Arthroscopic Trochleoplasty

This page is about the Trochleoplasty operation. This surgery create or deepen the groove in which the kneecap glides. Noteworthy the surgery can be done by arthroscopic technique and you can read more below. Though once the Arthroscopic trochleoplasty was considered experimental surgery, it is now done routinely in nine different countries.

Background

Trochleoplasty is a surgery for the Trochlear groove, a groove that helps the kneecap, also called the Patella to stay in place. By this surgery a new and deeper groove is created to normalize anatomy. 

Why am I going to have a trochleoplasty operation?

So if you are troubled by unstable kneecap or chronic anterior knee pain, you might also have trochlear dysplasia (flatt groove). This means that a trochleoplasty operation may be the best option for you.

If you have Trochlear Dysplasia

As mentioned in the section on "Why the kneecap dislocate?" this procedure can be relevant for you. This is if your groove for the kneecap is filled up with too much bone, also called Trochlear Dysplasia (flat or shallow groove). This basically means that you have to little bony support for the Patella, and therefore it tends to pop out. 

The Surgery 

The principle of trochleoplasty is to release the cartilage from the trochlea, and to remove the excessive bone and to create an outer wall to support the patella. So when the trochlear groove has been deepened, the cartilage is finally re-located by means of a resorbable bands. You can find examples by the images below. Certainly the trochleoplasty operation is, from a mechanical point of view, the most anatomically correct operation to perform if you have trochlear dysplasia.

History

Since 2008 I have done more than 100 arthroscopic deepening trochleoplasty procedures. I used to do the trochleoplasty procedure open, but I have stopped this, since it leaves a bigger scar, it is more painful and less risky. For open trochleoplasty I started out in 2005.

More about the Arthroscopic Trochleoplasty

Arthroscopic trochleoplasty technique is less traumatic for your knee , and this means that the rehabilitation is likely to be more accelerated. Just to let you know, then the Arthroscopic trochleoplasty operation is nearly always performed in combination with a MPFL reconstruction.

Why also MPFL reconstruction?

Why should you also have reconstructed the MFPL (mediale patellofemoral ligament) when you do the trochleoplasty? Because first of all is the MPFL always torn when the kneecap dislocate and therefore it has to be reconstructed. Moreover it also so, that the trochlear ground , do not provide stability to your kneecap, before the kneecap reach the trochlea and this first happens after your knee is bend about 20 degrees. This means that the MPFL is needed to provides stability to your kneecap from full straightened  knee and until your kneecap reach the new groove. Hence you need to have both operations simultaneous. In contrast if you problem is chronic anterior knee pain and trochlear dysplasia, here is the patella stable, and therefore you do not need to have the ligament reconstructed - eventually read more in the page about anterior knee pain.

I am Lars Blond an inventor of the arthroscopic trochleoplasty - eventually go to the front page or read my CV or download scientific papers

Trochleoplasty by pinholes = Arthroscopic Trochleoplasty

Patients are coming from abroad to undergo arthroscopic trochleoplasty - or I travel to the respective places. Until now I have operated patients from 12 different countries - Norway, USA, Qatar, Spain, Romania, United Arab Emirates, Poland, India, Austria, Germany, and the United Kingdom, but naturally most patients are from Denmark.

In case you would like a second opinion regarding your MRI or just your general knee situation, I do Skype consultations. The cost is 150 euro - email [email protected]

You can eventually go to Facebook and check out either "Lars Blond + Trochleoplasty" or just "Trochleoplasty" for more details and recent updates

Eventually read what some patients says in the testimonial page - or see this Youtube video called trochleoplasty gathering (Danish language but English text)

Frequently asked questions:
  • The surgery typically last 2- 2.5 hours - less if no MFPL reconstruction is needed.
  • When can you fly back? This depends on the distance but this is from 3 - 10 days. A seat with the possibility to straighten the leg is needed.
  • Crutches are used for 2-4 weeks - with huge individual differences
  • No brace is needed after this type of surgery and full weight bearing is allowed
  • Some think - should I start with one type of minor surgery and if I do not work, then try another surgery - I my view only one surgery should be necessary if the right one is done from the start.
  • Only one knee is operated (in one out of three both knees are involved)
  • How long is the recovery?
    The knee will improve the first one or two years
  • When can I return to sport or job - this has very huge individual differences and if you have an sedentary job it is about 4 weeks and lighter sports is after approx. 3 month
  • Will my insurance pay? Normally they will pay for the surgery and travelling expences (still cheaper than similar surgery in US)
  • The price for a Skype consultation incl evaluation of MRI? 150 Euro.
    MRI scans can be posted by mail, by Dropbox or webtransfer or similar (E-mail: [email protected])
  • The price for combined arthroscopic trochleoplasty and MPFL reconstruction is approx. 11000 euro incl implants (implant cost alone is 2000 euro)
  • For physiotherapy and exercises Physiotherapist Dorte Nielsen (Proalign.dk) has a huge experience of training patients troubled by patellar instability, and has seen several patients after arthroscopic trochleoplasty. Dorte Nielsen has uploaded videos on YouTube.
About Aleris-Hamlet Parken

Aleris-Hamlet Parken has very high safety. A rate of infection close to zero and with high cleanliness and has undergone accreditation after the highest international standards and use the latest technologies. All doctors are experienced doctors. All personnel speaks English.

Rehabilitation after Trochleoplasty and MPFL reconstruction - by Dorte Nielsen

Rehabilitation trochleoplasty
Example of an "Arthroscopic Deepening Trochleoplasty".

Before (left) and after (right). The blue band dissolves after 6 weeks and is therefore only temporary until the cartilage has healed.

MRI before (left) and after (right) Arthroscopic Deepening Trochleoplasty
Trochlea before and and after the trochleoplasty 

- "It is difficult to balance a tennis ball on a football"

Arthroscopic second look

Two different examples of how it looks after 3 months postoperatively after an Arthroscopic Deepening Trochleoplasty. You see that the cartilage has healed very nicely and blue bands/tapes are dissolved.

Arthroscopic Trochleoplasty - 3 years after

Illustration showing the tapes in place after arthroscopic deepening trochleoplasty

Nice small scars after combined arthroscopic trochleoplasty and MFPL reconstruction

The scars after Arthroscopic Trochleoplasty and reconstruction of the medial patellofemoral ligament eight weeks postoperatively

Eight weeks after the surgery and the scars will become much more nice over time. I recommend you to use tape in the first month after surgery, since this will reduce traction in the scars, hence you can avoid that the scars becomes wide.

Video arthroscopic trochleoplasty

Kenneth doing well one year after

Why should I also have trochleoplasty and not just MPFL reconstruction?

That is a good question and no surgeon really knows for sure. Nevertheless, sometimes I see patients having trochlear dysplasia and who have had an MPFL reconstruction only. Then after some years the kneecap starts to becomes loose again or they develop a painful knee. Therefore if you visit a surgeons, who do not do trochleoplasty surgery, and you do have this flatt groove, try to get a second opinion in case this surgeon tells you that the surgery is rare surgery and it´s not necessary. 

Case Study - Mikkel

Mikkel was the first patient who was operated upon with an Arthroscopic Deepening Trochleoplasty, in March 2008. Previously he had unsuccessful kneecap-stabilizing surgery. Most noteworthy Mikkel had been troubled in both his knee since he was 8 years old and had been unable to run. Finally he underwent surgery on both his knees with arthroscopic trochleoplasty at 29 years old. So 21 years without running. So today, Mikkel is doing well in his knees and is running. He claims that the only annoyance is the sound from the knees when he climbs stairs. Go to YouTube and listen to his and other stories during the trochleoplasty gathering in 2014. Many thanks to Asker Blønd - my son - who created this video. Click here trochleoplasty gathering.or check this video

Outcome after trochleoplasty

Generally the outcomes after trochleoplasty is very good, with only rarely new dislocations and the quality of life seems to rise dramatically. I have followed all my arthroscopic trochleoplasty patients for now more than 10 years and in average there as been improvements in all measured parameters and high satisfaction.  Both the technique and the results of this operation, have been published in peer reviewed journals. Above all until the date of this website article I have presented "The Arthroscopic Deepening Trochleoplasty" technique in the United States, Japan, Netherlands, UK, Sweden, Norway, Poland, Germany, Austria, Portugal and China. 

Tibial Tubercle Transfer?

What about having a tibial tubercle osteotomy instead of a trochleoplasty surgery? The fact is that no surgeon know what is best since the science has not yet given the answer to that question. Nevertheless is there indications that trochleoplasty give better results on within the first years. We also know that trochleoplasty normalize the anatomy. We know that patients who had tibial tubercle osteotomy after a decade are having declining results. The first trochleoplasty patients I operated more than 10 years ago are still doing fine. So based on this and my clinical experience by doing both many tibial tubercle osteotomies an trochleoplasty surgeries, I prefer to do trochleoplasty if you are having severe trochlear dysplasia.

Here is the latest paper on arthroscopic deepening trochleoplasty here or simply go the page where you can find all my scientific papers

Photo library with some examples of arthrocopic trochleoplasty
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References for Trochleoplasty papers

1. Banke IJ, Kohn LM, Meidinger G, Otto A, Hensler D, Beitzel K, Imhoff AB, Schöttle PB (2013) Combined trochleoplasty and MPFL reconstruction for treatment of chronic patellofemoral instability: a prospective minimum 2-year follow-up study. Knee Surg Sports Traumatol Arthrosc. 2014 Nov;22(11):2591-8
2. Blønd L, Haugegaard M (2013) Combined arthroscopic deepening trochleoplasty and reconstruction of the medial patellofemoral ligament for patients with recurrent patella dislocation and trochlear dysplasia. Knee Surg Sports Traumatol Arthrosc. 2014 Oct;22(10):2484-90
3. Dejour D, Byn P, Ntagiopoulos PG (2012) The Lyon’s sulcus-deepening trochleoplasty in previous unsuccessful patellofemoral surgery. International orthopaedics. 2013 Mar;37(3):433-9
4. Donell ST, Joseph G, Hing CB, Marshall TJ (2006) Modified Dejour trochleoplasty for severe dysplasia: operative technique and early clinical results. Knee 13(4):266–73
5. Fucentese SF, Zingg PO, Schmitt J, Pfirrmann CW a, Meyer DC, Koch PP (2011) Classification of trochlear dysplasia as predictor of clinical outcome after trochleoplasty. Knee Surg Sports Traumatol Arthrosc 19(10):1655–61
6. Koch PP, Fuchs B, Meyer DC, Fucentese SF (2011) Closing wedge patellar osteotomy in combination with trochleoplasty. Acta OrthopBelg 77(1):116–121
7. Masse Y (1978) [Trochleoplasty. Restoration of the intercondylar groove in subluxations and dislocations of the patella]. RevChir Orthop Reparatrice ApparMot 64(1):3–17
8. Nelitz M, Dreyhaupt J, Lippacher S (2013) Combined Trochleoplasty and Medial Patellofemoral Ligament Reconstruction for Recurrent Patellar Dislocations in Severe Trochlear Dysplasia: A Minimum 2-Year Follow-up Study. Am J Sports Med 1–8
9. Ntagiopoulos PG, Byn P, Dejour D (2013) Midterm results of comprehensive surgical reconstruction including sulcus-deepening trochleoplasty in recurrent patellar dislocations with high-grade trochlear dysplasia. Am J Sports Med 41(5):998–1004
10. Reddy KR, Reddy NS (2012) Trochleoplasty and medial patellofemoral ligament reconstruction for recurrent patellar dislocation. Indian journal of orthopaedics 46(2):242–5
11. Schöttle PB, Fucentese SF, Pfirrmann C, Bereiter H, Romero J (2005) Trochleaplasty for patellar instability due to trochlear dysplasia: A minimum 2-year clinical and radiological follow-up of 19 knees. Acta orthop 76(5):693–8
12. Thaunat M, Bessiere C, Pujol N, Boisrenoult P, Beaufils P (2011) Recession wedge trochleoplasty as an additional procedure in the surgical treatment of patellar instability with major trochlear dysplasia: early results. Orthop Traumatol Surg Res 97(8):833–45
13. Utting MR, Mulford JS, Eldridge JDJ (2008) A prospective evaluation of trochleoplasty for the treatment of patellofemoral dislocation and instability. J Bone Joint Surg Br 90(2):180–5
14. Verdonk R, Jansegers E, Stuyts B (2005) Trochleoplasty in dysplastic knee trochlea. Knee Surg Sports Traumatol Arthrosc 13(7):529–33
15. Von Knoch F, Böhm T, Bürgi ML, von Knoch M, Bereiter H, Bohm T, Burgi ML (2006) Trochleoplasty for recurrent patellar dislocation in association with trochlear dysplasia. A 4- to 14-year follow-up study. J Bone Joint Surg Br 88(10):1331–1335

The Spanish version

La operación llamada “trocleoplastia” tiene el objetivo de crear o profundizar el surco (tróclea) de la rótula. Como se mencionó en la sección "¿Por qué se desplaza la rótula" la tróclea es el surco de la rótula que tiene exceso de hueso. La finalidad de la trocleoplastia es levantar el cartílago de la tróclea y eliminar el exceso del hueso y una vez el surco (tróclea) se profundiza, el cartílago se vuelve a fijar con la ayuda de una cinta reabsorbible, como se muestra en los siguientes imágenes. La trocleoplastia es la operación anatómicamente más correcta, desde un punto de vista mecánico de la rodilla. Los resultados de la trocleoplastia parecen prometedores a largo plazo, en comparación con otros métodos, pero todavía hay poca información. Desde 2008 he hecho cerca de 80 operaciones artroscópicas de trocleoplastia para profundizar la tróclea. Antes había hecho la operación abierta (no artroscópico), pero he dejado de hacerlo porque es demasiado doloroso, hay más riesgo de infección y cicatrices de tejido. El proceso artroscópico también es más preciso y hoy ya no encuentro ninguna razón para hacer la procedimiento abierto. Algunos otros cirujanos que hacen trocleoplastia han reconocido recientemente esto y han aprendido el procedimiento artroscópico. Para la fisioterapia colaboro estrechamente con Proalign.dk

Ejemplo de una " trocleoplastia artroscópica” para profundizar la tróclea. Antes (izquierda) y después (derecha). La cinta azul se disuelve después de 6 semanas, por lo que es sólo temporal hasta que el cartílago se haya curado.

A veces los pacientes vienen desde el extranjero para someterse a una trocleoplastia artroscópica. Hasta ahora he operado pacientes de Estados Unidos, Qatar, Noruega, Rumanía y Polonia.

La técnica artroscópica de trocleoplastia es menos traumática para la rodilla y causa menos dolor y cicatrices más pequeñas, es más precisa, y además la rehabilitación es más acelerada. La trocleoplastia artroscópica se realiza siempre en combinación con la reconstrucción del ligamento medial patelofemoral (MPFL), cuando hay instabilidad de la rótula, sin embargo, en casos con dolor de la rodilla de la zona delantera, esto no es necesario. Tanto la técnica como los resultados de esta operación se han publicado en estudios médicos revisados por pares (médicos autorizados). Hasta ahora he presentado la técnica de "La trocleoplastia artroscópica" en los Estados Unidos, Japón, Países Bajos, Reino Unido, Suecia, Noruega, Polonia. y China. El primer paciente que operé con trocleoplastia artroscópica fue Mikkel – Se va a poder leer más sobre él más adelante.

Preguntas frecuentes:

El precio de una consulta via Skype con evaluación de los imágenes de resonancia magnética? 150 Euro

La cirugía por lo general dura 2,5 horas

¿Cuándo se puede regresar en un vuelo después de la operación? Esto depende de la distancia, pero aproximadamente a partir de 3 - 10 días. Un asiento con más espacio, con la posibilidad de enderezar la pierna es necesario.

Normalmente no se necesita rodillera / abrazadera después de este tipo de cirugía

E-mail: [email protected]

Dos ejemplos diferentes de cómo se ve 3 meses después de la operación trocleoplastia artroscópica. El cartílago se ha curado y las bandas / cintas azules quedaron disueltas.

Resonancia Magnética antes (izquierda) y después (derecha) de la trocleoplastia artroscópica.

Mikkel fue el primer paciente que fue operado con un trocleoplastia artroscópica en marzo de 2008. Él anteriormente tenía una cirurgia para estabilizar la rótula sin éxito. Había tenido problemas desde los 8 años de edad y había sido incapaz de correr. Se sometió a una cirugía en ambas rodillas con trocleoplastia artroscópica con 29 años. Después de 21 años sin correr, hoy en día, las rodillas de Mikkel funcionan bien y puede correr. La única molestia que tiene es el sonido de las rodillas cuando sube las escaleras. Él habló sobre su historia durante la reunión de trocleoplastia en 2014.

La fisioterapeuta Dorte Niesen Proalign.dk tiene una enorme experiencia trabajando con pacientes con problemas de inestabilidad de la rótula, y ha visto varios pacientes que tenían una trocleoplastia artroscópica. Dorte Nielsen ha subido vídeos a Youtube.