Sulcus-Deepening Trochleoplasty and Medial Patellofemoral Ligament Reconstruction Provide Good Clinical Outcomes in Addressing Patellar Instability at Mid-Term Follow-Up: A Retrospective Case Series.

Purpose: To update previously published clinical and radiographic outcomes of Dejour sulcus-deepening trochleoplasty and medial patellofemoral ligament reconstruction (MPFL-R), at mid-term follow-up, and monitor trends in patient reported outcome scores and satisfaction.

Methods: Using the same cohort of patients from our previously published short-term series of 2-year follow up, interval follow-up was performed on 67 patients (76 knees) with severe trochlear dysplasia and recurrent patellar instability who were prospectively enrolled and underwent Dejour sulcus-deepening trochleoplasty and MPFL-R combined with other patellar-stabilization procedures. Patients with less than 2-year follow-up were excluded. Evaluation involved radiographic analysis, physical examination, clinical follow-up, and patient-reported outcome scores.

Results: 37 patients (45 knees) were included in the current study, with mean follow-up of 6.1 years postoperatively (Standard deviation [SD] 2.7 years). Two interval re-operations were performed (arthroscopic lysis of adhesions; hardware removal and arthroscopic shaving chondroplasty). There remained no occurrences of re-operation for recurrent patellar instability. Patient reported outcomes were largely stable from early (mean 3.6 years) to mid-term (mean 6.1 years) follow up with no statistically significant difference between early and mid-term International Knee Documentation Committee (IKDC) (P = 0.75), Kujala (P = 0.47) or VAS (Visual analog scale) pain (P = 0.06) scores. Compared to preoperative knee scores, there was a significant difference in IKDC (49.3 vs 82.0, P < 0.001, d = 1.85), Kujala (56.5 vs 89.3, P < 0.001, d = 2.03), and VAS pain (3.8 vs 1.9, P = 0.003, d = 0.33) scores at mid-term follow up (mean 6.1 years). Mean Kellgren-Lawrence grading of patellofemoral arthritis showed no statistically significant change from 0.56 to 0.52 (P = 0.511) on sunrise radiographs at the most recent follow-up.

Conclusions: At mid-term follow-up, Dejour sulcus-deepening trochleoplasty and MPFL-R, combined with other patellar stabilization procedures, achieves durable resolution of patellar instability with maintained patient-reported outcome scores and satisfaction rates, and is without interval evidence of clinical or radiographic progression of patellofemoral arthritis.

Level of evidence: IV, Case Series.