Xu H, Ding M, Liao BH, Lei SG, Zheng C, Wang YC. Precise arthroscopic mini-trochleoplasty combined with medial patellofemoral ligament reconstruction yields comparable complications to isolated medial patellofemoral ligament reconstruction. World J Orthop 2026; 17(5): 118163 [DOI: 10.5312/wjo.v17.i5.118163]
Corresponding Author of This Article
Ying-Chun Wang, Chief Physician, Department of Orthopaedics, The First Affiliated Hospital of Air Force Military Medical University, Sports Medicine Institution, No. 127 Changle West Road, Xi’an 710000, Shaanxi Province, China. wangyingchun2024@126.com
Research Domain of This Article
Orthopedics
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Orthop. May 18, 2026; 17(5): 118163 Published online May 18, 2026. doi: 10.5312/wjo.v17.i5.118163
Precise arthroscopic mini-trochleoplasty combined with medial patellofemoral ligament reconstruction yields comparable complications to isolated medial patellofemoral ligament reconstruction
Hu Xu, Ming Ding, Bing-Hui Liao, Shang-Guan Lei, Chao Zheng, Ying-Chun Wang
Hu Xu, Ming Ding, Bing-Hui Liao, Shang-Guan Lei, Chao Zheng, Ying-Chun Wang, Department of Orthopaedics, The First Affiliated Hospital of Air Force Military Medical University, Sports Medicine Institution, Xi’an 710000, Shaanxi Province, China
Co-first authors: Hu Xu and Ming Ding.
Author contributions: Xu H, Ding M, Liao BH, Lei SG, Zheng C, and Wang YC developed the methodology of this study; Wang YC and Ding M contributed significantly to the data collection and parameter measurement; Liao BH, Lei SG, Zheng C, and Xu H performed patient selection and statistical analysis; Xu H, Ding M, and Wang YC drafted the manuscript; Xu H and Ding M contributed equally to this manuscript and are co-first authors. All authors edited and approved the final manuscript.
Institutional review board statement: The institutional review board approval was acquired from the Ethics Committee of the First Affiliated Hospital of the Air Force Medical University (No. KY20222161-C-1).
Informed consent statement: Exempted informed consent was obtained in this study.
Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: Anonymized sources of the Technical appendix, statistical code, and dataset are available from the corresponding author on reasonable request.
Corresponding author: Ying-Chun Wang, Chief Physician, Department of Orthopaedics, The First Affiliated Hospital of Air Force Military Medical University, Sports Medicine Institution, No. 127 Changle West Road, Xi’an 710000, Shaanxi Province, China. wangyingchun2024@126.com
Received: December 25, 2025 Revised: January 19, 2026 Accepted: February 12, 2026 Published online: May 18, 2026 Processing time: 144 Days and 9.2 Hours
Abstract
BACKGROUND
Trochlear dysplasia (TD) is the most prevalent risk factor of recurrent patellar dislocation (RPD). Surgeons remain hesitant to perform open trochleoplasty even in severe TD, due to high complication rates. A goal to reduce complications underlies the development of arthroscopic trochleoplasty. Our method, precise arthroscopic mini-trochleoplasty (PAM trochleoplasty), involves minimal osteotomy and damage to patellofemoral joint. Medial patellofemoral ligament reconstruction (MPFLR) is the most frequently selected safe procedure for RPD treatment. MPFLR is associated with low complication rates. No prior study has compared outcomes and complications between combined arthroscopic trochleoplasty with MPFLR and isolated MPFLR in RPD treatment.
AIM
To compare outcomes and complications, at 2-year follow-up in patients who underwent either combined PAM trochleoplasty with MPFLR or isolated MPFLR.
METHODS
Thirty patients who underwent PAM + MPFLR, and 20 patients isolated MPFLR were included. Clinical outcomes assessment consisted of patient-reported outcome measure scores (PROMs), including visual analog scale (VAS), International Knee Documentation Committee (IKDC) score, Knee Injury and Osteoarthritis Outcome Score (KOOS), Lysholm score, and Tegner activity score, and complications. Subgroups of cases with type B TD of Dejour classification were assessed. Radiological evaluation included tibial tubercle-trochlear groove (TT-TG) distance, lateral trochlear inclination (LTI), and lateral patellar tilt (LPT).
RESULTS
PAM + MPFLR group demonstrated more severe multiple dysplasia compared to MPFLR group (P < 0.001). At 2-year follow-up, all PROMs significantly improved in both groups (P < 0.001-0.05). No significant differences were observed between groups in VAS score, KOOS subscales for pain, symptoms, activities of daily living, and quality of life, or Lysholm score (P > 0.05). However, MPFLR group demonstrated significantly higher IKDC and Tegner scores (P < 0.05). In type B TD subgroups, no significant differences were found in most PROMs, except for IKDC score. Postoperative radiological outcomes showed that PAM + MPFLR group had significantly greater improvements in TT-TG distance, LTI, and LPT (P < 0.001), whereas MPFLR group showed significant improvement only in LPT. There were no significant differences in complication rates between two groups or within subgroups (P > 0.05).
CONCLUSION
Both PAM + MPFLR and isolated MPFLR result in favorable clinical outcomes and comparable complication rates. These findings suggest PAM + MPFLR may be considered as an option for treating RPD with severe TD.
Core Tip: Open trochleoplasty for recurrent patellar instability with trochlear dysplasia (TD) demonstrates high complication rates. Our technique combines medial patellofemoral ligament reconstruction (MPFLR) with precise arthroscopic mini-trochleoplasty, yielding good clinical outcomes, and allowing for minimally invasive correction of severe TD with complication rates similar to those of conventional MPFLR. This provides a comprehensive arthroscopic solution for recurrent patellar dislocation associated with severe TD.
