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Knee Surg Sports Traumatol Arthrosc. 2020 Mar 4. doi: 10.1007/s00167-020-05906-9. [Epub ahead of print]

Trochleoplasty improves knee flexion angles and quadriceps function during gait only if performed bilaterally.

Author information

1
Kantonsspital Baden, Im Ergel 1, 5404, Baden, Switzerland.
2
Basel Medical School, University of Basel, Petersplatz 1, 4003, Basel, Switzerland.
3
Paediatric Orthopaedic Department, University Children's Hospital Basel (UKBB), Spitalstrasse 33, 4056, Basel, Switzerland.
4
Department of Orthopedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
5
Praxis Zeppelin, Brauerstrasse 95, 9016, St. Gallen, Switzerland.
6
Praxis Zeppelin, Brauerstrasse 95, 9016, St. Gallen, Switzerland. camathias.carlo@gmail.com.
7
Department of Orthopedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA. camathias.carlo@gmail.com.
8
Basel Medical School, University of Basel, Petersplatz 1, 4003, Basel, Switzerland. camathias.carlo@gmail.com.

Abstract

PURPOSE:

To investigate if a trochleoplasty increases knee flexion angles and extensor moments in the gait of patients with patellar instability and to compare postoperative gait to a healthy control group.

METHODS:

A bilateral dislocation group (6 patients) and a unilateral dislocation group (14 patients) were treated with bilateral and unilateral trochleoplasty, respectively. Kinematics and kinetics of the lower extremity were captured using 3D-gait analysis (VICON, 12 cameras, 200 Hz, plug-in-gait, two force plates). The mean of six trials was computed. The gait cycles were compared pre to postoperatively for each group. The gait of the two groups was compared to each other and the gait of a healthy population (54 knees).

RESULTS:

After trochleoplasty, the knee flexion angles and knee extensor moments only increased in the bilateral dislocation group, whereas the gait pattern of the unilateral dislocation group remained unchanged. Compared to the healthy population, the postoperative gait pattern of the bilateral dislocation group did not differ. In contrast, knee flexion angles and extensor moments of the unilateral dislocation group were still lower.

CONCLUSION:

In adolescents with bilateral recurrent patellar dislocations, trochleoplasty of both knees increases knee flexion angles and knee extensor moments comparable to normal gait. Unilateral symptomatic patients undergoing a unilateral trochleoplasty did not achieve normal walking. These findings point out that patellar instability should be considered as a bilateral problem, even in patients with unilateral dislocations.

LEVEL OF EVIDENCE:

III.

KEYWORDS:

Adolescents; Gait analysis; Kinematics; Kinetics; Knee; Patella dislocation; Patellar dislocation; Patellar instability; Quadriceps avoidance; Recurrent dislocation; Trochlear dysplasia; Trochleoplasty

PMID:
32130444
DOI:
10.1007/s00167-020-05906-9

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