Arthroscopic Deepening Trochleoplasty for Trochlear Dysplasia
Arthroscopic deepening trochleoplasty is a minimally invasive surgical technique designed to correct trochlear dysplasia and restore normal patellofemoral stability. The procedure reshapes the trochlear groove anatomically while preserving cartilage, reducing pain, improving patellar tracking, and preventing recurrent dislocations.
This page provides a concise overview of indications, surgical steps, recovery, scientific evidence, and the advantages of the arthroscopic technique compared with traditional open trochleoplasty — especially relevant for international patients seeking specialized treatment.
What is arthroscopic trochleoplasty?
Trochlear dysplasia is a structural abnormality where the trochlear groove is too shallow or flat, causing the patella to slip out of place. Arthroscopic deepening trochleoplasty corrects this by reshaping the groove through keyhole incisions, allowing precise anatomical reconstruction with minimal soft‑tissue trauma.
The technique is based on:
- full arthroscopic visualization,
- controlled deepening of the groove,
- preservation of cartilage,
- stable fixation of the osteochondral flap.
With this surgery a new and a deeper groove is created to normalize your anatomy if you have trochlear dysplasia. If you just want to know why the benefits are clear to have it done by the arthroscopic technique you need to jump down to Why Choose Arthroscopic Trochleoplasty?.
Who Is a Candidate for the Procedure?
Arthroscopic trochleoplasty is indicated for patients with:
- recurrent patellar instability,
- high‑grade trochlear dysplasia (low lateral inclination angle),
- failed previous stabilization surgery (e.g., MPFL reconstruction),
- pain caused by maltracking,
- instability during sports or daily activities.
It is particularly beneficial for young, active patients who require fast recovery and minimal scarring. However it is also advantageous in older patients and I have operated several patients about 50 years and the oldest was 58 years
International patients
International patients from Europe, the UK, Middle East and USA frequently travel for this procedure. Fast recovery, minimal scarring, and expert surgical care.
Illustration showing new trochlear groove and the sutures keeping the cartilage in place after arthroscopic trochleoplasty
Advantages Compared to Open Trochleoplasty
Arthroscopic deepening trochleoplasty offers several advantages:
- Minimally invasive (small portals, no large incision)
- Less postoperative pain
- Faster rehabilitation
- More precise groove shaping
- Better visualization of cartilage and anatomy
- Lower risk of stiffness
- Superior cosmetic result
- Reduced soft‑tissue disruption
- Reduced heating of the cartilage flap.
- Reduced heating means less risk of damage to cartilage cells.
Many patients return to normal activities significantly faster than after open surgery.
Surgical Technique (Step‑by‑Step)
The procedure includes:
- Arthroscopic assessment of trochlear dysplasia and patellar tracking.
- Creation of an osteochondral flap while preserving cartilage integrity.
- Deepening of the trochlear groove to the correct anatomical shape.
- Repositioning and fixation of the flap using bioabsorbable sutures and anchors.
- Verification of patellar tracking throughout the range of motion.
- MPFL reconstruction.
The technique restores normal trochlear geometry and eliminates the mechanical cause of instability.
Recovery and Rehabilitation
- Most patients experience:
- immediate improvement in patellar stability,
- reduced pain compared to open surgery,
- rapid return of motion.
- Typical recovery timeline:
- Week 1–2: walking with full weight bearing and free range of motion
- Week 4–6: return of full range of motion
- Month 3: light sports
- Month 6: full athletic activity is allowed if possible
- Rehabilitation is individualized based on dysplasia severity and additional procedures.
Scientific Evidence and Publications
- Arthroscopic deepening trochleoplasty is supported by multiple peer‑reviewed studies demonstrating:
- significant improvement in stability,
- high patient satisfaction,
- low complication rates,
- excellent anatomical correction.
- Selected publications:
- Blønd L. et al. Arthroscopic deepening trochleoplasty – clinical outcomes and technique development. Read more here
- ESSKA presentations and international surgical courses.
- Comparative studies showing reduced pain and faster recovery vs. open trochleoplasty.
Why Choose Arthroscopic Trochleoplasty?
- This technique is ideal for patients seeking:
- anatomical correction,
- minimal scarring,
- fast recovery,
- reduced pain,
- long‑term stability,
- preservation of cartilage.
- reduced risk of arthrofibrosis
- It is one of the most advanced treatments available for trochlear dysplasia.
About the Surgeon
Lars Blønd, MD Orthopaedic Surgeon – Patellofemoral Specialist International instructor in arthroscopic trochleoplasty techniques. Developed the minimally invasive arthroscopic trochlear deepening techniques in 2007. Performed a large number of arthroscopic deepening trochleoplasties, not only in Denmark but also in high number of countries. Author of multiple peer‑reviewed publications. Speaker at ESSKA, ISAKOS, and international courses. Also author of the chapter on patellar instability in the latest European textbook published by ESSKA on arthroscopic treatments.
Contact and International Patients
Patients from Europe, the UK, and overseas frequently travel for this procedure. For consultation or referral, please contact the clinic directly.
Or direct to my email lars.blond combined with @aleris.dk
Zoom
In case you would like a second opinion regarding your MRI or just your general knee situation, I do Zoom consultations. The cost is 225 euro.
History
I used to perform the open trochleoplasty. In 2007 I invented the arthroscopic technique. I started out in 2008 doing the first arthroscopic deepening trochleoplasty procedures. The open trochleoplasty method leaves a bigger scar, and in addition it is more painful and the risk of scar formation arthrofibrosis is 30%. The rate of complication after this arthroscopic procedure is very low. In the past years studies from other international groups adopted the arthroscopic deepening trochleoplasty technique. They demonstrate comparable result to our three previous publications. Until now I have operated patients from 15 different countries:
More about the groove surgery
By using the pinhole technique (arthroscopic), consequently the surgery becomes less traumatic for your knee , and therefore the rehabilitation is likely to become accelerated. To notice is the groove operation mostly done in combination with a reconstruction of the inner ligament for the kneecap (MPFL reconstruction). Even the most severe cases of trochlear dysplasia can be operated with arthroscopic deepening trochleoplasty.
Heating of cartilage flap
Doing open trochleoplasty, you need to debride bone with a high speed burr on the rear side of the cartilage flap and this might lead to heating. Heating might impair the cartilage viability. During the arthroscopic trochleoplasty, a huge constant waterflow ensure that there is no heating.
Why also perform MPFL reconstruction?
Why is the groove surgery not enough? And why should you also have reconstructed the MFPL? (mediale patellofemoral ligament = inner ligament for kneecap). That is first of all because the MPFL is always torn when the kneecap dislocate. In most circumstances does it not heal normally and therefore it has to be reconstructed. Moreover, it is also the case that the trochlear groove, do not provide stability to your kneecap, until the kneecap reach the trochlea. Importantly this first happens after your knee is bend about 20 degrees. This means that the MPFL is needed to provide stability to your kneecap from full straightened knee and until your kneecap reach the new groove at 20 degrees of bending. There is scientific evidence to support this. Read more about MPFL reconstruction here
Arthroscopic trochleoplasty and no MPFL reconstruction.
If your problem is chronic anterior knee pain as a consequence of a too shallow groove, and your kneecap is stable, likewise you do not need to have the ligament to stabilize the kneecap reconstructed - eventually read more in the page about anterior knee pain.
In some situations, there is a combination of trochlear dysplasia and increased femoral anteversion and/or increased external tibia torsion (Kissing Knees) and then this has to be examined further, otherwise there is a risk that the outcome of the arthroscopic trochleoplasty is suboptimal.
After surgery
Science
I have published following peer-reviewed scientific papers. Moreover have i been involved in several papers about trochlear dysplasia and authored the one and only book on the topic.
- 1. Blønd L. and Schöttle P. The arthroscopic deepening trochleoplasty. PDF Version
- 2 Blønd L., & Haugegaard M. Combined arthroscopic deepening trochleoplasty and reconstruction of the medial patellofemoral ligament for patients with recurrent patella dislocation and trochlear dysplasia. PDF Version
- 3. Blønd L. Arthroscopic deepening trochleoplasty - The technique. PDF Version
- 4. Blønd L. Arthroscopic deepening trochleoplasty for chronic anterior knee pain after previous failed conservative and arthroscopic treatment. Report of two cases. PDF Version
- 5. Blønd L, Barfod KW. Trochlear Shape and Patient-Reported Outcomes After Arthroscopic Deepening Trochleoplasty and Medial Patellofemoral Ligament Reconstruction: A Retrospective Cohort Study Including MRI Assessments of the Trochlear Groove. PDF version
Frequently asked questions (FAQ)
How long does the surgery take?
The procedure typically lasts between 1.5 and 2.5 hours.
When can I fly back home?
This depends on distance. Most European patients fly home after 3 days, and patients from the US usually return after about a week. A seat that allows you to straighten the leg may be necessary.
Do I need crutches?
Yes. Crutches are normally used for 2–4 weeks, depending on individual recovery speed.
Do I need a brace after surgery?
No brace is required. Full weight bearing and free range of motion are allowed immediately.
Should I try a smaller surgery first?
No. If trochlear dysplasia is the underlying cause, one correct surgery is usually sufficient. Doing “smaller” procedures first often leads to repeated failures.
Is only one knee operated?
Yes. Only one knee is operated at a time. About one‑third of patients have dysplasia in both knees.
How long is the recovery?
The knee improves over 1–2 years. Most patients feel fairly good after 3 months.
Why is this procedure not more widespread globally?
Arthroscopic trochleoplasty is technically demanding and requires extensive arthroscopic experience. Many surgeons continue using the open technique because it is familiar, not because it is better.
When can I return to work or sports?
Sedentary work is usually possible after about 4 weeks. Light sports typically begin around 6 months.
Do I need antithrombotic medication?
Yes, if you are 30 years or older.
Do I need a CPM machine?
No. You perform active exercises yourself starting immediately after surgery.
Do I need physiotherapy?
Yes. Rehabilitation is essential. Many international patients work with physiotherapist Dorte Nielsen (Proalign.dk), who has extensive experience with trochleoplasty recovery.
Will I receive a postoperative plan?
Yes. You will receive a clear plan. Full weight bearing and free movement are allowed, but crutches are needed for the first weeks.
Will my insurance cover the surgery?
In most cases, yes — including travel expenses. The procedure is often significantly cheaper than similar surgery in the US.
What is the price for an online consultation and MRI evaluation?
225 Euro. MRI scans can be sent via mail, Dropbox, WeTransfer or similar.
What is the price for combined arthroscopic trochleoplasty and MPFL reconstruction?
Approximately 11,000 Euro including implants (implant cost alone is about 2,000 Euro) and that includes eventual follow-up visits.
How often do you see complications?
Until now (2026) there have to my knowledge not been any deep infections. One case with arthrofibrosis. One case with re-dislocation of patella, due to increased femoral anteversion. Three cases of deep thrombosis, all above 30 years.
Why Patients Travel to Denmark for Arthroscopic Trochleoplasty
Patients from Europe, the UK, the United States and overseas often travel to Denmark for arthroscopic deepening trochleoplasty because the procedure is highly specialized and performed by only a few surgeons worldwide. Denmark offers a unique combination of surgical expertise, predictable outcomes and fast recovery.
Key reasons international patients choose Denmark:
- Minimally invasive technique Arthroscopic deepening trochleoplasty preserves cartilage, reduces pain and allows faster rehabilitation compared with traditional open surgery.
- High surgical volume and experience The technique has been performed for many years with consistent results, making Denmark one of the leading centers for trochlear dysplasia treatment.
- Accurate diagnosis and individualized planning Detailed MRI evaluation ensures that trochlear dysplasia, patella tilt, patella alta and rotational issues are correctly identified before surgery.
- Short hospital stay and safe travel timeline Most European patients return home after 3 days, and US patients typically travel back after about a week.
- Clear postoperative instructions Full weight bearing, free range of motion and structured physiotherapy make recovery straightforward for international patients.
- Transparent pricing Surgical costs are significantly lower than in many countries, and insurance often covers both the procedure and travel expenses.
Rehabilitation protocol
After Arthroscopic Trochleoplasty and MPFL reconstruction - by Dorte Nielsen
Dorte Nielsen Proalign.dk
Dorte Nielsen is the physiotherapist who have treated far most of my arthroscopic trochleoplasty patients for more than 10 years. She often also help patients from abroad. She can see you both before and after surgery and guide you. She can tell you when you train too little or to much and guide you if something is different from normal. Here is a link to her webpage.
Medical Disclaimer:
Online meeting
If you have been told that you have trochlear dysplasia, however you are unsure how severe it is, you are welcome to have an online consultation. Similar if you consider coming to Denmark and undergo surgery by me. The cost for an online meeting is 225 Euro. You must send me the MRI (dicom files). When I have received the MRI we can set a time to meet online.
Author
Orthopaedic surgeon with international expertise in trochlear dysplasia. Author of the first scientific book on trochlear dysplasia. Developed and investigated the arthroscopic trochleoplasty operation. Also author of the chapter on patellar instability in the latest European textbook published by ESSKA on arthroscopic treatments.
Booking
Aleris Hospital Søborg
Gyngemose Parkvej 66, 2860 Søborg
Phone +45 38170700
Below more information for the nerdy
Example of an "Arthroscopic Deepening Trochleoplasty".
Before (left) and after (right). The blue band dissolves after 6 weeks and is therefore only temporary until the cartilage has healed.
MRI before (left) and after (right)
Trochlea before and after the groove surgery
- "It is difficult to balance a tennis ball on a football"
Second look
Two different examples of how it looks inside the knee 3 months after a groove surgery. If you notice has the cartilage healed very nicely and blue bands/tapes are dissolved.
Second look - 3 years after
Pictures that somehow illustrate the difference in scar formation between open and arthroscopic deepening trochleoplasty.
Nice small scars after combined arthroscopic trochleoplasty and MFPL reconstruction
Eight weeks after the surgery and the scars will improve significantly over time. I recommend you to use tape in the first month after surgery, since this will reduce traction in the scars. Hence you can avoid the scars becomes wide.
Open trochleoplasty
My last open trochleoplasty
Video arthroscopic trochleoplasty
Kenneth doing well one year after
Video
Why should I also have a groove surgery and not just MPFL reconstruction?
That is a good question and some surgeon argue that it is not necessary. Maybe it is not 100% necessary if you just want stability, but if you also want a knee without anterior knee pain, trochleoplasty have to be done. Also, sometimes I see patients having trochlear dysplasia and who have had an MPFL reconstruction only. Then after some years the kneecap starts to becomes loose again because the MPFL reconstruction get loose by time. Therefore if you visit a surgeons, who do not do trochleoplasty surgery, and you do have this flatt groove. Most importantly try to get a second opinion in case this surgeon tells you that the surgery is rare, dangerous and complicated surgery since this is not correct.
Case Study - Mikkel
Mikkel was the first patient who was operated upon with an Arthroscopic Trochleoplasty, and this was back in March 2008. Previously he had unsuccessful kneecap-stabilizing surgery and by doctor and physiotherapist he was told that he would never be able to sports again. Most noteworthy, Mikkel had been troubled in both his knee since he was 8 years old and had never been able to run. Finally he underwent surgery on both his knees with the groove surgery at 29 years old. Meaning 21 years without running.
Follow-up on Mikkel
Today is Mikkel doing well in his knees and he is running and playing soccer. He claims that the only annoyance is the sound from the knees, when he climbs stairs. Go to YouTube and listen to his and other stories during the trochleoplasty gathering in 2014. Many thanks to Asker Blønd - my son - who created this video. Click here trochleoplasty gathering.or check this video
Outcome after trochleoplasty
Generally the outcomes after groove surgery is very good, with less than 2 percent new dislocations. Consequently is the quality of life dramatically better. I have followed all my arthroscopic trochleoplasty patients for now more than 18 years and in average there as been improvements in all measured parameters and high satisfaction. Both the technique and the results of this operation, have been published in peer reviewed journals. Today I have presented "The Arthroscopic Deepening Trochleoplasty" technique in the United States, Japan, Netherlands, UK, Sweden, Norway, Poland, Germany, Austria, Portugal and China. Moreover has the surgery been adopted by other surgeons and is now performed in fifteen different countries world wide.
Tibial Tubercle Osteotomy =TTO
What about having a TT osteotomy instead of a groove surgery? There are several studies indicating that the groove surgery gives better results - read more here. We know that trochleoplasty surgery normalize the anatomy. Moreover does we know that patients, who have had TT surgery after a decade are having declining results. The first trochleoplasty patients I operated more than 19 years ago are still doing fine. So based on this and my clinical experience by doing both many tibial tubercle osteotomies an trochleoplasty surgeries, I strongly recommend to you to undergo trochleoplasty if you have trochlear dysplasia. Unfortunately, many orthopedic surgeons argue, that they do not perform trochleoplasty and therefore they recommend TTO, but instead they must refer you to someone who do trochleoplasty, and preferable the arthroscopic trochleoplasty.
Here is the latest paper on arthroscopic deepening trochleoplasty here or simply go the page where you can find all my scientific papers
LinkedIn 2023
Photo library with some examples of arthrocopic trochleoplasty
