The evaluation and treatment of trochlear dysplasia
Howard, Daniel Scott
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Patellofemoral instability is a difficult condition to treat, owing to the complex anatomy of the patellofemoral joint. The bony structures of the patellofemoral joint include the patella, the largest sesamoid bone in the human body, and the femoral trochlear, a cartilaginous groove at the distal end of the femur in which the patella slides during knee flexion. Many contributing factors have been identified in patients with recurrent patellofemoral instability, but dysplasia of the trochlear groove has been established as the most significant with it identified in 85% of patients with patellofemoral instability. Despite ample evidence of trochlear dysplasia’s impact on patellofemoral instability, little consensus has been reached on both the evaluation and treatment of trochlear dysplasia. Some of the patient-reported outcome measures commonly implemented in studies of patellofemoral instability interventions have recently fallen into question, with newer measures proposed to better capture the nature of the condition. One surgical procedure that has received attention in the past couple of decades is trochleoplasty, which involves reshaping the dysplastic trochlear groove to a more physiological anatomy. This would seem to be the most logical solution in the treatment of trochlear dysplasia, but it is relatively under-researched and avoided with many surgeons citing the technical difficulty of the procedure. This review intends to evaluate the assessments and treatments applied to patients with patellofemoral instability due to trochlear dysplasia and consider trochleoplasty as an appropriate primary surgical treatment.