First of all sorry for this awful word trochleoplasty, however there is no simple word to better explain it. Maybe Grooveplasty would be a better term - if you have a better suggestion please do not hesitate to contact me. Trochleoplasty is a surgery for the Trochlear groove, a groove that helps the kneecap (the Patella) to stay in place. By this surgery a new and a deeper groove is created to normalize your anatomy.
Why am I going to have a groove operation?
If you are troubled by unstable kneecap or chronic anterior knee pain, you might also have an abnormal groove. This means that the groove for your kneecap is more shallow than normal or it can be even flat or convex. In short, when your knee groove is too shallow, this tends to make you kneecap unstable. It basically means that it might either go half the way out (called subluxation) or it even dislocate. The condition of having a shallow groove is called trochlear dysplasia or dysplatic trochlea (abnormal groove). In these cases were you groove is flat, this operation called trochleoplasty, is the best option for you.
If you have a shallow groove
We know when your groove is shallow or flat, it is a result of too much bone in the center of the groove. This basically means that you have too little bony support for the kneecap.
The principle of the groove surgery is basically to deepen the groove. First is the cartilage released from the groove. Subsequently excessive bone is removed. This is followed by creation of an outer bony wall to support the patella. After that, when the groove has been deepened and re-shaped, the cartilage is re-located by means of a special blue or white bands. Those tapes or bands are later resolved. You can find picture examples by the images below. Certainly the groove operation is, from a mechanical point of view, the most anatomically correct operation to perform, if you have an abnormal groove.
After having invented the technique, I started out 12 years ago doing arthroscopic deepening trochleoplasty procedures. I used to do the groove procedure openly by the Bereiter method. I have stopped to do the open surgery. since it leaves a bigger scar, and in addition it is more painful and I believe that I can obtain better results by doing it arthroscopic in most situations.
More about the groove surgery
By using the pinhole technique (arthroscopic), consequently the surgery becomes less traumatic for your knee , and therefore the rehabilitation is likely to become accelerated. To notice is the groove operation mostly done in combination with a reconstruction of the inner ligament for the kneecap (MPFL reconstruction).
Why go for arthroscopic trochleoplasty instead of open trochleoplasty?
By using the pinhole technique (arthroscopic), consequently the surgery becomes less traumatic for your knee , and I have had no case of excessive scar tissue (arthrofibrosis). Doing open trochleoplasty it´s a well known risk - read more here
Why also MPFL reconstruction?
Why is the groove surgery not enough? And why should you also have reconstructed the MFPL? (mediale patellofemoral ligament = inner ligament for kneecap). That is first of all because the MPFL is always torn when the kneecap dislocate. It does not heal normally and therefore it has to be reconstructed. Moreover it also so, that the trochlear groove, do not provide stability to your kneecap, before the kneecap reach the trochlea. Importantly 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 at 20 degrees of bending. Read more about MPFL reconstruction here
Arthroscopic trochleoplasty and no MPFL reconstruction.
If you problem is chronic anterior knee pain as a consequence of a too shallow groove, and your kneecap is stable, likewise you do not need to have the ligament to stabilize the kneecap reconstructed - eventually read more in the page about anterior knee pain.
You are allowed full weight bearing and free range of movement, immediately after your surgery. There will not be applied any brace, but you will need crutches for approx 2 weeks. You will only stay in hospital for approx 6 hours. Some have traveled 2000 km back home just after surgery. Normally you start physiotherapy within 3 to 10 days after surgery. Some might think this rehabilitation regime sounds a little scary, however it have proved itself for more than ten years without any problems.
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. E-mail [email protected]
You can eventually go to Facebook. Check out either "Lars Blond + Trochleoplasty" or just "Trochleoplasty". Here you can notice more details and recent updates
The company Arthrex that help me develop the technique have now also produced at video in 4K quality - see it here
Arthrex is also the company that help other surgeons to learn the technique. Regularly I teach other surgeons in Arthrex Lab in Munich or I am send by Arthrex abroad to help surgeon to do their first cases.
What does KneeGuru say about arthroscopic trochleoplasty? - Read here
When are you too old for this? No one know, however the trochlea cartilage have to be fairly okay, without too huge defects. The oldest one I have succefully operated was 57 years. The youngest was 12 years.
New interesting paper for ordinary people
Latest paper about arthrocopic trochleoplasty from 2021
Research Outreach article - click here
Trochleoplasty surgery cost
The price for an isolated arthroscopic deepening trochleoplasty is approximately 9.000 euro
Frequently asked questions:
- The surgery typically last 1½- 2½ hours.
- When can you fly back? This depends on the distance but this is from 1 to 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 and will be fairly okay after 3 month.
More freguently asked questions:
- 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.
Aleris-Hamlet is the largest private hospital in Denmark with 10 operating rooms and 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 protocol after Arthroscopic Trochleoplasty and MPFL reconstruction - by Dorte Nielsen
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)
Trochlea before and and after the groove surgery
- "It is difficult to balance a tennis ball on a football"
Two different examples of how it looks in-site the knee 3 months after a groove surgery. If you notice has the cartilage healed very nicely and blue bands/tapes are dissolved.
Second look - 3 years after
Illustration showing the tapes in place after arthroscopic trochleoplasty
Nice small scars after combined arthroscopic trochleoplasty and MFPL reconstruction
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 a groove surgery and not just MPFL reconstruction?
That is a good question and some surgeon argue that it is not necessary. Maybe it is not 100% necessary if you just want stability, but if you also want a knee without anterior knee pain, trochleoplasty have to be done. Also, 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 because the MPFL reconstruction get loose by time. Therefore if you visit a surgeons, who do not do trochleoplasty surgery, and you do have this flatt groove. Most importantly try to get a second opinion in case this surgeon tells you that the surgery is rare, dangerous and complicated surgery since this is not correct.
Case Study - Mikkel
Mikkel was the first patient who was operated upon with an Arthroscopic Trochleoplasty, and this was back in March 2008. Previously he had unsuccessful kneecap-stabilizing surgery and by doctor and physiotherapist he was told that he would never be able to sports again. Most noteworthy Mikkel had been troubled in both his knee since he was 8 years old and had never been able to run. Finally he underwent surgery on both his knees with the groove surgery at 29 years old. Meaning 21 years without running.
Follow-up on Mikkel
Today is Mikkel doing well in his knees and he is running and playing soccer. 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 groove surgery is very good, with less than 2 percent new dislocations. Consequently is the quality of life dramatically better. 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. Today I have presented "The Arthroscopic Deepening Trochleoplasty" technique in the United States, Japan, Netherlands, UK, Sweden, Norway, Poland, Germany, Austria, Portugal and China. Moreover has the surgery been adopted by other surgeons and is now performed in ten differnet countries world wide.
Tibial Tubercle Transfer =TT?
What about having a TT osteotomy instead of a groove surgery? The fact is that no surgeon know what exactly what is best since the science has not yet given a final answer to that question. However is there many indications that the groove surgery gives better results. In addition we know that trochleoplasty surgery normalize the anatomy. Moreover does we know that patients, who have had TT surgery after a decade are having declining results. The first trochleoplasty patients I operated more than 13 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.
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