Description
Introduction:
The study aims to describe a novel arthroscopic thin flap deepening trochleoplasty technique guided by C-Arm and to evaluate its preliminary postoperative outcomes.
Materials and Methods:
The indication for arthroscopic deepening trochleoplasty (ADT) was patients with objective patellar instability, Dejour type B or D trochleas, and a positive jsign and 20° apprehension test. A high supero-medial (HSM) and a supero-lateral (SL) portal are used during the procedure. A small chisel (4-6mm) and a high-speed 4.5mm burr are alternately used to develop a thin osteochondral flap. The chisel and the burr are used to remove the supratrochlear spur and shape a new groove. The resection is checked under C- Arm with both fluoroscopic and arthroscopic control, verifying the distal extension of the trimming, the depth of the new sulcus, and the osteochondral flap reduction. Crossing sign and supratrochlear spur elimination are verified with the same technique. The osteochondral flap is fixed on the femur using knotless anchors. The Medial PatelloFemoral Ligament (MPFL) is always reconstructed. After the surgery, a 0-100° range of motion is permitted. Weight-bearing is allowed with crutches and hinge knee brace for 40 days. Each patient was evaluated pre-operatively and at the last follow-up with the Knee injury and Osteoarthritis Outcome Score (KOOS), Lysholm score, and Kujala Anterior Knee Pain Score (Kujala).
Results:
Ten consecutive patients underwent the ADT and MPFL reconstruction. The mean age was 23.9± 5.5 years. The mean KOOS Symptoms passed from 71.7 ± 8.2 to 87.2 ± 6.7; the mean KOOS pain passed from 74.3 ± 4.6 to 88.5 ± 5.6; the mean KOOS activity daily living passed from 77.7 ± 6.5 to 91.5 ± 5.3; the mean KOOS sport passed from 61.8 ± 8.6 to 86.8 ± 8.0; the mean KOOS quality of life passed from 61.4 ± 11.1 to 88.1 ± 7.9 (p<0.05 for all the result). The mean Lysholm score passed from 68.3 ± 12.4 to 85.6 ± 7.1 (p< 0.05). Kujala score passed from 66.3 ± 11.9 to 86 ± 7.7 (p< 0.05). The mean operative time was 144 ± 11.7 minutes. One case of postoperative arthrofibrosis (ROM 5-70°) occurred and was treated with arthroscopic arthrolysis with an acceptable recovery (final ROM 0-115°). One case of intraoperative longitudinal flap rupture occurred and was managed with an additional anchor placement to stabilize the fragment. No postoperative complication emerged and the patient had satisfying outcomes at the scores evaluation . The mean post-operative follow-up was 11.4 ± 2.9 months.
Conclusions:
DAT is a safe and reliable procedure providing low invasiveness and rapid postoperative recovery. The use of intraoperative C-Arm guidance provides precise control of the bone resection increasing the accuracy of the procedure. Studies are still needed to analyze the long-term outcomes of this procedure.
