No significant difference in thick versus thin osteochondral flap trochleoplasty in the treatment of trochlear dysplasia: A systematic review

Abstract

AbstractPurposeTrochleoplasty has become increasingly utilised to address patellar instability in the setting of severe trochlear dysplasia. There remains a paucity of literature on the outcomes of ‘thick’‐ versus ‘thin’‐osteochondral flap trochleoplasty. The purpose of this study is to compare clinical and radiographic outcomes between patients with patellar instability with symptomatic trochlear dysplasia treated using a ‘thick’ versus ‘thin’ osteochondral flap trochleoplasty.MethodsA systematic review and meta‐analysis were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines using a PRISMA checklist. Quality assessment of final articles was conducted by two blinded reviewers. Articles were separated based on the use of a ‘thick’ versus ‘thin’ flap trochleoplasty. Data collection consisted of recording the following variables: patient demographics, indications for trochleoplasty, mean follow‐up time, additional procedures performed during trochleoplasty, patient‐reported outcome measures (PROMs), radiographic outcomes (tibial tubercle‐trochlear groove [TT‐TG] distance, Caton–Deschamps Index [CDI] and sulcus angle [SA]) and the incidence of any postoperative complications and patellar redislocation rates.ResultsA total of 24 studies, consisting of 927 patients, were identified as meeting inclusion criteria. A total of five papers described a ‘thick’ flap technique, while 19 papers described the use of a ‘thin’ flap technique. No significant difference in the mean improvement of Kujala scores was appreciated when comparing ‘thick’ versus ‘thin’ techniques (p > 0.05). Improvements in mean radiographic outcomes based on TT‐TG, CDI and SA were observed in both ‘thick’ and ‘thin’ flap trochleoplasty groups. The overall redislocation rate was 0.35%.ConclusionNo significant difference in Kujala scores was observed in patients undergoing trochleoplasty utilising ‘thick’ versus ‘thin’ technique, while improvements in mean TT‐TG, CDI and SA were noted in both technique groups, with an overall redislocation rate of 0.35%.Level of EvidenceLevel IV.