Trochleoplasty

The procedure is often recommended for individuals who have chronic patellar instability due to severe trochlear dysplasia and who haven’t responded to non-surgical treatment options or other types of surgery.

The surgery is generally performed under general anesthesia. Your knee surgeon Dr. Ben Mayo will make an incision over the knee to access the trochlea. He will then remove a thin layer of bone from under the cartilage surface of the trochlea. This allows the groove of the trochlea to be deepened. The removed bone layer is then repositioned back onto the reshaped trochlea and fixed in place with suture and tiny plastic anchors.

The recovery timeline from trochleoplasty surgery varies depending on the individual. Generally, you’ll need crutches for the first 6 weeks to avoid putting weight on the knee. You may return to desk work or light activities within a few weeks after surgery, but it can take 6 months or more before you’re able to return to high-impact activities or sports.

Immediately after surgery, your knee will be in a brace to keep it stable. You’ll likely have some pain and swelling, which can be managed with prescribed medications. Physical therapy usually begins soon after surgery to help restore motion and strength in the knee.

Physical therapy is an essential part of the recovery process after trochleoplasty, including:

• Early Stage (Weeks 1-6): The main goals are pain management, swelling reduction, and regaining knee motion. The therapist will guide you through gentle range-of-motion exercises and help you manage daily activities with crutches.
• Middle Stage (Weeks 6-12): As your knee heals, the focus shifts towards regaining strength and flexibility. Low-impact cardio exercises like cycling may be introduced.
• Late Stage (Weeks 12 and beyond): This stage emphasizes a return to normal function and activities, gradually increasing the intensity and complexity of exercises.

While trochleoplasty is generally a safe procedure, there are potential risks, including:

• Infection: Like any surgical procedure, there’s a risk of infection, although this is quite rare.
• Blood clots: There’s a small risk of deep vein thrombosis (DVT) or pulmonary embolism (PE).
• Nerve damage: There’s a minor risk of damage to nerves in the knee, which could lead to numbness or weakness in the leg.
• Recurrence of instability: In some cases, patellar instability can recur after surgery, requiring further treatment.

If you don’t undergo a trochleoplasty when it is recommended, the potential risks include:

• Continued knee instability: Without the procedure, you might continue to experience frequent knee dislocations or feelings of instability.
• Further joint damage: Chronic instability can lead to additional knee joint damage over time, including damage to the cartilage and development of osteoarthritis.