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TROCHLEOPLASTY FOR A DISLOCATING KNEECAP

Method
Deepening of the groove (trochlea) where it is dysplastic
Duration
about 90 minutes
Recovery time
4 to 6 months

Trochleoplasty is a specialised surgical procedure for treating trochlear dysplasia – that is, a flattened or malformed groove in the thigh bone in which the kneecap (patella) is normally held stably. This malformation is a major risk factor for the kneecap slipping out repeatedly.

The aim of the operation is to restore a natural, V-shaped groove in which the kneecap can be held centred and stable – particularly where the dysplasia is severe (Dejour B-D). Trochleoplasty is often part of a combined surgical concept for instability of the kneecap.

What is a trochleoplasty?

After arthroscopic assessment and planning, the lower thigh bone is exposed openly. The cartilage of the groove is lifted superficially and a bony channel is then deepened with a special burr. The plate of cartilage is laid back into it without tension and fixed with bioabsorbable pins or small titanium screws.

Trochleoplasty can be combined with further procedures such as an MPFL reconstruction, a transfer of the tibial tuberosity or a corrective osteotomy, in order to achieve the best possible biomechanical result.

Rehabilitation after a trochleoplasty

Aftercare following a trochleoplasty proceeds step by step and requires close co-operation with the physiotherapists. Controlled mobilisation protects the reconstructed groove and supports the healing of the bone:

Phase I (0-6 weeks): protective phase
  • Partial weight-bearing with forearm crutches (about 20 kg)
  • Orthosis with a limited range of movement (for instance 0-60°)
  • CPM splint for passive mobilisation
  • Cooling, elevation, lymphatic drainage
Phase II (6-12 weeks): building up load
  • Increasing the load under physiotherapy supervision
  • Muscle-building programme: quadriceps, gluteal muscles
  • Increasing active movement up to free flexion
Phase III (from week 12): functional integration
  • Gait training, balance and proprioception
  • Sport-specific training (from about 4-6 months)
  • Return-to-activity testing