J Knee Surg 2017; 30(09): 887-893
DOI: 10.1055/s-0037-1598038
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Quality-of-Life Outcomes of Patients following Patellofemoral Stabilization Surgery: The Influence of Trochlear Dysplasia

Laurie Anne Hiemstra
1   Department of Orthopaedics, Banff Sport Medicine, Banff, Canada
2   Department of Surgery, University of Calgary, Calgary, Canada
,
Sarah Kerslake
1   Department of Orthopaedics, Banff Sport Medicine, Banff, Canada
,
Mark R. Lafave
3   Department of Physical Education and Recreation Studies, Mount Royal University, Calgary, Canada
› Author Affiliations
Further Information

Publication History

22 February 2016

19 December 2016

Publication Date:
20 February 2017 (online)

Abstract

Trochlear dysplasia is a well-described risk factor for recurrent patellofemoral instability. Despite its clear association with the incidence of patellofemoral instability, it is unclear whether the presence of high-grade trochlear dysplasia influences clinical outcome after patellofemoral stabilization. The purpose of this study was to assess whether trochlear dysplasia influenced patient-reported, disease-specific outcomes in surgically treated patellar instability patients, when risk factors were addressed in accordance with the à la carte surgical approach to the treatment of patellofemoral instability. The study design is of a case series. A total of 318 patellar stabilization procedures were performed during the study period. Of these procedures, 260 had adequate lateral radiographs and complete Banff Patellar Instability Instrument (BPII) scores available for assessment. A Pearson r correlation was calculated between four characteristics of trochlear dysplasia, the BPII total and the BPII symptoms, and physical complaints scores, a mean of 24 months following patellofemoral stabilization. Independent t-tests were performed between stratified trochlear dysplasia groups (no/low grade and high grade) and all BPII measures. There was a statistically significant correlation between measures of trochlear dysplasia and quality-of-life physical symptoms scores, an average of 2 years following patellofemoral stabilization surgery. The BPII symptoms and physical complaints domain score, as well as the individual weakness and stiffness questions, correlated with the classification of trochlear dysplasia as well as the presence of a trochlear bump (p < 0.05). Independent t-tests demonstrated statistically significant differences between the no/low-grade and high-grade dysplasia groups for the BPII stiffness (p = 0.002), BPII weakness (p = 0.05) and BPII symptom, and physical complaints values (p = 0.04). Two additional measures—the 24-month postoperative total BPII score (p = 0.11) and BPII pain score (p = 0.07)—demonstrated trends toward statistical significance. This research has established a statistically significant correlation between trochlear dysplasia and disease-specific quality-of-life outcomes following patellofemoral stabilization surgery. There was a significant correlation between patient-reported physical symptoms after surgery and high-grade trochlear dysplasia.

 
  • References

  • 1 Dejour H, Walch G, Nove-Josserand L, Guier C. Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc 1994; 2 (01) 19-26
  • 2 Balcarek P, Oberthür S, Hopfensitz S. , et al. Which patellae are likely to redislocate?. Knee Surg Sports Traumatol Arthrosc 2014; 22 (10) 2308-2314
  • 3 Steensen RN, Bentley JC, Trinh TQ, Backes JR, Wiltfong RE. The prevalence and combined prevalences of anatomic factors associated with recurrent patellar dislocation: a magnetic resonance imaging study. Am J Sports Med 2015; 43 (04) 921-927
  • 4 Dejour D, Le Coultre B. Osteotomies in patello-femoral instabilities. Sports Med Arthrosc Rev 2007; 15 (01) 39-46
  • 5 Amis AA, Oguz C, Bull AM, Senavongse W, Dejour D. The effect of trochleoplasty on patellar stability and kinematics: a biomechanical study in vitro. J Bone Joint Surg Br 2008; 90 (07) 864-869
  • 6 Bollier M, Fulkerson JP. The role of trochlear dysplasia in patellofemoral instability. J Am Acad Orthop Surg 2011; 19 (01) 8-16
  • 7 Fithian DC, Paxton EW, Cohen AB. Indications in the treatment of patellar instability. J Knee Surg 2004; 17 (01) 47-56
  • 8 Fucentese SF, Schöttle PB, Pfirrmann CW, Romero J. CT changes after trochleoplasty for symptomatic trochlear dysplasia. Knee Surg Sports Traumatol Arthrosc 2007; 15 (02) 168-174
  • 9 Escala JS, Mellado JM, Olona M, Giné J, Saurí A, Neyret P. Objective patellar instability: MR-based quantitative assessment of potentially associated anatomical features. Knee Surg Sports Traumatol Arthrosc 2006; 14 (03) 264-272
  • 10 van Huyssteen AL, Hendrix MR, Barnett AJ, Wakeley CJ, Eldridge JD. Cartilage-bone mismatch in the dysplastic trochlea. An MRI study. J Bone Joint Surg Br 2006; 88 (05) 688-691
  • 11 Ali SA, Helmer R, Terk MR. Analysis of the patellofemoral region on MRI: association of abnormal trochlear morphology with severe cartilage defects. AJR Am J Roentgenol 2010; 194 (03) 721-727
  • 12 Fitzpatrick CK, Steensen RN, Tumuluri A, Trinh T, Bentley J, Rullkoetter PJ. Computational analysis of factors contributing to patellar dislocation. J Orthop Res 2016; 34 (03) 444-453
  • 13 Stephen JM, Lumpaopong P, Dodds AL, Williams A, Amis AA. The effect of tibial tuberosity medialization and lateralization on patellofemoral joint kinematics, contact mechanics, and stability. Am J Sports Med 2015; 43 (01) 186-194
  • 14 Senavongse W, Amis AA. The effects of articular, retinacular, or muscular deficiencies on patellofemoral joint stability: a biomechanical study in vitro. J Bone Joint Surg Br 2005; 87 (04) 577-582
  • 15 Van Haver A, De Roo K, De Beule M. , et al. The effect of trochlear dysplasia on patellofemoral biomechanics: a cadaveric study with simulated trochlear deformities. Am J Sports Med 2015; 43 (06) 1354-1361
  • 16 Lewallen LW, McIntosh AL, Dahm DL. Predictors of recurrent instability after acute patellofemoral dislocation in pediatric and adolescent patients. Am J Sports Med 2013; 41 (03) 575-581
  • 17 Balcarek P, Terwey A, Jung K. , et al. Influence of tibial slope asymmetry on femoral rotation in patients with lateral patellar instability. Knee Surg Sports Traumatol Arthrosc 2013; 21 (09) 2155-2163
  • 18 Hopper GP, Leach WJ, Rooney BP, Walker CR, Blyth MJ. Does degree of trochlear dysplasia and position of femoral tunnel influence outcome after medial patellofemoral ligament reconstruction?. Am J Sports Med 2014; 42 (03) 716-722
  • 19 Kita K, Tanaka Y, Toritsuka Y. , et al. Factors affecting the outcomes of double-bundle medial patellofemoral ligament reconstruction for recurrent patellar dislocations evaluated by multivariate analysis. Am J Sports Med 2015; 43 (12) 2988-2996
  • 20 Nelitz M, Theile M, Dornacher D, Wölfle J, Reichel H, Lippacher S. Analysis of failed surgery for patellar instability in children with open growth plates. Knee Surg Sports Traumatol Arthrosc 2012; 20 (05) 822-828
  • 21 Wagner D, Pfalzer F, Hingelbaum S, Huth J, Mauch F, Bauer G. The influence of risk factors on clinical outcomes following anatomical medial patellofemoral ligament (MPFL) reconstruction using the gracilis tendon. Knee Surg Sports Traumatol Arthrosc 2013; 21 (02) 318-324
  • 22 Ahn JH, Kang JH, Kasat NS, Kim JG. Patellar instability with and without trochlear dysplasia: new arthroscopic medial soft tissue plication with pullout technique. Orthopedics 2013; 36 (11) e1385-e1393
  • 23 Schöttle PB, Scheffler SU, Schwarck A, Weiler A. Arthroscopic medial retinacular repair after patellar dislocation with and without underlying trochlear dysplasia: a preliminary report. Arthroscopy 2006; 22 (11) 1192-1198
  • 24 Yeung M, Leblanc MC, Ayeni OR. , et al. Indications for medial patellofemoral ligament reconstruction: a systematic review. J Knee Surg 2016; 29 (07) 543-554
  • 25 Song GY, Hong L, Zhang H. , et al. Trochleoplasty versus nontrochleoplasty procedures in treating patellar instability caused by severe trochlear dysplasia. Arthroscopy 2014; 30 (04) 523-532
  • 26 Smith TO, Davies L, O'Driscoll ML, Donell ST. An evaluation of the clinical tests and outcome measures used to assess patellar instability. Knee 2008; 15 (04) 255-262
  • 27 Lafave MR, Hiemstra L, Kerslake S. Factor analysis and item reduction of the Banff Patella Instability Instrument (BPII): introduction of BPII 2.0. Am J Sports Med 2016; 44 (08) 2081-2086
  • 28 Hiemstra LA, Kerslake S, Lafave MR, Heard SM, Buchko GM, Mohtadi NG. Initial validity and reliability of the Banff Patella Instability Instrument. Am J Sports Med 2013; 41 (07) 1629-1635
  • 29 Hiemstra LA, Kerslake S, Lafave M, Mohtadi NG. Concurrent validation of the Banff patella instability instrument to the Norwich patellar instability score and the Kujala score in patients with patellofemoral instability. Orthop J Sports Med 2016; DOI: 10.1177/2325967116646085.
  • 30 Lippacher S, Dejour D, Elsharkawi M. , et al. Observer agreement on the Dejour trochlear dysplasia classification: a comparison of true lateral radiographs and axial magnetic resonance images. Am J Sports Med 2012; 40 (04) 837-843
  • 31 Nelitz M, Williams RS, Lippacher S, Reichel H, Dornacher D. Analysis of failure and clinical outcome after unsuccessful medial patellofemoral ligament reconstruction in young patients. Int Orthop 2014; 38 (11) 2265-2272