Trochleoplasty Overview

Trochleoplasty is a specialized surgical procedure to correct severe trochlear dysplasia—a key risk factor for recurrent patellar (kneecap) instability. In 2025, advances in imaging, patient selection, and technique allow for individualized treatment and improved outcomes for patients suffering from repeated kneecap dislocations and dysfunction.

What Is Trochleoplasty?

Trochleoplasty is a surgery performed to reshape the femoral trochlea (the groove at the end of the thigh bone where the patella sits and glides). In patients with high-grade trochlear dysplasia, the groove is abnormally shallow or misshapen, predisposing to patella subluxation or dislocation. Correcting the groove’s depth and shape restores stable patellar tracking throughout knee motion and can prevent further joint damage.

Indications

• Recurrent patellar instability with severe (Dejour B–D) trochlear dysplasia

• Failed previous stabilization surgeries

• Minimal pre-existing patellofemoral arthritis

• Skeletally mature patients (not performed in growing children)

Contraindications include advanced arthritis, open growth plates, and low-grade dysplasia (type A, near-normal trochlea), where other surgeries may be more appropriate.

Types of Trochleoplasty Procedures

1. Sulcus Deepening Trochleoplasty (Dejour technique)

   • The surgeon creates a deeper groove, reshaping the trochlea so the patella will track stably.

   • Osteochondral flaps are created and fixed in the newly formed sulcus.

2. Bereiter Subchondral Deepening Trochleoplasty

   • A thin “cartilage flake” is elevated, bone removed beneath, and the flap molded into a more anatomical groove.

   • Can be performed open or arthroscopically.

3. Recession Wedge Trochleoplasty

   • Involves removing a bony wedge from behind the trochlear spur and closing the gap to recess the bone.

   • Particularly useful with high supratrochlear spur.

4. Lateral Facet Elevation Trochleoplasty

   • Rare today, involves elevating the lateral facet using a bone graft—mainly for specific anatomical variants.

Trochleoplasty is often combined with other procedures, such as medial patellofemoral ligament (MPFL) reconstruction or tibial tubercle transfer, for comprehensive correction of patellar instability.

Expected Outcomes, Benefits & Risks

Outcomes

• Most patients experience a reduction in patellar dislocation, improved stability, and better function.

• Success is highest in patients with high-grade dysplasia and instability, particularly when performed as a primary procedure.

• Short- to mid-term outcome studies show improvement in pain and knee scores; no re-dislocations are reported in most series, though recurrences and persistent pain can occur.

Risks/Complications

• Superficial wound issues, infection, or deep vein thrombosis

• Postoperative stiffness/arthrofibrosis

• Residual anterior knee pain

• Rarely, progression to patellofemoral arthritis over time, especially in already-damaged joints

• Potential need for reoperation, especially if performed in isolation rather than as part of a comprehensive approach

Recovery and Rehabilitation

• Hospital stay: 1–4 days, depending on procedure specifics

• Initial phase: Partial weight-bearing with a brace/crutches, early passive motion exercises

• Physical therapy: Essential to regain knee flexibility, muscle strength, and safe patellar tracking

• Return to activities: Desk work in 3–6 weeks, gentle exercise in 2–3 months, full return to sports 4–6+ months post-op

• Full outcome continues to evolve for up to a year as strength and mobility return.