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Journal of Peking University (Health Sciences) ›› 2025, Vol. 57 ›› Issue (5): 947-955. doi: 10.19723/j.issn.1671-167X.2025.05.020

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Clinical efficacy of arthroscopic medial patellofemoral complex reconstruction for recurrent patellar dislocation with high-grade trochlear dysplasia

Fengyi HU, Qingyang MENG, Nayun CHEN, Jianing WANG, Zhenlong LIU, Yong MA, Yuping YANG, Xi GONG, Cheng WANG, Ping LIU*(), Weili SHI*()   

  1. Department of Sports Medicine, Peking University Third Hospital; Institute of Sports Medicine of Peking University; Beijing Key Laboratory of Sports Injuries, Beijing 100191, China
  • Received:2023-02-06 Online:2025-10-18 Published:2024-05-07
  • Contact: Ping LIU, Weili SHI
  • Supported by:
    Peking University Third Hospital Clinical Key Program(BYSYZD2022011); Interdisciplinary Cooperation Project of Beijing Nova Program of Beijing Municipal Science & Technology Commission(Z211100002121015)

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Abstract: Objective: To investigate the midterm clinical efficacy of medial patellofemoral complex (MPFC) reconstruction for recurrent patellar dislocation with high-grade trochlear dysplasia. Methods: A retrospective analysis was carried out among adult patients who underwent arthroscopically assisted MPFC reconstruction between January 2014 and December 2020. Dejour classification was evaluated to grade trochlear dysplasia; tibial tubercle-trochlear groove (TT-TG) distance and Insall-Salvati index were measured. Preoperative and postoperative patient-reported outcome measures (PROMs) were compared, including International Knee Documentation Committee (IKDC) score, Kujala score, Lysholm score and Tegner score. Information regarding returning-to-sport rate, re-instability events and complications was collected. Patellar tilt (PT), lateral patellar displacement (LPD) and bisect offset (BSO) ratio were measured based on axial computed tomography before and after surgery to assess the patellofemoral congruence. Results: A total of 46 MPFC reconstructions in 43 patients were enrolled, including 16 male and 27 female. Mean age at surgery was (22.2±7.6) years (range: 14-44 years). Mean follow-up was (49.9±22.6) months (range: 18-102 months). The percentages of Dejour B, C and D dysplasia were 37.0% (17/46), 43.5% (20/46), and 19.6% (9/46), respectively. Mean Insall-Salvati index was 1.2±0.2 (range: 0.85-1.44), and mean TT-TG distance was (19.6±3.5) mm (range: 10.6-28.7 mm). At latest follow-up, there were significant improvements in all PROMs (P < 0.001): IKDC score, from 56.3±15.1 to 86.2±8.1; Kujala score, from 58.9±15.6 to 92.6±5.4; Lysholm score, from 63.7±15.0 to 94.0±5.7; Tegner score, from 3.1±1.4 to 4.7±1.4, and there were no significant differences in the improvements of the scores between the patients with Dejour B, C and D dysplasia. Overall, ninety percent of the patients returned to their preoperative sports level. One patient reported a postoperative subluxation, while no cases of infection, limited range of motion or patella fracture were observed. PT, LPD and BSO ratio were all significant altered (P < 0.001) after MPFC reconstruction. Conclusion: Arthroscopically assisted MPFC reconstruction yielded satisfactory midterm clinical results for recurrent patellar dislocation with high-grade trochlear dysplasia. No significant differences of improvements in knee function were observed among the three types of high-grade trochlear dysplasia.

Key words: Patellar dislocation, Recurrence, Medial patellofemoral complex reconstruction, Femoral trochlear dysplasia, Dejour classification

CLC Number: 

  • R684.76

Figure 1

Arthroscopically assisted medial patellofemoral complex reconstruction A, a patellar tunnel was made at the upper third point of the medial patella with a 4.5 mm drill; B, guide sutures were introduced through the patellar tunnel with an eyelet pin; C, a quadricep-tendon tunnel was created at the midpoint of the superior patella using a blunt cannula; D, guide sutures were pulled out through the medial femoral incision with a grasper; E, the autograft was introduced into the patellar tunnel (arrow 1) and the quadricep-tendon tunnel (arrow 2) with guide sutures; F, intraarticular view of the double-bundle (arrow 3 and 4) reconstructed graft."

Figure 2

Examples of 4-grade Dejour classification based on axial CT A, a 38-year-old male was diagnosed with Dejour A trochlear dysplasia, whose CT scan indicated a trochlear groove angle of >145 degree and symmetric trochlear facets; B, a 21-year-old male was diagnosed with Dejour B trochlear dysplasia, whose CT scan indicated a flat trochlea (arrow); C, a 16-year-old female was diagnosed with Dejour C trochlear dysplasia, whose CT scan indicated asymmetric trochlear facets and hypoplastic medial facet (arrow); D, a 17-year-old female was diagnosed with Dejour D trochlear dysplasia, whose CT scan indicated a positive cliff pattern (arrow). CT, computed tomography."

Figure 3

Measurements of radiographic parameters on lateral plain radiographs and axial CT A, Insall-Salvati index is the ratio of the patellar tendon length (T) to the patellar height (P1, distance from the superior pole to the inferior pole) on lateral plain radiographs; B, TT-TG distance is calculated by the transverse length between the trochlear groove and the tibial tuberosity on axial images; C, PT is the angle between the transverse axis of the patella and the posterior femoral condylar line; D, LPD describes the distance between the medial margin of the patella and the medial trochlear margin measured by lines perpendicular to the posterior femoral condylar line; E, bisect offset is determined by the ratio at which the patella width was bisected from its lateral aspect to the transverse width of the patella (L/P2). CT, computed tomography; LPD, lateral patellar displacement; PT, patellar tilt; TT-TG, tibial tubercle-trochlear groove."

Table 1

Anatomical risk factors and chondral lesion"

Parameters Data
Dejour classification
  Type B 17 (37.0)
  Type C 20 (43.5)
  Type D 9 (19.6)
Patellar height (Insall-Salvati index) 1.2±0.2
   < 1.2 21 (45.7)
  ≥ 1.2 25 (54.3)
TT-TG distance 19.6±3.5
   < 20 mm 24 (52.2)
  ≥ 20 mm 22 (47.8)
Patellar tilt/(°) 30.9±10.5
Chondral lesion
  Patella > ICRS Ⅱ 23 (50.0)
  Trochlea > ICRS Ⅱ 1 (2.2)
  Lateral femoral condyle > ICRS Ⅱ 8 (17.3)

Table 2

Comparison of anatomical risk factors among Dejour type B, C and D dysplasia"

Parameters Type B (n=17) Type C (n=20) Type D (n=9) F P
Insall-Salvati index 1.1±0.2 1.2±0.2 1.3±0.1 2.641 0.083
TT-TG distance/mm 19.0±3.3 19.4±3.9 21.2±2.5 1.232 0.302
Patellar tilt/(°) 30.2±9.1 31.2±12.7 31.9±8.7 0.066 0.936

Table 3

Comparison of patient-reported outcome measures before and after surgery"

Outcome measures Preoperative score Postoperative score Z P
IKDC score 56.3±15.1 86.2±8.1 -5.896 < 0.001
Kujala score 58.9±15.6 92.6±5.4 -5.906 < 0.001
Lysholm score 63.7±15.0 94.0±5.7 -5.906 < 0.001
Tegner score 3.1±1.4 4.7±1.4 -4.867 < 0.001
Subjective satisfaction 9.1±1.0

Table 4

Comparison of improvements in patient-reported outcome measures among Dejour type B-D dysplasia"

Outcome measures Type B (n=17) Type C (n=20) Type D (n=9) F P
ΔIKDC score 27.2±17.7 29.1±15.2 37.0±13.7 1.173 0.319
ΔKujala score 27.5±12.8 30.8±13.9 34.4±13.5 1.378 0.263
ΔLysholm score 31.6±14.8 32.1±14.9 41.0±14.6 0.815 0.449
ΔTegner score 1.4±1.5 1.5±1.7 2.2±1.4 0.896 0.416

Table 5

Relationship between postoperative symptomatic knee pain and stages of chondral lesion"

Chondral lesion No lesion ICRS Ⅰ ICRS Ⅱ ICRS Ⅲ ICRS Ⅳ P
Patella 0.869
  Symptomatic knee pain (-) 3 2 13 9 8
  Symptomatic knee pain (+) 2 0 3 3 3
Trochlea facet 0.287
  Symptomatic knee pain (-) 12 2 21 0 0
  Symptomatic knee pain (+) 5 0 5 1 0
Lateral femoral condyle >0.995
  Symptomatic knee pain (-) 26 1 1 2 5
  Symptomatic knee pain (+) 10 0 0 0 1

Table 6

Comparison between preoperative and postoperative CT parameters of the patellofemoral joint"

Parameters Preoperative value Postoperative value Z P
Patellar tilt/(°) 30.9±10.5 9.8±6.0 -5.443 < 0.001
Lateral patellar displacement/mm 10.4±8.1 -8.7±7.1 -5.442 < 0.001
Bisect offset ratio 1.1±0.3 0.6±0.2 -5.442 < 0.001

Figure 4

Comparison of axial CT scans of the patellofemoral joint before and after MPFC reconstruction Patient 1 was a 17-year-old male diagnosed with recurrent patellar dislocation of the right knee. Preoperative CT scan showed significant patellar tilt and lateral displacement, which were both corrected on postoperative scan. Patient 2 was a 16-year-old male diagnosed with recurrent patellar dislocation of the right knee. Preoperative CT scan demonstrated a dislocated patella with remarkable tilt and lateral translation, while the patellofemoral congruence was restored on postoperative scan. CT, computed tomography; MPFC, medial patellofemoral complex reconstruction."

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