Trochleoplasty for Patellar Instability

The trochleoplasty procedure is a reshaping of an abnormal trochlea.  Ideally, the trochlea is shaped like a “V” or a “U” but for many people with patellar instability the trochlea is flat or is convex like and upside down “V” or “U”.  The goal of the trochleoplasty is to create a more normally shaped trochlea that allows the patella, or kneecap to fit properly.

During surgery, the cartilage of the trochlea is safely elevated from the underlying bone.  Extra bone is removed and the remaining bone is reshaped to create a groove to match the shape of the patella.  The cartilage is then molded to fit the new groove and held in place with resorbable suture and suture anchors.  The sutures lay on top of the cartilage and dissolve in about 6-8 weeks while the suture anchors are placed below the level of the cartilage and gradually turn to bone over 4 -5 years.

The procedure is performed through an open incision on the outside, or lateral aspect, of the kneecap with a second small incision on the inside, or medial, aspect of the knee.

In addition to the bony reshaping of the trochlea, soft tissue rebalancing surgery should be performed at that same time.  There is a ligament on the inner portion of the kneecap called the medial patellofemoral ligament, or MPFL, that gets stretched out and becomes incompetent in the setting of recurrent instability.  Conversely, a ligament on the outer portion of the kneecap, called the lateral retinaculum becomes overly tight.  Thus, whenever a trochleoplasty is performed, a MPFL reconstruction and lateral retinacular lengthening are also performed to rebalance these ligaments and optimize kneecap stability.

The procedure is performed as an outpatient which means that the patient goes home afterwards. After surgery, immediate weightbearing and full bending and straightening of the knee is encouraged.  Crutches are for comfort and a brace is seldom if ever worn for more than a few days.  Physical therapy starts within a week or so after surgery.  Complete recovery is variable and patient dependent.  Some patients can rehabilitate and be back to all their activities within 3-4 months while others may take 6 months or more.

Your Local and National Expert

Dr. Pace is a national leader in patellar instability, and as of January 2020, Dr. Pace is the highest volume trochleoplasty surgeon in the country.  He has performed this procedure over 100 times and counting and has a national clientele. The trochleoplasty is a standard procedure in Europe, and Dr. Pace traveled to Munich, Germany to learn this procedure from one of the pioneers in trochleoplasty surgery, Dr. Philip Schoettle. A trochleoplasty can be technically challenging, and it takes extensive training and experience to perform this surgery successfully, but a well-done trochleoplasty can be life-changing for people who need the procedure.

If you are experiencing any type of knee issues or pain, call us at (860) 837-9220 today so that we can help.

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