Management of Severe Trochlear Dysplasia and Recurrent Patellofemoral Instability

Description

In this presentation, Laurie Hiemstra discusses trochleaplasty and high-grade dysplasia, emphasizing the importance of understanding trochlear dysplasia in patients with patellar instability. She reflects on her experiences and biases, indicating that her understanding of the condition may be influenced by her connections in the UK. Hiemstra outlines the current classification systems, particularly criticizing David Dejour's ABCD classification for its lack of interobserver reliability, as she has encountered significant variability in how different physicians perceive and classify trochlear dysplasia.



She explains the critical distinction between high and low-grade dysplasia, particularly in surgical decision-making. Hiemstra introduces the concept of the "trochlear bump"—an anatomical deformation that can affect patellar tracking and stability. She emphasizes that not all patients with high-grade dysplasia require a trochleoplasty, detailing the assessment tools, including the Tibial Tubercle Trochlear Groove (TT-TG) distance, that help clinicians make informed decisions about surgical interventions.



Throughout the talk, Hiemstra emphasizes the importance of precise measurement and classification to improve patient outcomes and reduce the risk of recurrence in patellar instability cases. She discusses her approaches to trochleoplasty, including indications for surgery and various surgical techniques, commenting on the need for careful selection of patients for optimal results. Hiemstra concludes by underlining the need for further research into the underlying mechanisms of trochlear dysplasia and calls for a better understanding of its role in patellar instability.

DOI: 10.1302/3114-240842

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