O3224: Trochleoplasty Utilization in the Management of Patellofemoral Instability - An International Survey of Surgeons

Background: Considerable variability exists in the described clinical and radiographic indications for use, surgical techniques, postoperative management, and risk profile following trochleoplasty for the management of patellofemoral instability. In areas of clinical uncertainty, a cohesive summary of expert opinion and identification of areas of variation in current practice can be useful in guiding current practice and future research efforts. The aim of this study was to assess via cross-sectional survey the current indications for use, surgical techniques, postoperative rehabilitation practices, and observed complication profile for trochleoplasty in the management of pediatric patellofemoral instability among surgeons who perform this procedure.

Methods: A 20-item REDCap cross-sectional survey was developed after literature review and investigator discussions to evaluate trochleoplasty in its current practice among surgeons around the world. The survey was distributed between December 2021 and April 2022 via organization distribution lists targeting orthopaedic surgeon membership of 5 national and international knee, arthroscopy and sports medicine societies to identify any surgeon with experience performing the trochleoplasty procedure in practice for the management of patellofemoral instability. Descriptive statistics of survey responses were performed to address study aims.

Results: Survey distribution identified 30 orthopaedic surgeons with experience performing the trochleoplasty procedure. Respondent demographics are listed in Table 1. Notably, the majority had performed their first trochleoplasty within the last decade. Most surgeons (28/30, 93%) performed the procedure at low volumes ( < 25 annually) and only two respondents reported performing more than 100 trochleoplasties in their career. Procedural indications were most commonly felt to be met with MRI-based Dejour classification of B or D. Nearly all surgeons (26/30, 87%) agreed trochleoplasty was appropriate as a primary surgical intervention for patellofemoral instability. Multiple surgical approaches were reported, but the majority utilized a Bereiter thin-flap technique with suture anchor fixation and performed in combination with an MPFL reconstruction. Postoperative weightbearing, ROM precautions and bracing practices varied among respondents. Postoperative imaging practices (radiographs and/or MRI) were not consistent across respondents. Arthrofibrosis was observed by the majority of surgeons with other reported complications listed in Table 2.

Conclusion: This study provides a summary of current provider opinion and experience regarding the use of trochleoplasty in the management of patellofemoral instability. Variation exists in the surgical indicators, technique and postoperative rehab practices of trocheloplasty surgeons. The results of this survey may prove useful to surgeons interested in adopting this procedure in their surgical armamentarium and for guiding future research efforts in the study of the trochleoplasty procedure.