The kneecap (patella) is a small bone in the front of the knee that helps support the extensor mechanism (quadriceps and patellar tendons). As the knee bends, the patella glides along a groove on the femur bone – the trochlea. Patellar instability refers to a condition in which the patella slides out of the trochlea (dislocates). Some individuals have a shallow trochlear groove (a flat trochlea). When the trochlear groove is shallow or flat, the patella is unstable as the knee bends and can slip out of place (dislocate). In those patients who do not improve with non-surgical management, Dr. Welch may recommend surgical intervention.
The goal of trochleoplasty is to create a deeper trochlea to stabilize the patella. During surgery, Dr. Welch makes an incision adjacent to the patella and identifies the trochlea. Using guide pins, Dr. Welch then makes cuts in the femur bone (around the trochlea) and repositions the cartilage and bone into a deep, V-shape. Dr. Welch is careful to deepen the groove enough to stabilize the patella. Usually, patients who require a trochleoplasty require an additional procedure, such as an MPFL reconstruction, to fully stabilize the patella.
Following surgery, full weight-bearing is encouraged with the knee locked in a brace in the extended position. Dr. Welch also recommends intermittent icing, straight leg raises for quad strength, and starting a dedicated physical therapy protocol one week after surgery. The physical therapist focuses on reducing swelling in the knee, range of motion, and restoring strength to the limb and core. Dr. Welch recommends advancing the physical therapy program to cutting, pivoting, and sport-specific activities approximately four months after surgery. Most patients return to competitive sports approximately six months after surgery. It is very important to follow the rehabilitation process carefully to achieve the best outcome.