Lateral trochlear lengthening osteotomy

INTRODUCTION: The purpose of this study was to describe the indications and technical aspects as well as evaluate the clinical and functional outcome of lengthening osteotomy of the lateral trochlear ridge in patients with patellofemoral pain and/or patella instability and presence of trochlear dysplasia Dejour type A or lack of Dejour type dysplasia and short lateral articular trochlea. MATERIALS AND METHODS: Six consecutive adult patients were treated with a lateral trochlear lengthening osteotomy. Five patients received a concomitant medial patellofemoral ligament reconstruction. Three patients had prior patella stabilization surgeries. Trochlea dysplasia (Dejour classification), Caton–Dechamps index, tibial tubercle trochlear groove (TT-TG) distance, patellar tilt and lateral condylar index were measured in preoperative MRIs. Clinical and functional evaluation included the Kujala Anterior Knee Pain Scale, the Lysholm Knee Score, the Tegner Activity Score, a subjective evaluation form and isokinetic muscle strength. RESULTS: Four patients had a Dejour type A dysplasia, two patients had no dysplasia. The mean (range) Caton-Dechamps index was 1.09 (0.95–1.16), TT-TG distance 10.9 mm (9.2–15.6 mm), patellar tilt 15° (4–32°) and lateral condylar index 82.0% (74–90%). One patient was lost to follow up, all others were followed for 2–5 years. All patients were satisfied with the clinical outcome. The Lysholm score increased from 55 (37–79) to 89 (76–100), the Tegner activity score from 3.6 (2–6) to 5.6 (5–7). The Kujala score postoperative was 90 (75–96). Some but not all patients had full strength recovery compared to the contralateral leg. CONCLUSION: We recommend measuring the lateral condylar index and considering the indication of a lateral trochlear lengthening osteotomy as an additional or isolated procedure in selected patients with trochlear dysplasia Dejour type A or lack of dysplasia and short lateral articular trochlea depending on the extent of the patellar instability. LEVEL OF EVIDENCE: Level IV, Case Series. TRIAL REGISTRATION NUMBER: NCT04378491, clinicaltrials.gov, May 7, 2020.