C-Arm Guidance During Thin Flap Arthroscopic Trochleoplasty for Chronic Patellar Instability

The purpose of this paper is to provide a complete Technical Note for our treatment of choice for recurrent patellar dislocation in cases of trochlear dysplasia, especially in patients with types B and D trochlear dysplasia according to the Dejour classification. Different surgical procedures have been reported for the treatment of recurrent patellar instability. One of the most important anatomic factors to address when treating a recurrent patella dislocation is trochlear dysplasia. Few types of open trochleoplasty have been classically described to treat a dysplastic trochlea. However, in recent years, arthroscopic techniques have been reported to reduce invasiveness and complications as well as to improve accuracy and clinical outcomes. In this technique is described an arthroscopic thin-flap tracheoplasty with the use of C-arm guidance in order to precisely control the bone resection and to verify intraoperatively the disappearance of the radiologic landmarks used for diagnosis and classification of the dysplasia. The advantage of this technique is the precision in removal of the supratrochlear spur and bump, the accurate and delicate reshaping of the sulcus with preservation of cartilage vitality, combined with increased reproducibility and safety.