Trochleoplasty in Pediatric Patients - A Systematic Review.

Background: Trochleoplasty is a surgical consideration for the treatment of high-grade trochlear dysplasia. The safety profile of this procedure remains particularly unclear in the skeletally immature population where concerns exist regarding physeal arrest and the development of premature patellofemoral arthritis. The purpose of this study was to systematically review the literature to evaluate trochleoplasty use, outcomes and complications observed among pediatric patients.

Methods: A systematic review was performed in accordance with PRISMA guidelines reviewing PubMed, SCOPUS, and Embase databases. Inclusion criteria were studies with a mean cohort age ≤ 18 in which individualized patient characteristics and resultant outcomes were reported after trochleoplasty. Patient demographics, dysplasia type, procedure type and patient outcomes were abstracted when available and summarized with descriptive statistics.

Results: Our search strategy identified 7 studies published from 2006-2020 that included 108 patients (mean age = 14.3) with a mean follow up of 27.6 months (range 12-60 months). All but one were classified as Level IV evidence (mean MINORS score of 10.5 [6-13]). Most patients were classified according to Dejour (107/108). The Bereiter technique was used most often (83/108). In studies including patient-reported outcome measures, mean Kujala and Lysholm scores increased postoperatively. Recurrent instability occurred in 1 patient (1%) following trochleoplasty. Postoperative complications, most commonly arthrofibrosis, were observed in 13% of patients (14/108). Premature radiographic osteoarthritic changes were identified in a single study using the Albee lateral wedge augmentation and observed in 4 of 23 (17.4%) of patients. No study identified premature physeal arrest or growth disturbance.

Conclusion: There remains a limited evidence base regarding trochleoplasty use in pediatric patients. Overall, favorable outcomes have been observed with infrequent recurrent instability and no reported growth disturbance from physeal arrest. Patellofemoral arthritic changes were observed radiographically in a small subgroup of patients undergoing a single trochleoplasty technique. Further work is necessary to determine if this is a result of the procedure itself or the underlying pathology being treated. As interest grows in implementing trochleoplasty in the pediatric population and among skeletally immature individuals, further work is necessary to clarify the complication profile in this population to appropriately counsel patients and inform surgical decision-making. Level of Evidence: III.