, 1.0-1.7); mean tibial tubercle–trochlear groove distance, 15 mm (range, 5-30 mm); and mean patellar tilt, 23° (range, 9°-47°). The mean Kujala score improved from 56.1 preoperatively to 88.8 ( P < .001). Ten failures were reported that required surgical revision for recurrent patellar instability (4.7%). Uni- and multivariate analyses highlighted 2 preoperative risk factors for failure: patella alta (CDI ≥1.3; odds ratio, 4.9; P = .02) and preoperative positive J-sign (odds ratio, 3.9; P = .04). Conclusion: In cases of recurrent patellar instability, isolated MPFL reconstruction would appear to be a safe and efficient surgical procedure with a low failure rate. Preoperative failure risk factors identified in this study were patella alta with a CDI ≥1.3 and a preoperative positive J-sign.

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MPFL reconstruction and tibial tuberosity transposition in patients with patellar instability: May it troubleshots also trochlear dysplasia?

Journal of Experimental Orthopaedics ◽

10.1186/s40634-021-00392-5 ◽

2021 ◽

Vol 8 (1) ◽

Author(s):

A. Castelli ◽

E. Jannelli ◽

E. Ferranti Calderoni ◽

G. Galanzino ◽

A. Ivone ◽

...

Keyword(s):

Patellar Instability ◽

Trochlear Dysplasia ◽

Functional Results ◽

Activity Level ◽

Tibial Tuberosity ◽

Mpfl Reconstruction ◽

Trochlear Groove ◽

Patellar Tilt ◽

Sulcus Angle

Abstract Purpose This study aimed to highlight short- and medium-term outcomes of combined medial patello-femoral ligament (MPFL) reconstruction and anterior tibial tuberosity (ATT) transposition surgery in patients with recurrent patellar instability and different degrees of trochlear dysplasia. Methods Between January 2014 and May 2019, 25 patients with patellar instability underwent a surgical procedure combining the lowering/transposition of the ATT and the MPFL reconstruction. Each patient were preoperative assessed by Kujala score, International Knee Documentation Committee (IKDC), Tegner activity level scale. The assessment of instability predisposing factors was carried out with patellar height, tibial tuberosity-trochlear groove (TT-TG) distance, trochlear dysplasia, sulcus angle, patellar tilt and MPFL injuries. Functional outcomes were evaluated with Kujala, IKDC and Tegner scores at 3, 6 and 12 months after surgery. Results The average age of the patients was 20 years (range 13–43 years). Pre- operative Caton–Deschamps index was pathological in 10 (40%). Sulcus angle was elevated in 13 patients (52%) and TT-TG distance was irregular in 17 patients (68%). Trochlear dysplasia was present in 13 patients (9 type A, 3 type B, 1 type C according to Dejour’s Classification). No re-dislocation occurred during the follow-up. There was a significant increase in the Kujala, IKDC and Lysholm scores after 3, 6 and 12 months, and the results were compared for the different follow-up times and patient’s trochlear dysplasia degree. Conclusion This prospective observational longitudinal study identified good clinical outcomes in patients who underwent MPFL reconstruction and ATT transposition for patellar instability. Finally, the different risk factors for patellar instability examined, particularly the presence of trochlear dysplasia, did not significantly influence the final functional results, which range from good to excellent without re-dislocation episodes.

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Prevalence of Trochlear Dysplasia and Associations with Patellofemoral Pathology (166)

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121s00288 ◽

2021 ◽

Vol 9 (10_suppl5) ◽

pp. 2325967121S0028

Author(s):

Clarabelle DeVries ◽

James Bomar ◽

Andrew Pennock

Keyword(s):

General Population ◽

Patellar Instability ◽

Trochlear Dysplasia ◽

Patellofemoral Pain ◽

High Grade ◽

Sulcus Angle ◽

Increased Risk ◽

History Of ◽

Total Knee ◽

The Mean

Objectives: Patellar instability is a common condition of adolescents with an incidence of 29 to 43 per 100,000. Trochlear dysplasia has been found in up to 85% of those with recurrent patellar instability and has been found in association with ACL rupture. However, the prevalence of trochlear dysplasia in the general population has not yet been defined. The purpose was to define the prevalence of trochlear dysplasia as defined by ultrasound in a skeletally mature population and characterize associations of trochlear dysplasia with patellofemoral pathology. Methods: Skeletally mature adolescents and parents aged 50 and under presenting to orthopedics clinics were recruited from 2019 to 2020. Those with a history of intra-articular fracture, total knee arthroplasty, and syndromic ligamentous laxity or neuromuscular disease were excluded. Surveys were collected detailing any history of knee symptoms and surgery as well as an abbreviated Anterior Knee Pain Score (AKPS) with a score of 4 or greater being considered positive. Ultrasounds were obtained of bilateral knees and the osseous sulcus angle of the trochlea as well as the trochlear depth were measured (Figure 1). Basic descriptive statistics are reported. Results: One hundred and two patients (203 knees) were studied. The mean osseous sulcus angle was 144.1±6.8° and the mean trochlear depth was 5.5±1.4mm. The distribution of outcomes of interest can be found in Table 1. High grade trochlear dysplasia was defined as two standard deviations from the mean which was shown to be a sulcus angle ≥158˚ or a trochlear depth of ≤3mm. Prevalence of high grade trochlear dysplasia based on sulcus angle was 3.0% and 5.9% based on trochlear depth. In the presence of high grade trochlear dysplasia as defined by osseous sulcus angle, there was a 32 times increased risk of previous patellar instability (p=0.007) and 10 times increased risk of a positive AKPS (p=0.016). All those with high grade trochlear dysplasia as defined by osseous sulcus angle had a history of, or current, patellofemoral pain. Conclusions: The prevalence of trochlear dysplasia in the general population is approximately 6%. There are significant associations of trochlear dysplasia not only with patellar instability but also with patellofemoral pain. Use of ultrasound to diagnose trochlear dysplasia may prove to be a rapid and useful tool in guiding patient education and treatment decisions.

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Safety and Efficacy of Cryoballoon versus Radiofrequency Ablation for Atrial Fibrillation in Elderly Patients and Predictors of Arrhythmia Recurrence

10.22541/au.160910676.61341519/v1 ◽

2020 ◽

Author(s):

Tauseef Akhtar ◽

Usama Daimee ◽

Bhradeev Sivasambu ◽

Erica Hart ◽

Eunice Yang ◽

...

Keyword(s):

Atrial Fibrillation ◽

Elderly Patients ◽

The United States ◽

Rf Ablation ◽

Limited Data ◽

Safety And Efficacy ◽

Significant Difference ◽

The Mean ◽

One Year

Introduction: There are limited data describing the experience of index radiofrequency (RF) vs. cryoballoon (CB) ablation for atrial fibrillation (AF) among elderly patients in the United States. Methods: We conducted a retrospective analysis of patients > 75 years of age undergoing index AF ablation between January 2010 and March 2019 at our center. Major complications and efficacy, defined as freedom from any atrial tachyarrhythmia (ATA) lasting ≥30 seconds after one year of follow-up, were assessed in patients with index RF vs. CB ablation. Predictors of ATA recurrence at 1 year follow-up were also evaluated. Results: In our cohort of 194 patients, the mean age was 78 ± 3.1 years, 58.2% were men, and 39.4% had persistent AF. The mean left atrial (LA) diameter was 4.5 ± 0.7, while the mean CHA2DS2-VASc score was 3.5 ± 1.2. The majority (n=149, 76.8%) underwent RF ablation. The incidence of complications was similar in the two sub-groups (RF: 1.3% vs. CB: 2.2%, p=0.67). No significant difference in success rate at 1-year follow-up was found between patients receiving RF vs. CB ablation (59.7% vs. 66.7%, p=0.68). In a multivariable model adjusting for the relevant covariates only LA size [HR=1.64, CI: 1.15-2.34, p<0.01] was independently associated with ATA recurrence at 1year follow-up. Conclusion: In our cohort of elderly patients undergoing index CA for AF, RF ablation was the predominant modality with similar safety and efficacy relative to CB ablation. LA size was a significant predictor of ATA recurrence at 1year independent of index ablation modality.

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Tibial Tubercle Osteotomy and Medial Patellofemoral Ligament Imbrication for Patellar Instability Due to Trochlear Dysplasia

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119865172 ◽

2019 ◽

Vol 7 (8) ◽

pp. 232596711986517

Author(s):

Jonathan D. Hodax ◽

Michael P. Leathers ◽

David Y. Ding ◽

Brian T. Feeley ◽

Christina R. Allen ◽

...

Keyword(s):

Patient Satisfaction ◽

Patellar Instability ◽

Medial Patellofemoral Ligament ◽

Trochlear Dysplasia ◽

Patellofemoral Instability ◽

Recurrent Dislocation ◽

Tibial Tubercle ◽

Tibial Tubercle Osteotomy ◽

The Mean

Background: The treatment of patellar instability in the setting of trochlear dysplasia is challenging. Purpose/Hypothesis: The purpose of this study was to evaluate outcomes for the treatment of recurrent patellar dislocations due to trochlear dysplasia using anteromedialization tibial tubercle osteotomy combined with medial patellofemoral ligament (MPFL) imbrication. We hypothesized that the treatment of patellar instability with tibial tubercle osteotomy and MPFL imbrication would result in improved patient satisfaction and decrease patellar instability events in patients with prior instability and trochlear dysplasia. Study Design: Case series; Level of evidence, 4. Methods: We performed a retrospective analysis of patients who underwent MPFL imbrication and concomitant anteromedialization tibial tubercle osteotomy for recurrent patellofemoral instability at a single institution. The minimum follow-up was 1 year. Patient demographic information including age at the time of surgery, sex, body mass index (BMI), tibial tubercle–trochlear groove (TT-TG) distance, and grade of trochlear dysplasia was collected along with relevant operative data. Postoperatively, recurrent dislocation events as well as Knee injury and Osteoarthritis Outcome Score (KOOS), Western Ontario and McMaster Universities Osteoarthritis Index, and Kujala scores were collected, and satisfaction was ascertained by asking patients whether they would undergo the procedure again. Results: A total of 37 knees from 31 patients (23 female) with a mean follow-up of 3.8 years (range, 1-8.9 years) were included. The mean patient age was 28.8 years (range, 14-45 years), the mean BMI was 24 kg/m2 (range, 20-38 kg/m2), and the mean preoperative TT-TG distance was 18.9 mm (range, 8.4-32.4 mm). Two knees were classified as low-grade trochlear dysplasia (Dejour A) and 35 as high-grade trochlear dysplasia (Dejour B-D). At final follow-up, patients reported mean KOOS subscale scores of 86.5 (Pain), 79.8 (Symptoms), 93.9 (Activities of Daily Living), 74.3 (Sports/Recreation), and 61.9 (Quality of Life), as well as a mean Kujala score of 81.3. Mean patient satisfaction was 8.3 of 10. The majority of knees (86.5%; 32/37) remained stable without recurrent instability after this procedure, while 13.5% (5 knees) suffered a recurrent dislocation, with 2 requiring revision surgery. Eight knees (21.6%) underwent subsequent hardware removal. Conclusion: Anteromedialization tibial tubercle osteotomy with MPFL imbrication can improve recurrent patellofemoral instability and provide significant clinical benefit to patients with trochlear dysplasia.

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Changes in femoral trochlear morphology following surgical correction of recurrent patellar dislocation associated with trochlear dysplasia in children

The Bone & Joint Journal ◽

10.1302/0301-620x.100b6.bjj-2017-1295.r1 ◽

2018 ◽

Vol 100-B (6) ◽

pp. 811-821 ◽

Cited By ~ 11

Author(s):

K. Fu ◽

G. Duan ◽

C. Liu ◽

J. Niu ◽

F. Wang

Keyword(s):

Patellar Dislocation ◽

Trochlear Dysplasia ◽

Morphological Characteristics ◽

Groove Depth ◽

Surgical Correction ◽

Trochlear Groove ◽

Recurrent Patellar Dislocation ◽

Sulcus Angle ◽

The Mean

Aims The aim of this study was to investigate the changes in femoral trochlear morphology following surgical correction of recurrent patellar dislocation associated with trochlear dysplasia in children. Patients and Methods A total of 23 patients with a mean age of 9.6 years (7 to 11) were included All had bilateral recurrent patellar dislocation associated with femoral trochlear dysplasia. The knee with traumatic dislocation at the time of presentation or that had dislocated most frequently was treated with medial patellar retinacular plasty (Group S). The contralateral knee served as a control and was treated conservatively (Group C). All patients were treated between October 2008 and August 2013. The mean follow-up was 48.7 months (43 to 56). Axial CT scans were undertaken in all patients to assess the trochlear morphological characteristics on a particular axial image which was established at the point with the greatest epicondylar width based on measurements preoperatively and at the final follow-up. Results Preoperatively, there were no statistically significant differences between the trochlear morphology in the two groups (sulcus angle, p 0.852; trochlear groove depth, p 0.885; lateral trochlear inclination, p 0.676; lateral-to-medial facet ratio, p 0.468; lateral condylar height, p 0.899; medial condylar height, p 0.816). Many radiological parameters of trochlear morphology were significantly different between the two groups at the final follow-up, including well-known parameters, such as the mean sulcus angle (Group S, 146.27° (sd 7.18); Group C, 160.61° (sd 9.29); p < 0.001), the mean trochlear groove depth (Group S, 6.25 mm (sd 0.41); Group C, 3.48 mm (sd 0.65); p < 0.001) and the mean lateral trochlear inclination (Group S, 20.99° (sd 3.87); Group C, 12.18° (sd 1.85); p < 0.001). Lesser known parameters such as the ratio of the lateral to medial trochlear length (Group S, 1.46 (sd 0.19); Group C, 2.14 (sd 0.42); p < 0.001), which is a measurement of facet asymmetry, and the lateral and medial condylar height were also significantly different between the two groups (p < 0.001). Conclusion The femoral trochlear morphology can be improved by early (before epiphyseal closure) surgical correction in children with recurrent patellar dislocation associated with femoral trochlear dysplasia. Cite this article: Bone Joint J 2018;100-B:811–21.

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Robotic-Assisted Patellofemoral Replacement—Correlation of Preoperative Planning with Intraoperative Implant Position and Early Clinical Experience: A Minimum 2-Year Follow-up

The Journal of Knee Surgery ◽

10.1055/s-0040-1716848 ◽

2020 ◽

Author(s):

Veenesh Selvaratnam ◽

Andrew Cattell ◽

Keith S. Eyres ◽

Andrew D. Toms ◽

Jonathan R. P. Phillips ◽

...

Keyword(s):

Functional Outcome ◽

Preoperative Planning ◽

Trochlear Dysplasia ◽

Oxford Knee Score ◽

Implant Position ◽

Robotic Assisted ◽

Implant Positioning ◽

Flexion Extension ◽

The Mean

AbstractPatello-femoral arthroplasty (PFA) is successful in a selected group of patients and yields a good functional outcome. Robotic-assisted knee arthroplasty has been shown to provide better implant positioning and alignment. We aim to report our early outcomes and to compare Mako's (Robotic Arm Interactive Orthopaedic System [RIO]) preoperative implant planning position to our intraoperative PFA implant position. Data for this study was prospectively collected for 23 (two bilateral) patients who underwent robotic-assisted PFA between April 2017 and May 2018. All preoperative implant position planning and postoperative actual implant position were recorded. Presence of trochlear dysplasia and functional outcome scores were also collected. There were 17 (two bilateral) female and 6 male patients with a mean age of 66.5 (range: 41–89) years. The mean follow-up period was 30 (range: 24–37) months. Eighteen knees (72%) had evidence of trochlear dysplasia. The anterior trochlear line was on average, 7.71 (range: 3.3–11.3) degrees, internally rotated to the surgical transepicondylar axis and on average 2.9 (range: 0.2–6.5) degrees internally rotated to the posterior condylar line. The preoperative planning range was 4-degree internal to 4-degree external rotation, 4-degree varus to 6-degree valgus, and 7-degree flexion to 3-degree extension. The average difference between preoperative planning and intraoperative implant position was 0.43 degrees for rotation (r = 0.93), 0.99 degrees for varus/valgus (r = 0.29), 1.26 degrees for flexion/extension (r = 0.83), and 0.34 mm for proudness (r = 0.80). Six patients (24%) had a different size component from their preoperative plan (r = 0.98). The mean preoperative Oxford Knee Score (OKS) was 16 and the mean postoperative OKS was 42. No patient had implant-related revision surgery or any radiological evidence of implant loosening at final follow-up. Our early results of robotic PFA are promising. Preoperative Mako planning correlates closely with intraoperative implant positioning. Longer follow-up is needed to assess long-term patient outcomes and implant survivorship.

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Patient Related Outcome Measures (PROMs) in Morton’s Neuroma: Conservative vs. Surgical Management at One-Year Follow-Up

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00021 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0002

Author(s):

Alastair Faulkner ◽

Alistair Mayne ◽

Fraser Harrold

Keyword(s):

Outcome Measures ◽

Surgical Management ◽

Conservative Management ◽

Morton’S Neuroma ◽

Significant Difference ◽

Morton's Neuroma ◽

One Year ◽

Patient Related Outcome ◽

Eq Vas

Category: Midfoot/Forefoot Introduction/Purpose: Morton’s neuroma is a common condition affecting the foot and is associated with chronic pain and disability. Conservative management including a combination of orthotic input; injection or physiotherapy, and surgical excision are current treatment options. There is a paucity of literature regarding patient related outcome measures (PROMs) data in patients managed conservatively. We sought to compare conservative with surgical management of Morton’s neuroma using PROMs data in patients with follow-up to one year. Methods: Prospective data collection commenced from April 2016. Patients included had to have a confirmed Morton’s neuroma on ultrasound scan. Patient demographics including age, sex and BMI were collected. The primary outcome measures were the Manchester Foot Score for pain (MOX-FQ), EQ time trade off (TTO) and EQ visual analogue scale (VAS) taken pre-operatively; at 26-weeks and at 52-weeks post-operatively. Results: 194 patients were included overall: 79 patients were conservatively managed and 115 surgically managed. 19 patients were converted from conservative to surgical management. MOX-FQ pain scores: pre-op conservative 52.15, surgical 61.56 (p=0.009), 6-months conservative 25.1, surgical 25.39 (p=0.810), 12 months conservative 18.54, surgical 20.52 (p=0.482) EQ-TTO scores: pre-op conservative 0.47, surgical 0.51 (p=0.814), 6-months conservative 0.41, surgical 0.49 (p=0.261), 12 months conservative 0.26, surgical 0.37 (p=0.047) EQ-VAS scores: pre-op conservative 63.84, surgical 71.03 (p=0.172), 6-months conservative 46.10, surgical 52.51 (p=0.337), 12 months conservative 30.77, surgical 37.58 (p=0.227) Satisfaction at 12 months: conservative 17 (21.5%), surgical 32 (27.8%) p=0.327 Conclusion: This is one of the first studies investigating long-term PROMs specifically in conservative management for Morton’s neuroma patients. There was no significant difference in pain score and EQ-VAS between all conservative treatments and surgical management at 12 months There was no significant difference in satisfaction at 12 months between conservative and surgical groups.

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