Bilateral Trochleoplasty Procedures Following Bilateral Femoral Rotational Osteotomies for Bilateral Dejour Type D Trochlear Dysplasia.

BACKGROUND

Trochlear dysplasia is a considerable risk factor for patellar instability. Surgical treatment options include medial patellofemoral ligament reconstruction, medial quadriceps tendon-femoral ligament reconstruction, femoral rotational osteotomy, tibial tubercle osteotomy, and trochleoplasty.

CASE REPORT: A 26-year-old female presented with bilateral knee pain and recurrent patellar dislocations since childhood that were unresponsive to physical therapy and bracing. Initial evaluation by an orthopedic trauma service revealed excessive femoral anteversion and Dejour type D trochlear dysplasia bilaterally. A right femoral rotational osteotomy with intramedullary nail fixation improved right-sided patellar stability. Eighteen months after the first surgery, the patient underwent a planned left femur rotational osteotomy. The patient continued to experience recurrent bilateral patellar subluxation and was referred for definitive treatment. Examination demonstrated bilateral patellar subluxation at rest and positive J-sign on flexion, with the left knee more symptomatic than the right. Imaging revealed healed osteotomies, persistent Dejour type D trochlear dysplasia, and elevated tibial tubercle-trochlear groove distances bilaterally. Merchant view radiographs and magnetic resonance imaging showed substantial lateral patellar subluxation on the left with intact patellofemoral cartilage. Computed tomography confirmed bilateral trochlear dysplasia. The patient underwent left knee recession wedge trochleoplasty, tibial tubercle osteotomy, and medial quadriceps tendon-femoral ligament reconstruction. One year later, the same procedures were performed on the right knee with good results.

CONCLUSION

Trochleoplasty, tibial tubercle osteotomy, and medial quadriceps tendon-femoral ligament reconstruction are effective when performed concomitantly for recalcitrant patellar instability associated with trochlear dysplasia and failed prior surgical intervention.