Recession wedge trochleoplasty yields superior postoperative functional outcomes in primary procedures when compared to revisions for treating recurrent patellar dislocations with high grade trochlear dysplasia

BACKGROUND: To compare long-term clinical and functional outcomes of patients undergoing a recession wedge trochleoplasty in either primary or revision patellar stabilizing procedures in patients with a high grade trochlear dysplasia. HYPOTHESIS: Primary trochleoplasty would result in superior functional outcomes. METHODS: This retrospective, monocentric, comparative study was conducted at a knee surgery center included 43 knees treated with trochleoplasty between January 1, 2008, and December 31, 2023. Of these, 33 cases underwent a trochleoplasty in primary procedures, while 10 trochleoplasties were performed as revision procedures. The groups were comparable. In both groups, surgeries were systematically combined with additional surgical procedures (distal tibial tubercle transfer and/or medialization, MPFL reconstruction, or lateral retinacular release), without any difference between groups. The primary outcome was postoperative functional assessment using three validated scores: Kujala, IKDC, and the Lille score. Secondary outcomes included patient satisfaction, recurrence of patellofemoral dislocation, subjective instability, postoperative complications, reoperation rates, postoperative pain, pre-to-postoperative Tegner activity score change, and return to sport (rate and time). RESULTS: Functional outcomes were significantly better in the primary trochleoplasty group versus revision group, as reflected by the mean Kujala and Lille scores (72.2 ± 17.1 versus 59.1 ± 12.9 (p < 0.02) and 77.5 ± 17.9 versus 65.1 ± 16.7 (p < 0.04), respectively). Postoperative subjective patellofemoral instability was higher in the revision group, than in the primary group (9 out of 10 patients (90%) versus 14 out of 33 patients (43.8%), respectively (p < 0.04)). DISCUSSION: Recession wedge trochleoplasty yields superior postoperative functional outcomes in primary procedures when compared to revisions for treating recurrent patellar dislocations with high grade trochlear dysplasia. These findings suggest that deferring an indicated trochleoplasty during initial surgical management may negatively affect long-term functional outcomes, thereby supporting its consideration earlier in the treatment algorithm. LEVEL OF EVIDENCE: III; retrospective comparative study.