A modification of the Bereiter trochleoplasty: indications, technique and outcomes
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ORIGINAL ARTICLE
A modification of the Bereiter trochleoplasty: indications, technique and outcomes Matthew Hampton1 · Thomas Pigott1 · Paul Mark Sutton1 Received: 29 April 2020 / Accepted: 23 September 2020 © Springer-Verlag France SAS, part of Springer Nature 2020
Abstract Introduction The Bereiter technique is one recognised method of trochleoplasty that was described using a lateral parapatellar approach. We present our surgical technique and outcomes of this procedure using a medial para-patellar approach allowing for accurate soft tissue balancing of the patella. Methods In total, 27 consecutive patients underwent a Bereiter trochleoplasty using a medial approach. Patients completed pre- and post-operative Kujala scores. All patients’ medical records and imaging were reviewed to identify pre-operative indications, complications and re-dislocations. Results Data were collected on 31 trochleoplasty procedures in the 27 patients. Mean age at time of surgery was 25 (17–39), and 16 patients were females. Follow-up ranged from 13 to 60 months. All patients had severe trochlea dysplasia with recurrent instability. Three patients underwent a planned tibial tubercle transfer for a pre-operative raised TT-TG distance. The mean pre-operative Kujala score was 53.9 (26–79) rising to 91.2 (88.6–100) post-operatively. A low post-operative Kujala score seen in patients had a significantly lower than average pre-operative score. No patients had any further dislocations following surgery. Two patients complained of significant stiffness in the early post-operative period. No patients required additional procedures to adequately balance the patella following the trochleoplasty combined with medial reefing plus lateral release involved in this modified technique. Conclusion A modified Bereiter trochleoplasty using a medial rather than a lateral para-patella approach gives excellent results. Level of evidence Level II evidence Keywords Patellar instability · Trochlear dysplasia · Trochleoplasty · Bereiter technique
Introduction The surgical management of patients with recurrent patella femoral joint (PFJ) instability can be challenging. It is estimated that most patients with a history of patella dislocation have an underlying predisposition and as many as 96% of these patients have signs of trochlea dysplasia on imaging compared to 3% of healthy controls [1]. Trochlea geometry plays a major role in the stability of the PFJ. Beyond 30 degrees of knee flexion the patella should engage within the * Matthew Hampton [email protected] 1
Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Herries Road, Sheffield S5 7AU, South Yorkshire, UK
trochlea and the primary restraint to lateral subluxation of the patella is the slope of the lateral wall of the trochlea [2]. For patients with recurrent PFJ dislocation and significant trochlea dysplasia, a trochleoplasty may be considered a surgical option. Trochleoplasty is a demanding and challenging operation which has been previously described us
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