Trochleoplasty Is Associated With High Rates of Patellofemoral Arthritis: A Systematic Review

Purpose To identify 2‐ to 5‐ and >10‐year complications of trochleoplasty and define rates of postoperative patellofemoral arthritis. Methods PubMed, Embase, and Web of Science were queried for terms related to trochleoplasty. Included studies were clinical studies using trochleoplasty to manage patellofemoral instability and were published in English in peer‐reviewed journals. Excluded studies were systematic reviews, meta‐analyses, cadaveric studies, animal studies, and case reports. Patient demographics, follow‐up time, concomitant procedures, complications, and subsequent surgeries were collected. Studies were grouped by follow‐up time into <2, 2 to 5, 5 to 10, and >10 years. Results Thirty‐five studies met inclusion criteria with 1336 patients (64% female). There were 142 (10.6%) patients with less than 2 years of follow‐up, 871 (65.2%) with 2 to 5 years, 221 (16.5%) with 5 to 10 years, and 102 (7.6%) with more than 10 years. The complication rates ranged from 0% to 33%. Seven (20%) studies specifically reported on postoperative arthritis. In patients with <2 years, the most common complication was arthrofibrosis at rates of 0% to 6.3%. Patellofemoral arthritis was the most common complication in patients with 2 to 5 (0%‐35.3%), 5 to 10 (0%‐17.4%), and >10 years of follow‐up (0%‐92.3%). In patients with more than 10 years of follow‐up, rates of patellofemoral arthritis worse than Iwano grade 2 were as high as 65%. Recurrent instability rates varied widely across studies and follow‐up times from 0% to 33.3%. Conclusions Patients undergoing trochleoplasty for patellar instability may experience low rates of recurrence but are prone to postoperative stiffness at <2‐ and 2‐ to 5‐year follow‐up. Complications following trochleoplasty in isolation are worse than when concomitant procedures are done. After 10 years, the incidence of all patellofemoral arthritis is as high as 92%, and more severe patellofemoral arthritis is as high as 65%, which is greater than the progression in patients with patellofemoral instability. Level of Evidence Level IV, systematic review of Level II to IV studies.