Long-Term Clinical Impact of Radiographic Patellofemoral Osteoarthritis After Sulcus-Deepening Trochleoplasty: A Retrospective Cohort Study.

Background: Sulcus-deepening trochleoplasty is an effective surgical treatment for high-grade trochlear dysplasia in patients with recurrent patellofemoral instability. However, concerns remain regarding the potential development of patellofemoral osteoarthritis (OA) over time and its effect on clinical outcomes. Purpose: To determine whether the presence of radiographic grade ≤2 OA after trochleoplasty is associated with inferior functional outcomes or patient satisfaction. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective study was conducted on 42 patients (47 knees) who underwent thick-flap sulcus-deepening trochleoplasty. After applying inclusion and exclusion criteria, 27 patients (33 knees) with a minimum follow-up of 10 years were included. Patients were categorized into OA and non-OA groups based on radiographic assessment (Iwano classification) at final follow-up. Functional outcomes were evaluated using the International Knee Documentation Committee (IKDC) and Kujala scores, while patient satisfaction was assessed on a 10-point scale. Group comparisons were performed using Mann-Whitney Results: At a mean follow-up of 14.97 years (range, 10.4-19 years), 20 knees (60.6%) demonstrated radiographic OA (Iwano grades 1-2), while 13 knees (39.4%) showed no OA. Patients in the OA group were older (37.5 ± 6.7 vs 30.5 ± 3.0 years, Conclusion: Low-grade patellofemoral OA (Iwano ≤2) was observed in 60% of knees at a mean follow-up of 15 years, but its presence did not negatively affect long-term functional outcomes or patient satisfaction. Importantly, no patient developed grade 3 or 4 OA, and radiographic changes were more frequent in older patients and those with longer follow-up, supporting trochleoplasty as a reliable surgical option for patients with high-grade trochlear dysplasia.