Sulcus-Deepening Trochleoplasty and Medial Patellofemoral Ligament Reconstruction Provide Good Clinical Outcomes in Addressing Patellar Instability at Mid-Term Follow-Up: A Retrospective Case Series.

Purpose: To update previously published clinical and radiographic outcomes of Dejour sulcus-deepening trochleoplasty and medial patellofemoral ligament reconstruction (MPFL-R), at mid-term follow-up, and monitor trends in patient reported outcome scores and satisfaction.
Methods: Using the same cohort of patients from our previously published short-term series of 2-year follow up, interval follow-up was performed on 67 patients (76 knees) with severe trochlear dysplasia and recurrent patellar instability who were prospectively enrolled and underwent Dejour sulcus-deepening trochleoplasty and MPFL-R combined with other patellar-stabilization procedures. Patients with less than 2-year follow-up were excluded. Evaluation involved radiographic analysis, physical examination, clinical follow-up, and patient-reported outcome scores.
Results: 37 patients (45 knees) were included in the current study, with mean follow-up of 6.1 years postoperatively (Standard deviation [SD] 2.7 years). Two interval re-operations were performed (arthroscopic lysis of adhesions; hardware removal and arthroscopic shaving chondroplasty). There remained no occurrences of re-operation for recurrent patellar instability. Patient reported outcomes were largely stable from early (mean 3.6 years) to mid-term (mean 6.1 years) follow up with no statistically significant difference between early and mid-term International Knee Documentation Committee (IKDC) (P = 0.75), Kujala (P = 0.47) or VAS (Visual analog scale) pain (P = 0.06) scores. Compared to preoperative knee scores, there was a significant difference in IKDC (49.3 vs 82.0, P < 0.001, d = 1.85), Kujala (56.5 vs 89.3, P < 0.001, d = 2.03), and VAS pain (3.8 vs 1.9, P = 0.003, d = 0.33) scores at mid-term follow up (mean 6.1 years). Mean Kellgren-Lawrence grading of patellofemoral arthritis showed no statistically significant change from 0.56 to 0.52 (P = 0.511) on sunrise radiographs at the most recent follow-up.
Conclusions: At mid-term follow-up, Dejour sulcus-deepening trochleoplasty and MPFL-R, combined with other patellar stabilization procedures, achieves durable resolution of patellar instability with maintained patient-reported outcome scores and satisfaction rates, and is without interval evidence of clinical or radiographic progression of patellofemoral arthritis.
Level of Evidence: IV, Case Series.
Competing Interests: Declaration of Competing Interest ☒ The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: David Diduch reports a relationship with American Orthopaedic Society for Sports Medicine that includes: board membership. David Diduch reports a relationship with Smith and Nephew Inc that includes: consulting or advisory. David Diduch reports a relationship with DePuy Synthes Mitek Sports Medicine that includes: consulting or advisory. David Diduch reports a relationship with Osteocentric that includes: paid expert testimony. David Diduch reports a relationship with DJ Orthopaedics that includes: funding grants. David Diduch reports a relationship with Moximed, Inc. that includes: funding grants. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2025. Published by Elsevier Inc.)