Trochleoplasty

What is Trochleoplasty?

A trochleoplasty is a surgery to correct a specific area of a bone in the leg, called the femur, when it has developed abnormally. Usually, the kneecap – called the patella – glides along a groove in the femur. That groove is known as the trochlea.

Sometimes the bone is shallow, flat or bumped up, instead of having a well-developed groove, and when that happens, the condition is called trochlear dysplasia. When that happens, the kneecap can easily and frequently dislocate. A trochleoplasty procedure fixes this problem by creating a new trochlear groove, enabling patients to return to sports and activities.

What are the benefits of Trochleoplasty?

A trochleoplasty surgery creates a new trochlear groove where the patient’s trochlear developed either flat, shallow or bumped out. By carving a proper groove, the procedure allows the kneecap to move normally without pain or instability and prevents future dislocations. Ligaments that have been damaged by kneecap dislocations are also fixed at the same time. Numerous published studies have shown that trochleoplasty are safe and effective.

What are the possible risks and side effects of Trochleoplasty?

Patients will experience temporary swelling and numbness after surgery near their scars. Most patients experience some stiffness in their knee as well as a small degree of cartilage damage and some minimal pain.

A small number of patients develop stiffness in their knee that could require additional surgery to regain their range of motion. Others could need to have a cartilage replacement procedure.

What are Children's Health's outcome metrics for Trochleoplasty?

The Children’s Health team uses the Banff Patellar Instability Instrument (BPII) and the International Knee Documentation Committee (IKDC) score to help determine a patient’s improvement after surgery.

What to expect with Trochleoplasty

The trochleoplasty procedure is an outpatient surgery, and patients are generally released to go home within a couple of hours after they wake up.

What to expect before Trochleoplasty

Before surgery, patients will meet with their surgeon for an assessment. The doctor will likely ask for X-rays, an MRI and, occasionally, a CT scan. These imaging tests allow your doctor to look inside the patient’s knee, understand the problem and plan the surgery.

On the weekday day before your surgery, the care team will reach out to you about when you should arrive at the surgery center or hospital. The care team (your surgeon, nurses, and other specialists) will review the surgery plan with you and welcome any questions you have.

The care team will also talk to you about what to expect after the procedure and what you can do to ensure the best possible recovery.

Patients are put to sleep using general anesthesia. The operation takes about two hours.

What to expect during Trochleoplasty

In the operating room, the surgeon will make two incisions on the knee. The new trochlear groove is created by elevating the cartilage of the trochlea and removing bone to shape a new groove. The cartilage is molded into the new groove and secured.

For most patients, ligaments on either side of the kneecap that have been damaged because of previous dislocations. These ligaments are reset using a donor's tendon to augment and strengthen the ligaments on the inner aspect of the kneecap.

What to expect after Trochleoplasty

Patients are generally released to go home within a couple of hours after surgery. For the first couple of days, your knee will feel painful and stiff. Your doctor will give you a prescription for pain medication. However, most patients don't need to take it for more than a week. Cold therapy is strongly encouraged as well.

Your knee will get better faster if you flex, bend and move it soon after surgery. Patients are also encouraged to put as much weight on their knee as they can tolerate. Depending on how their knee feels, the patient will need to use crutches for two to four weeks after their procedures.

What do recovery and long-term rehabilitation look like?

Your surgical care team will connect you with a physical therapy team to plan an evaluation within one to two weeks after surgery. One benefit of coming to the Children’s Health Andrews Institute is that our physical therapists specialize in treating athletic conditions and are fully integrated into our surgical care program. This means they work closely with your surgeon, to understand what your needs are and create a tailored physical therapy plan.

Our physical therapists will work with you to design immediate and long-term goals for your health, safety and participation in activities. We aim to have patients fully rehabilitated and cleared to resume sports within four to six months.

How do I prepare my child for the Trochleoplasty procedure?

Fortunately, there is little to no prep work before this procedure. If you are young and healthy, there is not typically any bloodwork or extra physician visits needed. If you have pre-existing medical conditions, then there may be the need for bloodwork and pre-surgical clearance from either your primary doctor or a specialist.

Patients will not be able to eat or drink anything after midnight the night before surgery. If you have a prescription medication that you need to take in the morning, this is typically fine to do with a sip of water but it’s important to share those medications with the nurse who calls you the day before surgery.

What questions should I ask my provider about Trochleoplasty?

• What other procedures correct trochlear dysplasia?
• How many trochleoplasties have you done?
• What are your trochleoplasty success rates?
• How long will it take to recover?
• What kind of physical therapy or rehabilitation support will I need to do?
• Are there any risks or complications that I should know about?
• Is there anything I should watch out for during recovery that might be abnormal?
• What level of pain is typical during the days and weeks after surgery?
• When will I be cleared for full activity after surgery?