Open and arthroscopic deepening trochleoplasty improves post-operative outcomes: A systematic review of the literature reveals lack of comparability between techniques

IF 5 2区医学 Q1 ORTHOPEDICS Knee Surgery, Sports Traumatology, Arthroscopy Pub Date : 2025-03-17 DOI:10.1002/ksa.12647

Signe Høj, Johanne Kofoed Lundegaard, Lars Blønd, Peter Lavard, Anke Simone Rechter, Christian Dippmann, Kristoffer W. Barfod

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Abstract

Purpose

Deepening trochleoplasty improves outcomes in patients with trochlear dysplasia. The aim of this systematic review was to present the outcomes after open thin-flap, open thick-flap and arthroscopic deepening trochleoplasty.

Methods

A systematic review was conducted using the PRISMA guidelines. Literature was searched in the PubMed, EMBASE and Cochrane databases on 16 December 2024. All studies from the inception of the databases to the date of the search were included in the search. Studies were included if they examined patients with patellar instability and trochlear dysplasia treated with either open or arthroscopic deepening trochleoplasty and reported pre- and post-operative outcomes. Two independent reviewers screened titles and abstracts, reviewed the full text and performed the quality assessment.

Results

A total of 32 studies, consisting of 1435 trochleoplasty cases in 1310 patients, were included. Of the included studies, 21 concerned open thin-flap trochleoplasty, 8 concerned open thick-flap trochleoplasty and 3 concerned arthroscopic trochleoplasty. The most used patient-reported outcome measures were the Kujala score, International Knee Documentation Committee score, visual analogue scale pain score, Lysholm Knee Score and Tegner Activity Scale; and the most reported radiological outcome measures were trochlear sulcus angle, trochlear bump, trochlear depth, tibial tubercle-trochlear groove distance, Caton–Deschamps index and patellar tilt. All three trochleoplasty techniques lead to improvements in post-operative outcome measures.

Conclusion

Deepening trochleoplasty improves post-operative outcome using both open thin-flap, open thick-flap and arthroscopic deepening technique. Comparison between the techniques is challenging due to low methodological quality of studies. Further research is needed to document treatment effect and improve patient outcome.

Level of Evidence

Level IV.

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开放和关节镜下加深滑车成形术可改善术后预后：对文献的系统回顾显示技术之间缺乏可比性。

目的：滑车加深成形术改善滑车发育不良患者的预后。本系统综述的目的是介绍切开薄瓣、切开厚瓣和关节镜下加深滑车成形术后的结果。方法：采用PRISMA指南进行系统评价。文献于2024年12月16日在PubMed、EMBASE和Cochrane数据库中检索。从数据库建立到检索日期的所有研究都包括在检索中。通过开放或关节镜下加深滑车成形术治疗髌骨不稳和滑车发育不良的患者并报告术前和术后结果的研究被纳入。两名独立审稿人筛选标题和摘要，审阅全文并进行质量评估。结果：共纳入32项研究，1310例患者，1435例滑囊成形术。在纳入的研究中，21例涉及切开薄瓣滑车成形术，8例涉及切开厚瓣滑车成形术，3例涉及关节镜滑车成形术。最常用的患者报告的结局指标是Kujala评分、国际膝关节文献委员会评分、视觉模拟量表疼痛评分、Lysholm膝关节评分和Tegner活动量表；报道最多的放射学指标是滑车沟角度、滑车肿块、滑车深度、胫骨结节-滑车沟距离、卡顿-德尚指数和髌骨倾斜。所有三种滑车成形术均可改善术后预后指标。结论：切开薄瓣、切开厚瓣及关节镜下加深技术均可改善滑车成形术的术后疗效。由于研究的方法学质量较低，技术之间的比较具有挑战性。需要进一步的研究来证明治疗效果并改善患者预后。证据等级：四级。

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来源期刊

Knee Surgery, Sports Traumatology, Arthroscopy 医学-外科

CiteScore

8.10

自引率

18.40%

发文量

418

审稿时长

2 months

期刊介绍： Few other areas of orthopedic surgery and traumatology have undergone such a dramatic evolution in the last 10 years as knee surgery, arthroscopy and sports traumatology. Ranked among the top 33% of journals in both Orthopedics and Sports Sciences, the goal of this European journal is to publish papers about innovative knee surgery, sports trauma surgery and arthroscopy. Each issue features a series of peer-reviewed articles that deal with diagnosis and management and with basic research. Each issue also contains at least one review article about an important clinical problem. Case presentations or short notes about technical innovations are also accepted for publication. The articles cover all aspects of knee surgery and all types of sports trauma; in addition, epidemiology, diagnosis, treatment and prevention, and all types of arthroscopy (not only the knee but also the shoulder, elbow, wrist, hip, ankle, etc.) are addressed. Articles on new diagnostic techniques such as MRI and ultrasound and high-quality articles about the biomechanics of joints, muscles and tendons are included. Although this is largely a clinical journal, it is also open to basic research with clinical relevance. Because the journal is supported by a distinguished European Editorial Board, assisted by an international Advisory Board, you can be assured that the journal maintains the highest standards. Official Clinical Journal of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA).