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Journal of Bone and Joint Surgery - British Volume, Vol 90-B, Issue 7, 864-869.
doi: 10.1302/0301-620X.90B7.20447  
Copyright © 2008 by British Editorial Society of Bone and Joint Surgery
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The effect of trochleoplasty on patellar stability and kinematics

A BIOMECHANICAL STUDY IN VITRO

A. A. Amis, PhD, DSc (Eng), Professor of Orthopaedic Biomechanics1; C. Oguz, FRCS, Specialist Registrar in Orthopaedic Surgery2; A. M. J. Bull, PhD, Reader in Musculoskeletal Biomechanics3; W. Senavongse, PhD, Head of Biomedical Engineering4; and D. Dejour, MD, Consultant Orthopaedic Surgeon5

1 Departments of Mechanical Engineering and of Musculoskeletal Surgery
2 St. Mary’s Hospital, Praed Street, London W2 1NY, UK.
3 Department of Bioengineering Imperial College London, South Kensington Campus, London SW7 2AZ, UK.
4 Srinakharinwirot University, Nakonnayok, Thailand, 26120.
5 Corolyon-Sauvegarde Hospital, 8 Ave Ben Gurion, Lyon 69009, France.

Correspondence should be sent to Professor A. A. Amis; e-mail: a.amis{at}imperial.ac.uk

Objective patellar instability has been correlated with dysplasia of the femoral trochlea. This in vitro study tested the hypothesis that trochleoplasty would increase patellar stability and normalise the kinematics of a knee with a dysplastic trochlea. Six fresh-frozen knees were loaded via the heads of the quadriceps. The patella was displaced 10 mm laterally and the displacing force was measured from 0° to 90° of flexion. Patellar tracking was measured from 0° to 130° of knee flexion using magnetic sensors. These tests were repeated after raising the central anterior trochlea to simulate dysplasia, and repeated again after performing a trochleoplasty on each specimen. The simulated dysplasia significantly reduced stability from that of the normal knee (p < 0.001). Trochleoplasty significantly increased the stability (p < 0.001), so that it did not then differ significantly from the normal knee (p = 0.244). There were small but statistically significant changes in patellar tracking (p< 0.001).

This study has provided objective biomechanical data to support the use of trochleoplasty in the treatment of patellar instability associated with femoral trochlear dysplasia.






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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General