Groove-deepening trochleoplasty reduces lateral patellar maltracking and increases patellofemoral contact pressures: Dynamic simulation

Groove-deepening trochleoplasty is performed to restore patellar stability by increasing the lateral constraint applied to the patella by the trochlear groove. Multibody dynamic simulation of knee function was used to characterize the influence of groove-deepening trochleoplasty on patellar tracking and patellofemoral contact pressures. Computational models were created to represent seven knees with trochlear dysplasia, indicated by a flat trochlear groove and supratrochlear spur. The models were manipulated to remove the spur and deepen the trochlear groove to represent the average shape following a trochleoplasty. Knee squatting was simulated for the preoperative and postoperative conditions. Statistically significant (p < 0.05) differences in output parameters were identified with repeated measures comparisons at every 5° of knee flexion. Trochleoplasty significantly decreased lateral patellar tracking, particularly at low knee flexion angles. Trochleoplasty decreased the peak lateral shift of the patella (bisect offset index) with the knee extended from 0.87 ± 0.14 to 0.75 ± 0.12. Trochleoplasty also significantly decreased the contact area and increased the maximum contact pressure at multiple flexion angles. Trochleoplasty decreased the average contact area by approximately 10% in mid-flexion, with a corresponding increase in the average maximum contact pressure of 13%–23%. Decreased contact area and increased contact pressures are related to altered patellofemoral congruity due to reshaping the femur without a corresponding change to the patella. Clinical significance: The results indicate groove-deepening trochleoplasty decreases lateral patellar maltracking, reducing the risk of patellar dislocations, but can elevate patellofemoral contact pressures, which could contribute to long-term degradation of cartilage.