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Wang D, Sun J, Liu Y, Tang Z, Zhang H. Knee morphology and patella malalignment in neglected developmental dysplasia of the hip: a systematic review and meta-analysis. J Orthop Surg Res 2025; 20:489. [PMID: 40394669 PMCID: PMC12090680 DOI: 10.1186/s13018-025-05877-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2025] [Accepted: 04/30/2025] [Indexed: 05/22/2025] Open
Abstract
PURPOSE To quantitatively analyze the structural changes of the knee in patients with neglected developmental dysplasia of the hip (DDH). METHODS PubMed, Embase, Web of Science, and Cochrane Library databases were searched to identify studies comparing the morphological parameters of the knee between DDH patients and healthy individuals. Data on rotational and mechanical parameters of the lower limb, rate of occasional anterior knee pain (AKP), and knee morphological parameters, were extracted. Review Manager and R statistic software were used to perform the statistical analysis. RESULTS Nine studies with a total of 790 legs in 521 neglected DDH patients and 431 legs in 303 health subjects were included. Patients were predominantly female (88.3%). The Crowe classification is most commonly used to assess the severity of DDH. The total incidence of occasional AKP ranged from 8.6 to 20.6%, with an overall pooled rate of 14.4% (95%CI = 9.8-19.8%). In patients with neglected DDH, significant increases (P < 0.0001) were observed in femoral anteversion (weighted mean: 39.1° vs. 17.7°), knee torsion (weighted mean: 9.0° vs. 1.6°), and the vertical dimension of the medial femoral condyle (weighted mean: 13.8 mm vs. 11.6 mm), along with a significant decrease in the lateral distal femoral angle (weighted mean: 82.1° vs. 84.8°), which can lead to torsion deformity of the lower limb and valgus inclination of the distal femoral articular surface. Compared with the intact subjects, DDH knees demonstrated an increased sulcus angle (weighted mean: 144.9° vs. 137.5°; P < 0.0001), decreased trochlear depth (weighted mean: 3.1 mm vs. 4.5 mm; P < 0.0001), increased lateral shift of the patella (5.1 mm vs. 3.8 mm, P = 0.06), and increased patellar tilt angle (weighted mean: 18.2° vs. 13.2°; P < 0.0001). These findings were associated with developmental dysplasia of femoral trochlear and patellar instability. CONCLUSION Developmental dysplasia of the hip leads to patellar malalignment and developmental changes in the bony anatomy of the knee joint, including the development of a valgus deformity of the lower extremity and trochlear dysplasia. These findings may be associated with patellar instability. LEVEL OF EVIDENCE III, systematic review. REGISTRATION This study was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42025640292).
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Affiliation(s)
- Daofeng Wang
- Sports Medicine Service, Beijing Jishuitan Hospital, Capital Medical University, No. 31, Xinjiekou East Street, Beijing, 100035, China
- Beijing Research Institute of Traumatology and Orthopaedics, No. 31, Xinjiekou East Street, Beijing, 100035, China
| | - Jianzhong Sun
- Sports Medicine Service, Beijing Jishuitan Hospital, Capital Medical University, No. 31, Xinjiekou East Street, Beijing, 100035, China
- Beijing Research Institute of Traumatology and Orthopaedics, No. 31, Xinjiekou East Street, Beijing, 100035, China
| | - Yang Liu
- Beijing Research Institute of Traumatology and Orthopaedics, No. 31, Xinjiekou East Street, Beijing, 100035, China
- Sports Medicine Service, The Fourth Clinical Medical College of Peking University, No. 31, Xinjiekou East Street, Beijing, 100035, China
| | - Zhengjie Tang
- Sports Medicine Service, Beijing Jishuitan Hospital, Capital Medical University, No. 31, Xinjiekou East Street, Beijing, 100035, China
- Beijing Research Institute of Traumatology and Orthopaedics, No. 31, Xinjiekou East Street, Beijing, 100035, China
| | - Hui Zhang
- Sports Medicine Service, Beijing Jishuitan Hospital, Capital Medical University, No. 31, Xinjiekou East Street, Beijing, 100035, China.
- Beijing Research Institute of Traumatology and Orthopaedics, No. 31, Xinjiekou East Street, Beijing, 100035, China.
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Borukhov I, Ismailidis P, Esposito CI, LiArno S, Lyon J, McEwen PJ. Kinematic alignment recreates femoral trochlear geometry more closely than mechanical alignment in total knee arthroplasty : a CT analysis. Bone Joint J 2024; 106-B:817-825. [PMID: 39945008 DOI: 10.1302/0301-620x.106b8.bjj-2023-1209.r1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/03/2025]
Abstract
Aims This study aimed to evaluate if total knee arthroplasty (TKA) femoral components aligned in either mechanical alignment (MA) or kinematic alignment (KA) are more biomimetic concerning trochlear sulcus orientation and restoration of trochlear height. Methods Bone surfaces from 1,012 CT scans of non-arthritic femora were segmented using a modelling and analytics system. TKA femoral components (Triathlon; Stryker) were virtually implanted in both MA and KA. Trochlear sulcus orientation was assessed by measuring the distal trochlear sulcus angle (DTSA) in native femora and in KA and MA prosthetic femoral components. Trochlear anatomy restoration was evaluated by measuring the differences in medial, lateral, and sulcus trochlear height between native femora and KA and MA prosthetic femoral components. Results Femoral components in both MA and KA alignments exhibited a more valgus DTSA compared to native femora. However, DTSA deviation from native was significantly less in KA than in MA (4.8° (SD 2.2°) vs 8.8° (SD 1.8°); p < 0.001). DTSA deviation from native orientation correlated positively with the mechanical lateral distal femoral angle (mLDFA) in KA and negatively in MA (r = 0.53, p < 0.001; r = -0.18, p < 0.001). Medial trochlear height was not restored with either MA or KA, with MA resulting in lower medial trochlear height than KA in the proximal 20% of the trochlea. Lateral and sulcus trochlear height was not restored with either alignment in the proximal 80% of the trochlea. At the terminal arc point, KA replicated sulcus and lateral trochlear height, while MA led to over-restoration. Conclusion Femoral components aligned in KA demonstrated greater biomimetic qualities than those in MA regarding trochlear sulcus orientation and trochlear height restoration, particularly in valgus femora. Variability across knees was observed, warranting further research to evaluate the clinical implications of these findings.
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Affiliation(s)
| | - Petros Ismailidis
- The Orthopaedic Research Institute of Queensland, Townsville, Australia
- Division of Tropical Health and Medicine, College of Health Care Sciences, James Cook University, Brisbane, Australia
- Department of Orthopaedics and Traumatology, University Hospital of Basel, Basel, Switzerland
| | | | | | | | - Peter J McEwen
- The Orthopaedic Research Institute of Queensland, Townsville, Australia
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Borukhov I, Esposito CI, Ismailidis P, LiArno S, Lyon JP, McCarthy TF, McEwen P. The trochlear sulcus of the native knee is consistently orientated close to the sagittal plane despite variation in distal condylar anatomy. Knee Surg Sports Traumatol Arthrosc 2023; 31:3618-3626. [PMID: 34291310 PMCID: PMC10435591 DOI: 10.1007/s00167-021-06667-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 07/09/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The aim of this study was to describe the native trochlear orientation of non-arthritic knees in three planes and to quantify the relationship between trochlear and distal condylar anatomy across race and sex. METHODS Computed tomography scans of 1578 femora were included in this study. The mediolateral position of the trochlear sulcus, the distal trochlear sulcus angle (DTSA) the medial sulcus angle (MSA) and the lateral sulcus angle (LSA) as well as the mechanical lateral distal femoral angle (mLDFA) were measured relative to a standard reference coordinate system. Multiple linear regression analyses were performed to account for potential confounding variables. RESULTS The mediolateral position of the trochlear sulcus had minimal mean deviation of the sagittal femoral plane. The mean DTSA was 86.1° (SD 2.2°). Multilinear regression analysis found mLDFA, sex, and age all influence DTSA (p < 0.05), with mLDFA having by far the greatest influence (r2 = 0.55). The medial facet of the trochlear sulcus was found to be flat proximally and more prominent distally. The lateral facet was relatively uniform throughout the arc. CONCLUSION In non-arthritic knees, due to a strong positive correlation between the DTSA and the mLDFA, the trochlear sulcus is consistently orientated in the sagittal femoral plane regardless of distal condylar anatomy. Minor deviations from the sagittal plane occur in a lateral direction in the middle part and in a medial direction at the proximal and distal part of the trochlea. These findings have relevance regarding the biomimetic design of total knee implants.
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Affiliation(s)
| | | | - Petros Ismailidis
- The Orthopaedic Research Institute of Queensland (ORIQL), 7 Turner St, Pimlico Townsville, QLD, Australia.
- Department of Orthopaedics and Traumatology, University Hospital of Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
| | | | | | | | - Peter McEwen
- The Orthopaedic Research Institute of Queensland (ORIQL), 7 Turner St, Pimlico Townsville, QLD, Australia
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Hansen P, Harving M, Øhlenschlæger T, Brinch S, Lavard P, Krogsgaard M, Boesen M. Comparison between conventional MRI and weight-bearing positional MRI reveals important differences in radiological measurements of the patellofemoral joint. Skeletal Radiol 2023:10.1007/s00256-023-04304-9. [PMID: 36877225 DOI: 10.1007/s00256-023-04304-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 02/07/2023] [Accepted: 02/07/2023] [Indexed: 03/07/2023]
Abstract
OBJECTIVE To compare radiological measurements of the patellofemoral joint (PFJ) morphology and measurement reproducibility across the following scanning modalities: (a) 3 T supine MRI, (b) 0.25 T supine MRI and (c) standing 0.25 T MRI. METHODS Forty patients referred to MRI of the knee were scanned by high field 3 T MRI in supine position and low field 0.25 T positional (pMRI) in supine and standing positions. Radiological measurements for assessment of femoral trochlear morphology, patellar tracking, patellar height and knee flexion angle were compared across scanning situations by one-way repeated-measures ANOVA. Measurement reliability and agreement were assessed by calculation of ICC, SEM and MDC. RESULTS Patellar tracking differed across scanning situations, particularly between 3.0 T supine and 0.25 T standing position. Mean differences are the following: patella bisect offset (PBO): 9.6%, p ≤ 0.001; patellar tilt angle (PTA): 3.1°, p ≤ 0.001; tibial tuberosity-trochlear groove distance (TT-TG): 2.7 mm, p ≤ 0.001). Measurements revealed slight knee joint flexion in supine and slight hyperextension in the standing position (MD: 9.3°, P ≤ 0.001), likely related to the observed differences in patellar tracking. Reproducibility was comparable across MRI field strengths. In general, PBO, PTA and TT-TG were the most robust measurements in terms of reproducibility and agreement across scanning situations (ICC range: 0.85-0.94). CONCLUSION Significant differences in important patellofemoral morphology measurements were observed between supine and standing MRI scanning positions. These were unlikely due to physiological factors such as changes in joint loading but rather induced by slight differences in knee flexion angle. This emphasises the need to standardise knee positioning during scanning, particularly for weight-bearing positional MRI before clinical use.
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Affiliation(s)
- Philip Hansen
- Musculoskeletal Imaging Research Unit Copenhagen, Department of Radiology, Bispebjerg-Frederiksberg Hospital, Nielsine Nielsens vej 41A, DK-2400, Copenhagen, NV, Denmark.
| | - Mette Harving
- Department of Radiology, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Tommy Øhlenschlæger
- Institute of Sports Medicine Copenhagen, IOC Research Center Copenhagen, Bispebjerg-Frederiksberg Hospital, Nielsine Nielsens vej 11, DK-2400, Copenhagen, NV, Denmark
| | - Signe Brinch
- Musculoskeletal Imaging Research Unit Copenhagen, Department of Radiology, Bispebjerg-Frederiksberg Hospital, Nielsine Nielsens vej 41A, DK-2400, Copenhagen, NV, Denmark
| | - Peter Lavard
- Section for Sports Traumatology M51, IOC Research Center Copenhagen, Bispebjerg-Frederiksberg Hospital, Nielsine Nielsens vej 3, DK-2400, Copenhagen, NV, Denmark
| | - Michael Krogsgaard
- Section for Sports Traumatology M51, IOC Research Center Copenhagen, Bispebjerg-Frederiksberg Hospital, Nielsine Nielsens vej 3, DK-2400, Copenhagen, NV, Denmark
| | - Mikael Boesen
- Musculoskeletal Imaging Research Unit Copenhagen, Department of Radiology, Bispebjerg-Frederiksberg Hospital, Nielsine Nielsens vej 41A, DK-2400, Copenhagen, NV, Denmark
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Tang S, Li W, Wang S, Wang F. Abnormal patellar loading may lead to femoral trochlear dysplasia: an experimental study of patellar hypermobility and patellar dislocation in growing rats. J Orthop Surg Res 2023; 18:39. [PMID: 36642731 PMCID: PMC9841663 DOI: 10.1186/s13018-023-03500-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 01/02/2023] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND This animal study aimed to explore the effects of patellar hypermobility and patellar dislocation on the developing femoral trochlea. METHODS Seventy-two 3-week-old Wistar rats were randomly divided into three groups. The sham group (SG) underwent simple incision and suture of the skin and subcutaneous tissue; the patellar hypermobility group (PHG) underwent medial and lateral retinacular release and pie-crusting technique for the patellar ligament; the patellar dislocation group (PDG) underwent plication of the medial patellofemoral retinaculum. Twelve rats in each group were euthanized at 3 and 6 weeks postoperatively, respectively, and specimens were collected. The bony sulcus angle (BSA), cartilaginous sulcus angle (CSA), trochlear sulcus depth (TSD), and thickness of the cartilage on the lateral facet (CTL), medial facet (CTM), and center (CTC) of the trochlea were measured on hematoxylin and eosin-stained sections. RESULTS In the PHG and PDG, the femoral condyles became blunt, the trochlear groove became shallower, and cartilage became thicker compared with the SG. Compared with the SG, the PHG and PDG had significantly larger BSA and CSA values at 3 (p < 0.05) and 6 weeks (p < 0.005), and a significantly shallower TSD (p < 0.05). At 3 weeks, all cartilage thicknesses in the PHG and the CTC and CTM in the PDG were significantly thinner than in the SG (PHG vs. SG: p = 0.009 for CTL, p < 0.001 for CTM, p = 0.003 for CTC; PDG vs. SG: p = 0.028 for CTC, p = 0.048 for CTM). At 6 weeks, the CTC was thicker in the PHG and PDG than the SG (PHG vs. SG: p = 0.044; PDG vs. SG: p = 0.027), and the CTL was thinner in the PDG than the SG (p = 0.044). CONCLUSION Patellar hypermobility and patellar dislocation may result in trochlear dysplasia that worsens with age. Excessive or insufficient loading leads to trochlear dysplasia.
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Affiliation(s)
- Shiyu Tang
- grid.452209.80000 0004 1799 0194Department of Joint Surgery, The Third Hospital of Hebei Medical, University, 139 Ziqiang Road, Shijiazhuang, 050051 Hebei China
| | - Weifeng Li
- grid.452209.80000 0004 1799 0194Department of Joint Surgery, The Third Hospital of Hebei Medical, University, 139 Ziqiang Road, Shijiazhuang, 050051 Hebei China
| | - Shengjie Wang
- grid.452209.80000 0004 1799 0194Department of Joint Surgery, The Third Hospital of Hebei Medical, University, 139 Ziqiang Road, Shijiazhuang, 050051 Hebei China
| | - Fei Wang
- grid.452209.80000 0004 1799 0194Department of Joint Surgery, The Third Hospital of Hebei Medical, University, 139 Ziqiang Road, Shijiazhuang, 050051 Hebei China
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The pathologic double contour sign and the trochlea shape patterns can diagnose trochlea dysplasia. J ISAKOS 2022; 8:74-80. [PMID: 36435430 DOI: 10.1016/j.jisako.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 06/12/2022] [Accepted: 11/10/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The goal of this study is to describe the distinct morphologic patterns of the normal and dysplastic trochleae, the trochlear shape patterns (TSP) seen on the axial views of MRI scans. METHOD Two cohorts of patients were used for comparison. Cohort 1: MRI scans of 100 patients with no history of patella instability. Cohort 2: MRI scans of 66 patients diagnosed with severe trochlea dysplasia and patella instability. The presence of the pathologic double contour (PDC) sign and the type of TSP were identified in the axial views at the level of three specific anatomical references: Trochlear Specific Zone 0 (TSZ 0), posterior femoral condyle line (PFCL) and transverse distal femoral physis line (tv-DFPL). The pathologic double contour sign is an area of flat or convex lateral trochlea which is elevated over the contour of the medial femoral condyle. Three basic morphologic patterns of trochlear shape were identified. TSP type 1 (normal trochlea): There is no PDC. There is a clearly defined sulcus delineating the lateral and medial trochlear facets (sulcus angle <165°). TSP type 2 (normal but shallow trochlea): There is no PDC. The trochlear groove is shallow (sulcus angle >165°), but the lateral and medial facets are present. TSP type 3: This pattern is characterised by the presence of a PDC. The chi-square test was used to determine whether the distribution of the TSP was the same between the two cohorts at the anatomical reference lines. RESULTS The differences observed in distribution of the TSP between the two cohorts were statistically significant. There was a strong positive correlation between the morphology of the trochlea (TSP) and patella instability. All patients in the patella instability cohort showed a PDC. CONCLUSION Normal trochleae show TSP type 1 and 2 proximal to the tv-DFPL. The presence of the pathologic double contour sign and trochlea shape pattern type 3 (TSP 3) proximal to the tv-DFPL (PFCL or TSZ 0) are diagnostic of trochlea dysplasia.
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Ormeci T, Turkten I, Sakul BU. Radiological evaluation of patellofemoral instability and possible causes of assessment errors. World J Methodol 2022; 12:64-82. [PMID: 35433342 PMCID: PMC8984217 DOI: 10.5662/wjm.v12.i2.64] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 10/27/2021] [Accepted: 02/10/2022] [Indexed: 02/06/2023] Open
Abstract
Patellofemoral instability (PI) is the disruption of the patella’s relationship with the trochlear groove as a result of abnormal movement of the patella. To identify the presence of PI, conventional radiographs (anteroposterior, lateral, and axial or skyline views), magnetic resonance imaging, and computed tomography are used. In this study, we examined four main instability factors: Trochlear dysplasia, patella alta, tibial tuberosity–trochlear groove distance, and patellar tilt. We also briefly review some of the other assessment methods used in the quantitative and qualitative assessment of the patellofemoral joint, such as patellar size and shape, lateral trochlear inclination, trochlear depth, trochlear angle, and sulcus angle, in cases of PI. In addition, we reviewed the evaluation of coronal alignment, femoral anteversion, and tibial torsion. Possible causes of error that can be made when evaluating these factors are examined. PI is a multi-factorial problem. Many problems affecting bone structure and muscles morphologically and functionally can cause this condition. It is necessary to understand normal anatomy and biomechanics to make more accurate radiological measurements and to identify causes. Knowing the possible causes of measurement errors that may occur during radiological measurements and avoiding these pitfalls can provide a more reliable road map for treatment. This determines whether the disease will be treated medically and with rehabilitation or surgery without causing further complications.
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Affiliation(s)
- Tugrul Ormeci
- Department of Radiology, School of Medicine, İstanbul Medipol University, Istanbul 34200, Turkey
| | - Ismail Turkten
- Department of Anatomy, School of Medicine, İstanbul Medipol University, Istanbul 34820, Beykoz, Turkey
| | - Bayram Ufuk Sakul
- Department of Anatomy, School of Medicine, İstanbul Medipol University, Istanbul 34820, Beykoz, Turkey
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Intraoperative analysis of patellofemoral joint morphology before and after total knee arthroplasty. DER ORTHOPADE 2022; 51:580-589. [PMID: 35254486 PMCID: PMC9249712 DOI: 10.1007/s00132-022-04224-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/01/2022] [Indexed: 12/03/2022]
Abstract
Background Patellofemoral problems after total knee arthroplast (TKA) are frequent and often associated with a change in the geometry of the trochlear groove. Objective The present study aimed to analyze the feasibility of intraoperative examination of the patellofemoral joint geometry before and after the implantation of bicondylar total knee replacements without exposing the patient to radiation. Material and methods The patellofemoral joint morphology geometries of 33 patients before and after implantation of a bicondylar total knee replacement was intraoperatively analyzed using a digital scanning method. Femoral surface geometries were extracted from intraoperatively recorded tactile scanning data using an in-house algorithm. The geometries were then characterized by sulcus height, medial femoral condyle height and lateral femoral condyle height. Results Our preliminary results show that these key geometric parameters are only partially restored after TKA leading to a distinctly different shaped profile of the anterior distal femur. Maximum and minimum mean differences in sulcus height, medial femoral condyle height, and lateral femoral condyle height before and after surgery were 2.00 mm/−3.06 mm, 2.51 mm/−6.25 mm and 2.74 mm/−3.58 mm, respectively. Conclusion A new method for intraoperative analysis of the patellofemoral joint morphology before and after TKA without radiation exposure was developed and utilized. Even with the use of modern total knee designs, the patellofemoral articulation is considerably changed postoperatively as quantified by the key parameters of sulcus height, medial femoral condyle height, and lateral femoral condyle height. This may result in altered knee biomechanics and might explain persistent patellofemoral disorders, which are often reported by patients after TKA.
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Gupta H, Batta NS, Kataria H, Batra V, Upadhyay AD, Jain V, Mishra P, Goel N. A Comparison of the Reliability of the Patellar Tendon-Trochlear Groove (PTTG) Distance and the Tibial Tuberosity-Trochlear Groove (TTTG) Distance Measured on MRI. Malays Orthop J 2020; 14:34-41. [PMID: 32296480 PMCID: PMC7156171 DOI: 10.5704/moj.2003.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 12/09/2019] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION An increased tibial tuberosity-trochlear groove (TTTG) distance is used for deciding a treatment plan in patello-femoral instability (PFI). The centre of the patellar tendon and the chondral trochlear groove can be directly visualised on MRI, and measured, giving the patellar tendon-trochlear groove (PTTG) distance. A study was designed to compare the inter-rater and the test-retest reliabilities of PTTG and TTTG measurements in MRI of patients without PFI and in a group with PFI. MATERIALS AND METHODS This cross-sectional reliability study was done on archival MRI films of 50 patients without patellar instability and 20 patients with patellar instability. TTTG and PTTG distances were independently measured by two orthopaedic surgeons and two radiologists. A hybrid PTTG measurement with bony landmarks on the femoral side and the patellar tendon landmark on the tibial side, was used to estimate the influence of the differences in the femoral and tibial landmarks on the difference in reliabilities. The intra-class correlation coefficient (ICC) was calculated for all four raters, as well as separately for each rater. RESULTS The PTTG distance had a higher inter-rater reliability (ICC=0.86, 95% CI=0.79-0.92) compared to the TTTG distance (ICC=0.70, 95% CI=0.59-0.80) in patients without PFI. Similar trends were seen in patients with PFI (0.83 vs 0.66). The inter-rater reliability for the hybrid PTTG distance was found to lie in between the TTTG and PTTG. CONCLUSIONS The MRI-based PTTG distance had better inter-rater reliability compared with the MRI-based TTTG distance.
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Affiliation(s)
- H Gupta
- Department of Sports Injury Centre, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - N S Batta
- Department of Radiodiagnosis, Mahajan Imaging, New Delhi, India
| | - H Kataria
- Department of Sports Injury Centre, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - V Batra
- Department of Radiodiagnosis, Mahajan Imaging, New Delhi, India
| | - A D Upadhyay
- Department of Biostatistics, All India Institute Of Medical Sciences, New Delhi, India
| | - V Jain
- Department of Sports Injury Centre, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - P Mishra
- Department of Sports Injury Centre, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - N Goel
- Department of Sports Injury Centre, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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Lu J, Wang C, Li F, Ji G, Wang Y, Wang F. Changes in Cartilage and Subchondral Bone of Femoral Trochlear Groove After Patellectomy in Growing Rabbits. Orthop Surg 2020; 12:653-660. [PMID: 32077243 PMCID: PMC7189040 DOI: 10.1111/os.12631] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 01/20/2020] [Accepted: 01/20/2020] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE To explore the effects of patellectomy on the bony and cartilaginous morphology of the trochlear groove in growing rabbits. METHODS Forty-eight 4-week-old New Zealand white rabbits were randomly assigned to two groups. The control group underwent a sham surgical procedure, whereas the patellectomy group underwent patella excision surgery. Half of the rabbits in each group were sacrificed 3 months postoperatively; the rest were sacrificed 6 months postoperatively. Hematoxylin and eosin staining was performed on collected samples. Measurements included the bony and cartilaginous sulcus angles of the trochlear groove. In addition, the thickness of the articular cartilage at the deepest sulcus position (central thickness) and at the mid-position of the medial and lateral facets was measured and compared between groups. RESULTS Three months after surgery, histological images revealed significant differences between the control group and the patellectomy group in cartilaginous sulcus angle (144.2° ± 1.5° vs 151.9° ± 2.4°, respectively; P < 0.001). No obvious difference in bony sulcus angle was found between the groups. Six months after surgery, significant between-group differences were observed in cartilaginous sulcus angle (136.3° ± 2.5° in control group vs 160.7° ± 3.0° in patellectomy group, P < 0.001) and bony sulcus angle (136.2° ± 2.2° in control group vs 160.4° ± 2.6° in patellectomy group, P < 0.001). However, there were no significant intra-group differences between cartilaginous and bony sulcus angles in either group. Three months after surgery, significant between-group differences were detected in articular cartilage thickness at the three different positions (medial facet: 324.3 ± 14.0 μm in control group vs 391.7 ± 98.8 μm in patellectomy group, P = 0.029; central position: 362.1 ± 13.6 μm in control group vs 730.3 ± 76.8 μm in patellectomy group, P < 0.001; lateral facet: 324.6 ± 12.7 μm in control group vs 358.5 ± 38.7 μm in patellectomy group, P = 0.009). No between-group differences in cartilage thickness were found at 6 months. CONCLUSIONS Abnormal mechanical stress (patellectomy) during a rabbit's development can cause flattening of the femoral trochlear cartilage, followed by changes in the subchondral osseous layer. Abnormal mechanical stress is a crucial factor in the development of trochlear groove dysplasia.
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Affiliation(s)
- Jiangfeng Lu
- Department of Joint Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Chenghai Wang
- Department of Orthopaedic Surgery, Affiliated Hospital of Hebei University of Engineering, Handan, Hebei, China
| | - Faquan Li
- Department of Joint Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Gang Ji
- Department of Joint Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Yanru Wang
- Department of Otorhinolaryngology Head and Neck Surgery, The 980th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army, Shijiazhuang, Hebei, China
| | - Fei Wang
- Department of Joint Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
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Koh YG, Nam JH, Chung HS, Lee HY, Kim HJ, Kim HJ, Kang KT. Gender-related morphological differences in sulcus angle and condylar height for the femoral trochlea using magnetic resonance imaging. Knee Surg Sports Traumatol Arthrosc 2019; 27:3560-3566. [PMID: 30879109 DOI: 10.1007/s00167-019-05423-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 02/15/2019] [Indexed: 01/25/2023]
Abstract
PURPOSE This study aimed to elucidate the primary differences in trochlear morphology between men and women utilizing three-dimensional magnetic resonance image reconstruction of the femoral trochlea. METHODS Differences in anthropometric femoral trochlea data of 975 patients (825 women, 150 men) were evaluated. The following morphological parameters were measured at three flexion angles (15°, 30°, and 45°) of the femoral trochlea: the sulcus angle, condylar height, and the trochlear groove orientation and mediolateral groove position. RESULTS The sulcus angle was significantly greater in women than in men at 15° and 45° flexions (P < 0.05). However, there was no gender difference found in the sulcus angle at 30° flexion. Medial and lateral condylar height values were greater in men than in women for the three flexion angles (P < 0.01). The trochlear groove orientation and mediolateral groove position showed no gender-related differences. CONCLUSIONS Magnetic resonance image reconstruction demonstrated that measurement of trochlear morphology varied significantly between men and women. This study provides guidelines for the design of a suitable femoral component for total knee arthroplasty, considering gender-specific differences in the Korean population. Biomechanical guidelines for total knee arthroplasty in Korean individuals can be optimized using our finding, so as the risk of patellar dislocation to be decreased. Surgeons should be aware of gender differences in femoral trochlear to optimize choice of implant. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Yong-Gon Koh
- Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, 10 Hyoryeong-ro, Seocho-gu, Seoul, 06698, South Korea
| | - Ji-Hoon Nam
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Hyun-Seok Chung
- Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, 10 Hyoryeong-ro, Seocho-gu, Seoul, 06698, South Korea
| | - Hwa-Yong Lee
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea
| | - Ho-Joong Kim
- Spine Center, Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
| | - Hyo-Jeoung Kim
- Department of Sport and Healthy Aging, Korea National Sport University, 1239 Yangjaedaero,Songpa-gu, Seoul, 05541, South Korea
| | - Kyoung-Tak Kang
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea.
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12
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Imai N, Miyasaka D, Hirano Y, Suzuki H, Tsuchiya K, Endo N. Tibiofemoral rotation is related to differences in the lateral femoral condyle configuration in both normal subjects and women with hip dysplasia: a three-dimensional analysis. BMC Musculoskelet Disord 2019; 20:353. [PMID: 31366348 PMCID: PMC6668094 DOI: 10.1186/s12891-019-2737-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 07/24/2019] [Indexed: 01/17/2023] Open
Abstract
Background We assessed the morphological differences in the knee joint related to knee rotation angle in patients with hip dysplasia. These results may explain the anatomy of the knee in patients with hip dysplasia and aid in planning knee surgery. Methods We enrolled 73 women (146 legs, 35.6 ± 9.0 years) with bilateral hip dysplasia and 45 healthy women (90 legs, 49.0 ± 18.9 years) without lumbago, knee symptoms, or osteoarthritic findings of the knee or spine on plain radiographs. We examined the parameters affecting knee rotation angle, such as the condylar twist angle and femoral condyle measurements with a three-dimensional bone model using the correlation coefficients of each parameter. Results The condylar twist angle and the length of the posterior part of the lateral femoral condyle were statistically positively correlated with knee rotation angle in both the normal (condylar twist angle: r = 0.286, p = 0.007, posterolateral: r = 0.429, p < 0.001) and developmental dysplasia of the hip groups (condylar twist angle: r = 0.230, p = 0.033, posterolateral: r = 0.272, p = 0.005). Knee rotation angle had no statistical correlation with femoral neck anteversion in the developmental dysplasia of the hip group (r = 0.094, p = 0.264), but had a statistical correlation with femoral neck anteversion in the normal group (r = 0.243, p = 0.039). Conclusions Knee joint morphology is affected by hip dysplasia. We found that the length of the posterior part of the lateral femoral condyle was significantly positively correlated with knee rotation angle in both the normal and developmental dysplasia of the hip groups, and this finding indicates that a greater posterolateral dimension was associated with a greater knee rotation angle. These morphological knee joint differences in patients with hip dysplasia may help determine the alignment of prostheses in total knee arthroplasty.
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Affiliation(s)
- Norio Imai
- Division of Comprehensive Geriatrics in Community, Niigata University Graduate School of Medical and Dental Sciences, Niigata 9518510, 1-757, Asahimachi-dori, Niigata, Japan. .,Department of Orthopedic Surgery, Niigata University Medical and Dental Hospital, Niigata, 9518510, Japan.
| | - Dai Miyasaka
- Department of Orthopedic Surgery, Niigata University Medical and Dental Hospital, Niigata, 9518510, Japan
| | - Yuki Hirano
- Department of Orthopedic Surgery, Niigata University Medical and Dental Hospital, Niigata, 9518510, Japan
| | - Hayato Suzuki
- Department of Orthopedic Surgery, Niigata University Medical and Dental Hospital, Niigata, 9518510, Japan
| | - Kazuki Tsuchiya
- Division of Advanced Materials Science and Technology, Niigata University Graduate School of Science and Technology, Niigata, 9502181, Japan
| | - Naoto Endo
- Department of Orthopedic Surgery, Niigata University Medical and Dental Hospital, Niigata, 9518510, Japan
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Purohit N, Hancock N, Saifuddin A. Surgical management of patellofemoral instability. I. Imaging considerations. Skeletal Radiol 2019; 48:859-869. [PMID: 30542758 DOI: 10.1007/s00256-018-3123-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 11/14/2018] [Accepted: 11/23/2018] [Indexed: 02/02/2023]
Abstract
The patellofemoral joint is a complex joint that relies on both bone and soft tissues for its stability. Dysfunction of the patellofemoral joint, whether pain or instability, is a common cause of medial consultation. Thorough clinical and imaging assessment is important for managing these patients, who may require a combination of a bony and soft tissue surgical procedure. Trochlear dysplasia, a cause of anterior knee pain and patellar instability, has been classified using conventional radiography. Radiographic signs on a lateral projection, such as the "double contour" sign and the "crossing sign", can alert the radiologist to the grade of trochlear dysplasia. Magnetic resonance imaging (MRI) is the gold standard for accurately assessing the soft tissue around the patellofemoral joint, such as the medial patellofemoral ligament and the medial and lateral patella retinacula, especially in the context of a transient patella dislocation. Risk factors for patellofemoral instability, such as patella alta, an increased tibial tubercle to trochlear groove distance and trochlear dysplasia, can all be assessed on MRI. Advanced imaging techniques such as dynamic MRI and CT are able to demonstrate patellar maltracking. These techniques can also be employed to reliably assess the outcomes of treatment. In this article, we review the normal and abnormal pre-operative imaging findings of the knee extensor mechanism in relation to patellofemoral joint instability. This review provides a useful tool for the reporting radiologist and highlights the imaging findings that are of relevance to the orthopaedic surgeon.
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Affiliation(s)
- Neeraj Purohit
- Department of Radiology, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK.
| | - Nicholas Hancock
- Department of Trauma and Orthopaedics, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK
| | - Asif Saifuddin
- Department of Radiology, The Royal National Orthopaedic Hospital NHS Trust, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK
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Cerveri P, Belfatto A, Baroni G, Manzotti A. Stacked sparse autoencoder networks and statistical shape models for automatic staging of distal femur trochlear dysplasia. Int J Med Robot 2018; 14:e1947. [PMID: 30073759 DOI: 10.1002/rcs.1947] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 06/13/2018] [Accepted: 07/10/2018] [Indexed: 01/17/2023]
Abstract
BACKGROUND The quantitative morphological analysis of the trochlear region in the distal femur and the precise staging of the potential dysplastic condition constitute a key point for the use of personalized treatment options for the patella-femoral joint. In this paper, we integrated statistical shape models (SSM), able to represent the individual morphology of the trochlea by means of a set of parameters and stacked sparse autoencoder (SSPA) networks, which exploit the parameters to discriminate among different levels of abnormalities. METHODS Two datasets of distal femur reconstructions were obtained from CT scans, including pathologic and physiologic shapes. Both of them were processed to compute SSM of healthy and dysplastic trochlear regions. The parameters obtained by the 3D-3D reconstruction of a femur shape were fed into a trained SSPA classifier to automatically establish the membership to one of three clinical conditions, namely, healthy, mild dysplasia, and severe dysplasia of the trochlea. The validation was performed on a subset of the shapes not used in the construction of the SSM, by verifying the occurrence of a correct classification. RESULTS A major finding of the work is that SSM are able to represent anomalies of the trochlear geometry by means of specific eigenmodes of variation and to model the interplay between morphologic features related to dysplasia. Exploiting the patient-specific morphing parameters of SSM, computed by means of a 3D-3D reconstruction, SSPA is demonstrated to outperform traditional discriminant analysis in classifying healthy, mild, and severe trochlear dysplasia providing 99%, 97%, and 98% accuracy for each of the three classes, respectively (discriminant analysis accuracy: 85%, 89%, and 77%). CONCLUSIONS From a clinical point of view, this paper contributes to support the increasing role of SSM, integrated with deep learning techniques, in diagnostics and therapy definition as quantitative and advanced visualization tools.
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Affiliation(s)
- Pietro Cerveri
- Department of Electronics, Information and Bioengineering, Politecnico di Milano University, Milan, Italy
| | - Antonella Belfatto
- Department of Electronics, Information and Bioengineering, Politecnico di Milano University, Milan, Italy
| | - Guido Baroni
- Department of Electronics, Information and Bioengineering, Politecnico di Milano University, Milan, Italy
| | - Alfonso Manzotti
- Orthopaedic and Trauma Department, "Luigi Sacco" Hospital, ASST FBF-Sacco, Milan, Italy
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Fu K, Duan G, Liu C, Niu J, Wang F. Changes in femoral trochlear morphology following surgical correction of recurrent patellar dislocation associated with trochlear dysplasia in children. Bone Joint J 2018; 100-B:811-821. [PMID: 29855234 DOI: 10.1302/0301-620x.100b6.bjj-2017-1295.r1] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Aims The aim of this study was to investigate the changes in femoral trochlear morphology following surgical correction of recurrent patellar dislocation associated with trochlear dysplasia in children. Patients and Methods A total of 23 patients with a mean age of 9.6 years (7 to 11) were included All had bilateral recurrent patellar dislocation associated with femoral trochlear dysplasia. The knee with traumatic dislocation at the time of presentation or that had dislocated most frequently was treated with medial patellar retinacular plasty (Group S). The contralateral knee served as a control and was treated conservatively (Group C). All patients were treated between October 2008 and August 2013. The mean follow-up was 48.7 months (43 to 56). Axial CT scans were undertaken in all patients to assess the trochlear morphological characteristics on a particular axial image which was established at the point with the greatest epicondylar width based on measurements preoperatively and at the final follow-up. Results Preoperatively, there were no statistically significant differences between the trochlear morphology in the two groups (sulcus angle, p 0.852; trochlear groove depth, p 0.885; lateral trochlear inclination, p 0.676; lateral-to-medial facet ratio, p 0.468; lateral condylar height, p 0.899; medial condylar height, p 0.816). Many radiological parameters of trochlear morphology were significantly different between the two groups at the final follow-up, including well-known parameters, such as the mean sulcus angle (Group S, 146.27° (sd 7.18); Group C, 160.61° (sd 9.29); p < 0.001), the mean trochlear groove depth (Group S, 6.25 mm (sd 0.41); Group C, 3.48 mm (sd 0.65); p < 0.001) and the mean lateral trochlear inclination (Group S, 20.99° (sd 3.87); Group C, 12.18° (sd 1.85); p < 0.001). Lesser known parameters such as the ratio of the lateral to medial trochlear length (Group S, 1.46 (sd 0.19); Group C, 2.14 (sd 0.42); p < 0.001), which is a measurement of facet asymmetry, and the lateral and medial condylar height were also significantly different between the two groups (p < 0.001). Conclusion The femoral trochlear morphology can be improved by early (before epiphyseal closure) surgical correction in children with recurrent patellar dislocation associated with femoral trochlear dysplasia. Cite this article: Bone Joint J 2018;100-B:811–21.
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Affiliation(s)
- K. Fu
- Department of Orthopaedic Surgery, Hebei
Medical University Third Affiliated Hospital, Shijiazhuang, Hebei, China
| | - G. Duan
- Department of Orthopaedic Surgery, Hebei
Medical University Third Affiliated Hospital, Shijiazhuang, Hebei, China
| | - C. Liu
- Department of Orthopaedic Surgery, Hebei
Medical University Third Affiliated Hospital, Shijiazhuang, Hebei, China
| | - J. Niu
- Department of Orthopaedic Surgery, Hebei
Medical University Third Affiliated Hospital, Shijiazhuang, Hebei, China
| | - F. Wang
- Department of Orthopaedic Surgery, Hebei
Medical University Third Affiliated Hospital, Shijiazhuang, Hebei, China
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Impact of Simulated Knee Injuries on the Patellofemoral and Tibiofemoral Kinematics Investigated with an Electromagnetic Tracking Approach: A Cadaver Study. BIOMED RESEARCH INTERNATIONAL 2018; 2018:7189714. [PMID: 29850554 PMCID: PMC5937613 DOI: 10.1155/2018/7189714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 02/13/2018] [Accepted: 03/12/2018] [Indexed: 01/01/2023]
Abstract
Purpose The purpose of this study was to evaluate the approach of using an electromagnetic tracking (EMT) system for measuring the effects of stepwise, simulated knee injuries on patellofemoral (PF) and tibiofemoral (TF) kinematics. Methods Three cadaver knees were placed in a motion rig. EMT sensors were mounted on the patella, the medial/lateral femoral epicondyles, the tibial condyle, and the tibial tuberosity (TT). After determining the motion of an intact knee, three injuries were simulated and the resulting bony motion was tracked. Results Starting with the intact knee fully extended (0° flexion) and bending it to approximately 20°, the patella shifted slightly in the medial direction. Then, while bending the knee to the flexed position (90° flexion), the patella shifted progressively more laterally. After transecting the anterior cruciate ligament (ACL), the base of the medial menisci (MM) at the pars intermedia, and the medial collateral ligament (MCL), individual changes were observed. For example, the medial femoral epicondyle displayed a medial lift-off in all knees. Conclusion We demonstrated that our EMT approach is an acceptable method to accurately measure PF joint motion. This method could also enable visualization and in-depth analysis of in vivo patellar function in total knee arthroplasty, if it is established for routine clinical use.
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Abstract
Trochleoplasty is a very effective procedure for correcting trochlear dysplasia and addressing instability of the patella. With an increasing knowledge about the anatomy and biomechanics of the anterior distal femur, a wider array of surgical techniques may be applied to address specific conditions. Patients must be carefully selected to undergo trochleoplasty by use of a thorough history and physical examination as well as basic and advanced imaging. The presence of a "J sign" on physical examination, a history of recurrent instability, patella alta, trochlear dysplasia, and elevated tibial tubercle to trochlear groove are signs and symptoms for which the patient should be evaluated. We attempt to elucidate when trochleoplasty is indicated by means of addressing all aspects of evaluation.
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18
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Matz J, Howard JL, Sisko ZW, Teeter MG, Lanting BA. Differences in Trochlear Surface Damage and Wear Between Three Different Total Knee Arthroplasty Designs. J Arthroplasty 2017; 32:3763-3770. [PMID: 28750858 DOI: 10.1016/j.arth.2017.06.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 06/22/2017] [Accepted: 06/26/2017] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Trochlear design plays a role in patellofemoral kinematics. Little is known regarding differences in the contact properties between modern designs. The purpose of the present study was to analyze patellofemoral joint contact by identifying areas of joint surface damage and wear in retrieved femoral components of 3 modern designs. MATERIALS Eighteen retrieved femoral components featuring 3 different modern designs (Triathlon, SIGMA, and GENESIS II) were matched based on time-in-vivo, age, gender, and body mass index. Trochlear wear and surface damage were assessed using visual inspection, light microscopy, and light profilometry. RESULTS Visual inspection of the femoral components showed evidence of surface damage in all implant types. No significant differences between the groups were found with respect to surface damage and wear on visual inspection. Light profilometry of retrieved components showed that retrieved Triathlon (P = .002) and SIGMA (P = .009) components were significantly rougher than the corresponding reference components. The GENESIS II retrieved components were not substantially rougher than the reference components (P = .48). Light profilometry analysis showed significantly increased roughness of retrieved SIGMA components compared with Triathlon or GENESIS II components, particularly in the proximal trochlear groove and the medial trochlea. CONCLUSION As the volume and patient demands for total knee arthroplasty increase, a greater understanding of the patellofemoral joint is warranted. Patellofemoral kinematics can have an effect on the surface characteristics of total knee arthroplasty components. Retrieved SIGMA components appeared to have increased roughness compared with Triathlon or GENESIS II components. The etiology and long-term effects of increased trochlear roughness require further investigation.
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Affiliation(s)
- Jacob Matz
- Division of Orthopedic Surgery, London Health Sciences Center, University Hospital, London, Ontario, Canada
| | - James L Howard
- Division of Orthopedic Surgery, London Health Sciences Center, University Hospital, London, Ontario, Canada
| | - Zachary W Sisko
- Division of Orthopedic Surgery, London Health Sciences Center, University Hospital, London, Ontario, Canada
| | - Matthew G Teeter
- Division of Orthopedic Surgery, London Health Sciences Center, University Hospital, London, Ontario, Canada; Surgical Innovation Program, Lawson Health Research Institute, London, Ontario, Canada
| | - Brent A Lanting
- Division of Orthopedic Surgery, London Health Sciences Center, University Hospital, London, Ontario, Canada
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Hinckel BB, Gobbi RG, Kihara Filho EN, Demange MK, Pécora JR, Rodrigues MB, Camanho GL. Why are bone and soft tissue measurements of the TT-TG distance on MRI different in patients with patellar instability? Knee Surg Sports Traumatol Arthrosc 2017; 25:3053-3060. [PMID: 27034087 DOI: 10.1007/s00167-016-4095-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 03/15/2016] [Indexed: 01/16/2023]
Abstract
PURPOSE To determine whether the tibial tuberosity-to-trochlear groove distance (TT-TG) and patellar tendon-to-trochlear groove distance (PT-TG) are equal, whether the bony and cartilaginous points coincide in the trochlea, and whether the insertion of the PT coincides with the most anterior point of the TT in patients with patellar instability. METHODS Fifty-three MRI scans of patients with patellar instability were examined. TT-TG and PT-TG were measured by three examiners in 31 knees. Additionally, the bone-cartilage distance in the trochlea [trochlear cartilage to trochlear bone (TC-TB)] and the distance between the mid-point of the PT insertion and the most anterior point of the TT (PT-TT) were measured by one examiner. The intraclass correlation coefficient was used to evaluate the reliability of the measurements between the three examiners. The relationships between the measurements were determined, the means of the measurements were calculated, and the correlations between PT-TG and TT-TG, PT-TT, and TC-TB were assessed. RESULTS The ICC was above 0.8. PT-TG was 3.7 mm greater than TT-TG. The TC and TB coincided in 73 % of cases, and the mean TC-TB was 0.3 mm. The PT was lateral to the TT in 94 % of the cases, and the mean PT-TT was 3.4 mm. The Pearson's correlation coefficients between PT-TG and TT-TG, PT-TT, and TC-TB were 0.946, 0.679, and 0.199, respectively. CONCLUSION TT-TG underestimated PT-TG, primarily due to the lateralization of the PT insertion relative to the most anterior point of the TT. CLINICAL RELEVANCE our study shows that in patients with patellar instability, there are differences in the absolute values of TT-TG and PT-TG, as previously reported for patients without patellar instability. Hence, normal cut-off values based on case-control studies of TT-TG cannot be equivalently used when measuring PT-TG to indicate TT medialization in patients with patellar instability. It is also important to note that the clinical outcomes cannot be directly compared between patients evaluated using TT-TG versus PT-TG measurements. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Betina B Hinckel
- Department of Orthopaedics and Traumatology, Institute of Orthopaedics and Traumatology, University of São Paulo, Ovídio Pires de Campos St, 333, 2nd Floor, Cerqueira César, São Paulo, SP, 5403-010, Brazil
| | - Riccardo G Gobbi
- Department of Orthopaedics and Traumatology, Institute of Orthopaedics and Traumatology, University of São Paulo, Ovídio Pires de Campos St, 333, 2nd Floor, Cerqueira César, São Paulo, SP, 5403-010, Brazil.
| | - Eduardo N Kihara Filho
- Department of Musculoskeletal Radiology, University of São Paulo, São Paulo, SP, 55403-010, Brazil
| | - Marco K Demange
- Department of Orthopaedics and Traumatology, Institute of Orthopaedics and Traumatology, University of São Paulo, Ovídio Pires de Campos St, 333, 2nd Floor, Cerqueira César, São Paulo, SP, 5403-010, Brazil
| | - José Ricardo Pécora
- Department of Orthopaedics and Traumatology, Institute of Orthopaedics and Traumatology, University of São Paulo, Ovídio Pires de Campos St, 333, 2nd Floor, Cerqueira César, São Paulo, SP, 5403-010, Brazil
| | - Marcelo B Rodrigues
- Department of Musculoskeletal Radiology, University of São Paulo, São Paulo, SP, 55403-010, Brazil
| | - Gilberto Luis Camanho
- Department of Orthopaedics and Traumatology, Institute of Orthopaedics and Traumatology, University of São Paulo, Ovídio Pires de Campos St, 333, 2nd Floor, Cerqueira César, São Paulo, SP, 5403-010, Brazil
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Morphological classification of the femoral trochlear groove based on a quantitative measurement of computed tomographic models. Knee Surg Sports Traumatol Arthrosc 2017; 25:3163-3170. [PMID: 27395356 DOI: 10.1007/s00167-016-4236-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 07/05/2016] [Indexed: 12/31/2022]
Abstract
PURPOSE This study aimed to investigate the natural morphology of the femoral trochlear groove based on quantitative measurement. METHODS Computed tomographic femur models of 50 male and 50 female healthy Chinese adults (30-60 years) were analysed using three-dimensional software. Coaxial cutting planes (15° increments) rotating about the trochlear groove axis from the proximal to distal point were created, followed by the deepest point of the trochlear groove marked at each cross section. The shape, position, and orientation of the trochlear groove were analysed. RESULTS The trochlear groove was located laterally relative to the mechanical axis and consisted of the laterally oriented proximal part and medially oriented distal part. Based on the turning points located on different cross sections, the trochlear groove was classified into four types: types 45°, 60°, 75°, and 90°. The mediolateral position relative to the mechanical axis was types 45°, 60°, 75°, and 90°, from the lateral to medial side, while the distal parts of them extended along the same path. The orientation of the trochlear groove was relatively consistent and smooth, which oriented at approximately 1° medially between two adjacent segments, except at approximately 10° medially at the turning point. CONCLUSION The trochlear groove tracking varies greatly amongst a population that is mainly categorized into four types. This study may be helpful for better understanding of the natural trochlear groove anatomy, prosthetic design modification, and provide the reference value for studying patellofemoral diseases such as patellar maltracking and trochlear dysplasia. LEVEL OF EVIDENCE Prospective study, Level II.
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Shen J, Qin L, Yao WW, Li M. The significance of magnetic resonance imaging in severe femoral trochlear dysplasia assessment. Exp Ther Med 2017; 14:5438-5444. [PMID: 29285073 PMCID: PMC5740687 DOI: 10.3892/etm.2017.5217] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 04/10/2017] [Indexed: 01/25/2023] Open
Abstract
The clinical diagnosis of femoral trochlear dysplasia primarily relies on imaging. In the past, plain imaging was the major source of diagnosis. The present study investigated the application of magnetic resonance imaging (MRI) in the objective assessment of severe femoral trochlear dysplasia. A retrospective analysis was performed on knee MRIs from 30 normal subjects (30 knees) and 59 patients (61 knees) with severe femoral trochlear dysplasia based on the Dejour morphological classification. Cartilage and subchondral bone landmarks were used to compare a series of measurements between patient and control groups. These measurements included the femoral trochlear groove depth, sulcus angle, the lateral trochlear inclination, trochlear facet asymmetry, the femoral medial and lateral condyle symmetry, and the ratios between the femoral medial/lateral condyles and the maximal trochlear width. The measurement values based on the two types of landmarks were also compared within the patient and control groups, separately. In addition, the femoral trochlear groove depth, sulcus angle, lateral trochlear inclination and trochlear facet asymmetry of patients with different Dejour types were compared. Significant differences were observed in the femoral trochlear groove depth, sulcus angle, lateral trochlear inclination and trochlear facet asymmetry between the patient and control groups (P<0.05). Based on the two types of landmark, all indexes were significantly different (P<0.05; with the exception of lateral trochlear inclination) between the patient and control groups. Among patients with various Dejour types, the femoral trochlear groove depth, sulcus angle, lateral trochlear inclination and trochlear facet asymmetry demonstrated no significant differences. MRI exhibited advantages in revealing articular cartilage over conventional radiography and computed tomography. Therefore, cartilage landmarks in MRI images may be utilized to objectively evaluate femoral trochlear dysplasia in patients with severe femoral trochlear dysplasia.
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Affiliation(s)
- Ji Shen
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, P.R. China
| | - Le Qin
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, P.R. China
| | - Wei-Wu Yao
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, P.R. China
| | - Mei Li
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, P.R. China
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Iranpour F, Merican AM, Teo SH, Cobb JP, Amis AA. Femoral articular geometry and patellofemoral stability. Knee 2017; 24:555-563. [PMID: 28330756 DOI: 10.1016/j.knee.2017.01.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 01/14/2017] [Accepted: 01/24/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Patellofemoral instability is a major cause of anterior knee pain. The aim of this study was to examine how the medial and lateral stability of the patellofemoral joint in the normal knee changes with knee flexion and measure its relationship to differences in femoral trochlear geometry. METHODS Twelve fresh-frozen cadaveric knees were used. Five components of the quadriceps and the iliotibial band were loaded physiologically with 175N and 30N, respectively. The force required to displace the patella 10mm laterally and medially at 0°, 20°, 30°, 60° and 90° knee flexion was measured. Patellofemoral contact points at these knee flexion angles were marked. The trochlea cartilage geometry at these flexion angles was visualized by Computed Tomography imaging of the femora in air with no overlying tissue. The sulcus, medial and lateral facet angles were measured. The facet angles were measured relative to the posterior condylar datum. RESULTS The lateral facet slope decreased progressively with flexion from 23°±3° (mean±S.D.) at 0° to 17±5° at 90°. While the medial facet angle increased progressively from 8°±8° to 36°±9° between 0° and 90°. Patellar lateral stability varied from 96±22N at 0°, to 77±23N at 20°, then to 101±27N at 90° knee flexion. Medial stability varied from 74±20N at 0° to 170±21N at 90°. There were significant correlations between the sulcus angle and the medial facet angle with medial stability (r=0.78, p<0.0001). CONCLUSIONS These results provide objective evidence relating the changes of femoral profile geometry with knee flexion to patellofemoral stability.
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Affiliation(s)
- Farhad Iranpour
- Musculoskeletal Laboratory, Imperial College London, Charing Cross Hospital, London, United Kingdom
| | - Azhar M Merican
- Musculoskeletal Laboratory, Imperial College London, Charing Cross Hospital, London, United Kingdom; National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Department of Orthopaedic Surgery, University of Malaya, Malaysia
| | - Seow Hui Teo
- National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Department of Orthopaedic Surgery, University of Malaya, Malaysia.
| | - Justin P Cobb
- Musculoskeletal Laboratory, Imperial College London, Charing Cross Hospital, London, United Kingdom
| | - Andrew A Amis
- Musculoskeletal Laboratory, Imperial College London, Charing Cross Hospital, London, United Kingdom; Biomechanics Section, Mechanical Engineering Department, Imperial College London, United Kingdom
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Tscholl PM, Wanivenhaus F, Fucentese SF. Conventional Radiographs and Magnetic Resonance Imaging for the Analysis of Trochlear Dysplasia: The Influence of Selected Levels on Magnetic Resonance Imaging. Am J Sports Med 2017; 45:1059-1065. [PMID: 28177645 DOI: 10.1177/0363546516685054] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Trochlear dysplasia is one of the most important risk factors for recurrent patellar instability. It is defined on true lateral conventional radiographs (CR) and axial magnetic resonance imaging (MRI). The type of trochlear dysplasia is decisive for surgical treatment; however, low agreement between CR and MRI has been reported. PURPOSE To compare the Dejour classification of trochlear dysplasia on CR and axial MRI using differing levels defined in the literature. STUDY DESIGN Cohort study (diagnosis); Level of evidence, 2. METHODS The 4-type classification of trochlear dysplasia by Dejour was used to analyze 228 knees with recurrent patellar dislocations on true lateral CR and axial MRI. The 2-type modification of the Dejour classification was also similarly analyzed. Measurements on axial MRI were performed at 3 different levels: MR1, the most proximal level where the intercondylar notch forms a "Roman arch"; MR2, 3 cm above the joint line; and MR3, the midpatellar height. RESULTS MR1 was measured at a mean distance of 29 ± 3.5 mm and MR3 at a mean of 38 ± 5.8 mm above the joint line. MR1 and MR2 were always measured on the cartilaginous trochlea, whereas 52% of MR3 was found more proximally. Overall agreement was fair between CR and MR1/MR2 (31.1%/25.4%, respectively) and highest for MR3 (45.2%; P < .01). The highest agreement (81.8%) was found for MR3 with the 2-type trochlear dysplasia classification (low-grade trochlear dysplasia: type A vs high-grade trochlear dysplasia: types B, C, and D) and lower for MR1 (67.5%) and MR2 (62.0%). CONCLUSION Trochlear dysplasia measured on CR and MRI shows only fair agreement, especially when the supratrochlear region of the distal femur is not analyzed on axial MRI. MRI analysis that considers the cartilaginous trochlea only tends to underestimate the severity of dysplasia according to Dejour. For a more precise evaluation of trochlear dysplasia, the entire distal femur should be analyzed on axial MRI.
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Affiliation(s)
- Philippe Matthias Tscholl
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.,Division of Orthopedics and Trauma Surgery, Geneva University Hospital, University of Geneva, Geneva, Switzerland
| | - Florian Wanivenhaus
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Sandro F Fucentese
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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Liu X, Ji G, Wang X, Kang H, Wang F. CT-based morphological analysis of the posterior femoral condyle in patients with trochlear dysplasia. Knee 2017; 24:231-236. [PMID: 28188083 DOI: 10.1016/j.knee.2016.12.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 11/20/2016] [Accepted: 12/20/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND The anterior part of the distal femur in trochlear dysplasia has been well investigated; however, to date, posterior morphological characteristics have not been well studied. This study aimed to evaluate whether the posterior femoral condyle in patients with trochlear dysplasia differs from those without trochlear dysplasia. METHODS Computed tomography scans of 75 knees with trochlear dysplasia and 55 knees with normal anatomy of the patellofemoral joint were analyzed retrospectively. Three observers assessed the width, length, and height of the posterior condyle between the two groups. The intra-class correlation coefficient was used to evaluate inter-observer reliability. The independent Student's t-test was used to assess the statistical significance of the qualitative variables. RESULTS There was excellent inter-observer reliability (intra-class correlation coefficient 0.91-0.99) for all of the quantitative measurements. There were significant differences between trochlear dysplastic and normal knees. The trochlear dysplasia group had a larger medial posterior condyle and smaller lateral posterior condyle than the control group. Furthermore, proportion of the posterior condyle in the distal femur markedly differed between the two groups: in the trochlear dysplasia group, the medial posterior condyle accounted for a bigger proportion, while the lateral posterior condyle accounted for a smaller proportion. CONCLUSION Patients with trochlear dysplasia have different posterior femoral condyles compared with those without trochlear dysplasia. Patients with this condition have bigger medial posterior condyles and smaller lateral posterior condyles. A greater amount of attention needs to be paid to this abnormality.
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Affiliation(s)
- Xiaohui Liu
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang 050051, Hebei, China
| | - Gang Ji
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang 050051, Hebei, China
| | - Xinmin Wang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang 050051, Hebei, China
| | - Huijun Kang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang 050051, Hebei, China
| | - Fei Wang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang 050051, Hebei, China.
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Sanchis-Alfonso V, Montesinos-Berry E, Ramirez-Fuentes C, Leal-Blanquet J, Gelber PE, Monllau JC. Failed medial patellofemoral ligament reconstruction: Causes and surgical strategies. World J Orthop 2017; 8:115-129. [PMID: 28251062 PMCID: PMC5314141 DOI: 10.5312/wjo.v8.i2.115] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 08/16/2016] [Accepted: 11/22/2016] [Indexed: 02/06/2023] Open
Abstract
Patellar instability is a common clinical problem encountered by orthopedic surgeons specializing in the knee. For patients with chronic lateral patellar instability, the standard surgical approach is to stabilize the patella through a medial patellofemoral ligament (MPFL) reconstruction. Foreseeably, an increasing number of revision surgeries of the reconstructed MPFL will be seen in upcoming years. In this paper, the causes of failed MPFL reconstruction are analyzed: (1) incorrect surgical indication or inappropriate surgical technique/patient selection; (2) a technical error; and (3) an incorrect assessment of the concomitant risk factors for instability. An understanding of the anatomy and biomechanics of the MPFL and cautiousness with the imaging techniques while favoring clinical over radiological findings and the use of common sense to determine the adequate surgical technique for each particular case, are critical to minimizing MPFL surgery failure. Additionally, our approach to dealing with failure after primary MPFL reconstruction is also presented.
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Du Z, Chen S, Yan M, Yue B, Zeng Y, Wang Y. Do size, shape, and alignment parameters of the femoral condyle affect the trochlear groove tracking? A morphometric study based on 3D- computed tomography models in Chinese people. BMC Musculoskelet Disord 2017; 18:4. [PMID: 28061849 PMCID: PMC5217221 DOI: 10.1186/s12891-016-1374-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 12/19/2016] [Indexed: 01/25/2023] Open
Abstract
Background Our study aimed to investigate whether geometrical features (size, shape, or alignment parameters) of the femoral condyle affect the morphology of the trochlear groove. Methods Computed tomography models of 195 femurs (97 and 98 knees from male and female subjects, respectively) were reconstructed into three-dimensional models and categorised into four types of trochlear groove morphology based on the position of the turning point in relation to the mechanical axis (types 45°, 60°, 75°, and 90°). Only subjects with healthy knees were included, whereas individuals with previous knee trauma or knee pain, soft tissue injury, osteoarthritis, or other chronic diseases of the musculoskeletal system were excluded. The size parameters were: radius of the best-fit cylinder, anteroposterior dimension of the lateral condyles (AP), and distal mediolateral dimension (ML). The shape parameters were: aspect ratio (AP/ML), arc angle, and proximal- and distal- end angles. The alignment parameters were: knee valgus physiologic angle (KVPA), mechanical medial distal femoral angle (mMDFA), and hip-knee-ankle angle (HKA). All variables were measured in the femoral condyle models, and the means for each groove type were compared using one-way analysis of variance. Results No significant difference among groove types was observed regarding size parameters. There were significant differences when comparing type 45° with types 60°, 75°, and 90° regarding aspect ratio and distal-end angle (p < 0.05), but not regarding proximal-end angle. There were significant differences when comparing type 90° with types 45°, 60°, and 75° regarding KVPA, mMDFA, and HKA (p < 0.05). Conclusion Among size, shape, and alignment parameters, the latter two exhibited partial influence on the morphology of the trochlear groove. Shape parameters affected the trochlear groove for trochlear type 45°, for which the femoral condyle was relatively flat, whereas alignment parameters affected the trochlear groove for trochlear type 90°, showing that knees in type 90° tend to be valgus. The morphometric analysis based on trochlear groove classification may be helpful for the future design of individualized prostheses.
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Affiliation(s)
- Zhe Du
- Department of Orthopaedic Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, 145 Shandong Middle Road, Shanghai, 200001, China
| | - Shichang Chen
- Department of Orthopaedic Surgery, Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Mengning Yan
- Department of Orthopaedic Surgery, Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Bing Yue
- Department of Orthopaedic Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, 145 Shandong Middle Road, Shanghai, 200001, China
| | - Yiming Zeng
- Department of Orthopaedic Surgery, Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - You Wang
- Department of Orthopaedic Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, 145 Shandong Middle Road, Shanghai, 200001, China.
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Deveci A, Cankaya D, Yilmaz S, Celen E, Sakman B, Bozkurt M. Are metric parameters sufficient alone in evaluation of the patellar instability? New angular measuring parameters. J Orthop Surg (Hong Kong) 2017; 25:2309499016684498. [PMID: 28117636 DOI: 10.1177/2309499016684498] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
PURPOSES When the evaluation of patellar instability is examined from the aspect of the conical-cylindrical anatomy of the tibia, metric measurement parameters such as the tuberositas tibia (TT)-trochlear groove (TG) and patellar tendon (PT) insertion-trochlear groove (TG) distances are not sufficient. We asked whether defined angular parameters reveal the rotational movement of the tuberositas tibia on the tibia shaft, additional to the metric parameters and there is a correlation between the metric and angular parameters. METHODS 19 patients with patellar instability and 22 patients without patellar instability were evaluated. For all patients, two angle and three length parameters were evaluated on the slices taken. Evaluations were made of the TT-TG, the midpoint of the PT insertion-TG distances, the anatomic midpoint of the dome of the TT-TG, the TG-PT angle, and the TG-dome angle (DA). The Pearson correlation test was used for the statistical analysis of correlations between groups. RESULTS A statistically significant increase was determined in the patellar instability group in the TG-DA and TG-PT angle values compared to the group without patellar instability ( p < 0.05). In both groups, a positive and strong correlation was determined between the TT-TG and the TG-PT and dome of the TT-TG distances, but no statistically significant correlation was determined between the tuberositas TT-TG and TG-PT angle and TG-DA. CONCLUSION Metric parameters may not be sufficient alone in the evaluation of patellar instability. Metric parameters should be supported by additional angular parameters which reveal the rotational movement of the TT on the tibia shaft.
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Affiliation(s)
- Alper Deveci
- 1 Department of Orthopaedics and Traumatology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Deniz Cankaya
- 1 Department of Orthopaedics and Traumatology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Serdar Yilmaz
- 1 Department of Orthopaedics and Traumatology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Ersin Celen
- 1 Department of Orthopaedics and Traumatology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Bulent Sakman
- 2 Department of Radiology, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Murat Bozkurt
- 3 Department of Orthopaedics and Traumatology, School of Medicine, Yildirim Beyazıt University, Ankara, Turkey
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Hiemstra LA, Kerslake S, Loewen M, Lafave M. Effect of Trochlear Dysplasia on Outcomes After Isolated Soft Tissue Stabilization for Patellar Instability. Am J Sports Med 2016; 44:1515-23. [PMID: 27217524 DOI: 10.1177/0363546516635626] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Trochlear dysplasia is a well-described risk factor for patellofemoral instability. Despite its clear association with the incidence of patellar instability, it is unclear whether the presence of high-grade trochlear dysplasia influences clinical outcome after patellofemoral stabilization. PURPOSE To determine whether isolated proximal soft tissue stabilization for patellofemoral instability is as successful in patients with high-grade dysplasia compared with low-grade or no dysplasia, as measured by disease-specific quality-of-life and pain scores. STUDY DESIGN Case series; Level of evidence, 4. METHODS A total of 277 patellofemoral stabilization procedures were performed during the study period. An isolated stabilization was performed in 233 patients, and 203 of these patients (87%) had adequate lateral radiographs and complete Banff Patella Instability Instrument (BPII) scores available for assessment. Of these, 152 patients underwent a medial patellofemoral ligament reconstruction (MPFL-R) and 51 patients received a medial patellofemoral ligament imbrication (MPFL-I). There were 21 patients with no trochlear dysplasia, 89 patients with low-grade dysplasia (Dejour type A), and 93 patients with high-grade dysplasia (Dejour types B-D). An independent-samples t test was used to determine the difference between the pre- and postoperative BPII scores. A Spearman rho correlation was calculated between 3 trochlear dysplasia groups and the BPII scores at a mean 24 months after patellofemoral stabilization. An independent-samples t test was used to assess the influence of trochlear bump size on outcomes by stratifying data and assessing for a relationship to BPII scores. RESULTS The independent-samples t test demonstrated statistically significant improvements in pre- to postoperative BPII scores for both groups. The MPFL-R group improved from a mean BPII score of 24.36 to 65.16 (P < .001), and the MPFL-I group improved from a mean of 28.92 to 73.45 (P < .01). For the MPFL-R patient cohort, the Spearman rho correlation demonstrated a significant relationship between postoperative BPII scores and presence of a trochlear bump and degree of dysplasia (P ≤ .05). Overall, a trochlear bump of ≥5 mm was associated with lower postoperative BPII scores (t(193) = 2.65, η(2) = 0.04). CONCLUSION This research has established a statistically significant correlation between trochlear dysplasia and disease-specific outcomes after MPFL-R surgery. Overall, there was evidence of significant improvement in disease-specific quality-of-life scores after patellofemoral stabilization surgery. This study is the largest cohort reported to date and therefore adds substantially to the evidence that trochlear dysplasia is a significant risk factor for and predictor of outcome among patients with patellofemoral instability.
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Affiliation(s)
- Laurie A Hiemstra
- Banff Sport Medicine, Banff, Canada Department of Surgery, University of Calgary, Calgary, Canada
| | - Sarah Kerslake
- Banff Sport Medicine, Banff, Canada Department of Physical Therapy, University of Alberta, Edmonton, Canada
| | | | - Mark Lafave
- Department of Physical Education and Recreation Studies, Mount Royal University, Calgary, Canada
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Huang G, Xia J, Wang S, Wei Y, Wu J, Chen F, Chen J, Shi J. Total knee arthroplasty using trochlear groove as guide for position of femoral component in severe knee osteoarthritis. BMC Surg 2016; 16:33. [PMID: 27216144 PMCID: PMC4877803 DOI: 10.1186/s12893-016-0148-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 04/30/2016] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Apart from transepicondylar axis, the native femoral sulcus was also reported to be used as a guide for the femoral component position in total knee arthroplasty (TKA). However, it was not shown in patients with severe knee osteoarthritis. This study was conducted to compare the position of trochlear groove in patients with and without osteoarthritis, and to assess whether trochlear groove could be used as a guide for position of femoral component in TKA for severe knee osteoarthritis. METHODS Total 50 severe knee osteoarthritis patients (Kellgren Lawrence grade 3 or 4) who underwent TKA were included. Meanwhile, 50 patients who underwent arthroscopic surgery without osteoarthritis were included as control. The distance from trochlear groove to the midpoint of a virtual anterior condyle osteotomy line (parallel to the posterior condyle line) (a-b) was recorded by radiological and surgical measurements. Midpoint of transepicondylar axis and trochlear groove were used as guide for placing prosthesis model in TKA, respectively. No-thumb test was performed to assess the patellar tracking. The position of femoral component was finally performed using trochlear groove as guide in TKA. RESULTS Value of "a-b" was significantly different between osteoarthritic and control knees (P = 0.008). During the placement of prosthesis model, similar patellar tracking was detected between using midpoint of transepicondylar axis and trochlear groove as guide (P > 0.05). After placing femoral component using trochlear groove as guide, most patients obtained good patellofemoral congruence with pneumatic tourniquet inflated (n = 43) or deflated (n = 5), and good patellofemoral congruence was also obtained by lateral patellar retinaculum release in two patients. CONCLUSION Despite the shifting of trochlear groove caused by severe knee osteoarthritis, trochlear groove can be used as a guide for position of femoral component, with equivalent patellar tracking compared with transepicondylar axis.
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Affiliation(s)
- Gangyong Huang
- Department of Orthopaedic Surgery, Huashan Hospital Fudan University, 12th Wulumuqi Middle Road, Shanghai, 200040, China
| | - Jun Xia
- Department of Orthopaedic Surgery, Huashan Hospital Fudan University, 12th Wulumuqi Middle Road, Shanghai, 200040, China.
| | - Siqun Wang
- Department of Orthopaedic Surgery, Huashan Hospital Fudan University, 12th Wulumuqi Middle Road, Shanghai, 200040, China
| | - Yibing Wei
- Department of Orthopaedic Surgery, Huashan Hospital Fudan University, 12th Wulumuqi Middle Road, Shanghai, 200040, China
| | - Jianguo Wu
- Department of Orthopaedic Surgery, Huashan Hospital Fudan University, 12th Wulumuqi Middle Road, Shanghai, 200040, China
| | - Feiyan Chen
- Department of Orthopaedic Surgery, Huashan Hospital Fudan University, 12th Wulumuqi Middle Road, Shanghai, 200040, China
| | - Jie Chen
- Department of Orthopaedic Surgery, Huashan Hospital Fudan University, 12th Wulumuqi Middle Road, Shanghai, 200040, China
| | - Jingsheng Shi
- Department of Orthopaedic Surgery, Huashan Hospital Fudan University, 12th Wulumuqi Middle Road, Shanghai, 200040, China
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Ridley TJ, Bremer Hinckel B, Kruckeberg BM, Agel J, Arendt EA. Anatomical patella instability risk factors on MRI show sensitivity without specificity in patients with patellofemoral instability: a systematic review. J ISAKOS 2016. [DOI: 10.1136/jisakos-2015-000015] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Abstract
OBJECTIVE The objective of our study as to assess several indexes relevant to patellofemoral instability (PFI) associated with femoral trochlear dysplasia as measured on oblique coronal MR images at three standardized reference levels. MATERIALS AND METHODS A total of 30 knee MRI examinations were selected as the study group of PFI patients. Sixty knee MRI examinations were included as a control group. MRI protocols included sagittal T2-weighted, axial proton density-weighted, and oblique coronal T2-weighted imaging. On a midline sagittal image, the following three levels of the femoral trochlear groove cartilage were determined: level 1 (one-fourth level of the trochlear groove in the midsagittal plane), level 2 (one-half level of the trochlear groove in the midsagittal plane), and level 3 (three-fourths level of the trochlear groove in the midsagittal plane). Three-level axial and oblique coronal images were selected using the sagittal image as a scout. Femoral trochlear indexes including the sulcus angle, sulcus depth, facet length, and trochlear groove area were measured on the axial and oblique coronal images. RESULTS Most indexes showed significant differences between the PFI and control groups in the axial and oblique coronal planes at all three levels (p < 0.05). Almost all indexes measured on the oblique coronal plane images were significantly different from those measured on the axial plane images (p < 0.05). Oblique coronal images showed little variability in the sulcus angle among the three levels in contrast to a marked decrease in the angle from the proximal to distal level on axial images. CONCLUSION Femoral trochlear indexes measured on oblique coronal knee MR images can be used to assess femoral trochlear dysplasia. Oblique coronal images showed less morphologic distortion of the distal femoral trochlear groove than axial images.
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Saffarini M, Demey G, Nover L, Dejour D. Evolution of trochlear compartment geometry in total knee arthroplasty. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:7. [PMID: 26855943 DOI: 10.3978/j.issn.2305-5839.2015.12.53] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND The study aimed to compare trochlear profiles in recent total knee arthroplasty (TKA) models and to determine whether they feature improvements compared to their predecessors. The hypothesis was that recent TKA models have more anatomic trochlear compartments and would display no signs of trochlear dysplasia. METHODS The authors analyzed the geometry of the 6 following TKA models using engineering software: PFC and Attune (DePuy), NexGen and Persona (Zimmer), Noetos and KneeTec (Tornier). The mediolateral trochlear profiles were plotted at various flexion angles (0°, 15°, 30° and 45°) to deduce the sulcus angle. RESULTS Analysis of sulcus angles reveals general convergence of recent designs towards anatomic values. At 0° of flexion, sulcus angles of recent implant models were between 156.0-157.4°, while those of previous generation models between 154.5-165.5°. At 30° of flexion, sulcus angles of recent models also lie within 145.7-148.6°, but those of previous models are between 149.5-152.0°. All three manufacturers deepened their trochlear profile at 30° of flexion in recent models compared to earlier designs. Sulcus angles converge towards anatomic values but still exceed radiologic signs of dysplasia by 2-5°. CONCLUSIONS Recent TKA designs have more anatomic trochlear geometries than earlier TKA models by the same manufacturers, but trochlear compartments still exceed radiologic signs of trochlear dysplasia by 2° to 5°. The hypothesis that recent TKA models display no signs of trochlear dysplasia is therefore refuted. Surgeons should be aware of design limitations to optimize choice of implant and extensor mechanisms alignment. LEVEL OF EVIDENCE IV geometric implant analysis.
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Affiliation(s)
- Mo Saffarini
- 1 Department of Medical Technology, Accelerate Innovation Management SA, 1704 Geneva, Switzerland ; 2 Lyon-Ortho-Clinic, Clinique de la Sauvegarde, 8 Avenue Ben Gourion, 69009 Lyon, France
| | - Guillaume Demey
- 1 Department of Medical Technology, Accelerate Innovation Management SA, 1704 Geneva, Switzerland ; 2 Lyon-Ortho-Clinic, Clinique de la Sauvegarde, 8 Avenue Ben Gourion, 69009 Lyon, France
| | - Luca Nover
- 1 Department of Medical Technology, Accelerate Innovation Management SA, 1704 Geneva, Switzerland ; 2 Lyon-Ortho-Clinic, Clinique de la Sauvegarde, 8 Avenue Ben Gourion, 69009 Lyon, France
| | - David Dejour
- 1 Department of Medical Technology, Accelerate Innovation Management SA, 1704 Geneva, Switzerland ; 2 Lyon-Ortho-Clinic, Clinique de la Sauvegarde, 8 Avenue Ben Gourion, 69009 Lyon, France
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ANTINOLFI PIERLUIGI, BARTOLI MATTEO, PLACELLA GIACOMO, SPEZIALI ANDREA, PACE VALERIO, DELCOGLIANO MARCO, MAZZOLA CLAUDIO. Acute patellofemoral instability in children and adolescents. JOINTS 2016; 4:47-51. [PMID: 27386447 PMCID: PMC4914373 DOI: 10.11138/jts/2016.4.1.047] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Patellofemoral problems are considered to be among the most frequent causes of knee pain in children and adolescents. Correcting bone abnormalities through specific and targeted interventions is mandatory in skeletally immature patients. Medial patellofemoral ligament (MPFL) reconstruction is the preferred procedure, but there are several important precautionary considerations that the surgeon must take into account. It must always be remembered that MPFL rupture is the result, not the cause, of an altered extensor mechanism; therefore, patellar stabilization with MPFL reconstruction is only the first step to be accomplished in the management of an MPFL rupture. If other anatomical alterations are encountered, alternative/additional surgical procedures should be considered. If MPFL rupture occurs without associated anatomical or functional knee alterations, an appropriate rehabilitation program after MPFL reconstruction should be sufficient to achieve a good outcome. In conclusion, an acute patellar dislocation should be managed conservatively unless there is evidence of osteochondral damage or medial retinaculum lesions. Osseous procedures are contraindicated in children, while MPFL anatomical reconstruction with "physeal sparing" is the primary surgical option.
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Affiliation(s)
| | - MATTEO BARTOLI
- Department of Orthopaedics, Università Cattolica del Sacro Cuore, Policlinico Gemelli, Rome, Italy
| | - GIACOMO PLACELLA
- Department of Orthopaedics, Università Cattolica del Sacro Cuore, Policlinico Gemelli, Rome, Italy
| | | | - VALERIO PACE
- Royal National Orthopaedic Hospital, Stanmore, London, UK
| | | | - CLAUDIO MAZZOLA
- Department of Orthopaedics, Ospedali Galliera di Genova, Italy
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CHO KJ, MÜLLER JH, ERASMUS PJ. TROCHLEAR GROOVE ALIGNMENT MEASUREMENT METHOD FOR SURGICAL APPLICATIONS. J MECH MED BIOL 2015. [DOI: 10.1142/s0219519415400333] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
In patellofemoral arthroplasty (PFA), rotational alignment is paramount for optimal patellofemoral function. Surgeons require a simple and effective measurement reference, through which the intact trochlear groove orientation can be quantified, to ensure good PFA alignment. We measured axial and coronal trochlear groove alignment in three-dimensional (3D) segmented computed tomography (CT) femurs relative to different references: The posterior condylar plane; the distal condylar plane, and the anatomical axis. The trochlear inclination angle (TIA) shows a better linear correlation with the axial groove angle when measured from the line perpendicular to the axial groove line as opposed to measurement from the posterior condylar plane. Similarly, a better linear correlation was achieved between the anatomical and the mechanical angles when measured from the coronal groove line as opposed to a line perpendicular to the distal condylar plane. Since axial and coronal groove alignment is quantifiable with respect to anatomical landmarks preoperatively, it may allow using the groove lines as a guideline for selection of the most appropriate patellofemoral prosthesis design. This may lead to the application of a PFA that better fits the patients' trochlear anatomy.
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Affiliation(s)
- K. J. CHO
- Department of Mechanical and Mechatronic Engineering, Stellenbosch University, Private Bag X1, Matieland 7600, South Africa
| | - J. H. MÜLLER
- Department of Mechanical and Mechatronic Engineering, Stellenbosch University, Private Bag X1, Matieland 7600, South Africa
| | - P. J. ERASMUS
- Department of Orthopaedics, Stellenbosch University, Private Bag X1, Matieland 7600, South Africa
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MacKay JW, Godley KC, Toms AP, Donell ST. Trochlear boss height measurement: a comparison of radiographs and MRI. Knee 2014; 21:1052-7. [PMID: 25115655 DOI: 10.1016/j.knee.2014.07.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 07/01/2014] [Accepted: 07/16/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND A key anatomical consideration and determinant of surgical approach in trochlear dysplasia is the trochlear boss height (TBH), traditionally defined by measurements on plain X-rays (XR). Magnetic resonance (MR) imaging is increasingly used for pre-operative planning and follow-up. However, it is unclear whether measurement of TBH on XR is applicable to MR. The aim of this study was to establish the reliability of TBH measurement on MR compared to XR. METHODS This study used lateral knee radiographs and MR scans of 14 knees of patients with trochlear dysplasia, six knees of non-dysplastic patients with anterior knee pain (AKP), and five knees of non-dysplastic controls with no AKP. Correlation between XR and MR measurements was assessed using Pearson correlation coefficients. Agreement between methods and observers was assessed using Bland-Altman plots with 95% limits of agreement. Intra- and inter-observer reliability was assessed using intraclass correlation coefficients (ICC). RESULTS Bland-Altman charts showed a total width of 95% limits of agreement of 4.78 mm for XR and MR subchondral bone (SB) TBH measurements, and 6.73 mm for XR and MR cartilage TBH measurements. Inter-observer ICCs were 0.86 for XR, 0.62 for MR SB, and 0.53 for MR cartilage. The widths of the Bland-Altman 95% limits of agreement between observers were 4.79 mm (XR), 5.04 mm (MR SB) and 4.74 mm (MR cartilage). CONCLUSION Measurement of TBH on MR is not directly interchangeable with XR. Adjustments need to be made to treatment thresholds based on XR measurement if MR is used instead.
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Affiliation(s)
- J W MacKay
- Department of Radiology, Norfolk & Norwich University Hospital, United Kingdom
| | - K C Godley
- Department of Radiology, Norfolk & Norwich University Hospital, United Kingdom
| | - A P Toms
- Department of Radiology, Norfolk & Norwich University Hospital, United Kingdom
| | - S T Donell
- Department of Trauma & Orthopaedics, Norfolk & Norwich University Hospital, United Kingdom
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Van Haver A, De Roo K, De Beule M, Van Cauter S, Audenaert E, Claessens T, Verdonk P. Semi-automated landmark-based 3D analysis reveals new morphometric characteristics in the trochlear dysplastic femur. Knee Surg Sports Traumatol Arthrosc 2014; 22:2698-708. [PMID: 23778869 DOI: 10.1007/s00167-013-2573-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 06/10/2013] [Indexed: 01/12/2023]
Abstract
PURPOSE The authors hypothesise that the trochlear dysplastic distal femur is not only characterised by morphological changes to the trochlea. The purpose of this study is to describe the morphological characteristics of the trochlear dysplastic femur in and outside the trochlear region with a landmark-based 3D analysis. METHODS Arthro-CT scans of 20 trochlear dysplastic and 20 normal knees were used to generate 3D models including the cartilage. To rule out size differences, a set of landmarks were defined on the distal femur to isotropically scale the 3D models to a standard size. A predefined series of landmark-based reference planes were applied on the distal femur. With these landmarks and reference planes, a series of previously described characteristics associated with trochlear dysplasia as well as a series of morphometric characteristics were measured. RESULTS For the previously described characteristics, the analysis replicated highly significant differences between trochlear dysplastic and normal knees. Furthermore, the analysis showed that, when knee size is taken into account, the cut-off values of the trochlear bump and depth would be 1 mm larger in the largest knees compared to the smallest knees. For the morphometric characteristics, the analysis revealed that the trochlear dysplastic femur is also characterised by a 10% smaller intercondylar notch, 6-8% larger posterior condyles (lateral-medial) in the anteroposterior direction and a 6% larger medial condyle in the proximodistal direction compared to a normal femur. CONCLUSIONS This study shows that knee size is important in the application of absolute metric cut-off values and that the posterior femur also shows a significantly different morphology.
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Affiliation(s)
- Annemieke Van Haver
- BioMech, Department of Mechanics, University College Ghent, Valentin Vaerwijckweg 1, 9000, Ghent, Belgium,
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Dejour D, Ntagiopoulos PG, Saffarini M. Evidence of trochlear dysplasia in femoral component designs. Knee Surg Sports Traumatol Arthrosc 2014; 22:2599-607. [PMID: 23229383 DOI: 10.1007/s00167-012-2268-z] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2012] [Accepted: 10/19/2012] [Indexed: 01/25/2023]
Abstract
PURPOSE The study aimed to compare trochlear profiles of various total knee arthroplasty (TKA) models to anatomic profiles observed in healthy and pathologic knees and to evaluate trochlear designs against radiologic indicators for PF disorders and trochlear dysplasia. METHODS The trochlear profiles of 14 different TKA models were digitized using a coordinate measurement machine at various flexion angles (0°, 15°, 30° and 45°) to deduce the following variables: sulcus angle, trochlear groove orientation, height of lateral facet, and mediolateral groove position. The effect of externally rotating the femoral component on those variables was simulated. RESULTS The sulcus angle was greater than the indicators for trochlear dysplasia of 144° in 11 implants at 45° flexion, and in 13 implants at 30° flexion. The lateral facet height was less than average anatomic values of 5 mm in eight specimens through the entire range of early flexion (0°-30°). The trochlear groove was oriented laterally in 13 specimens (3.3°-11.7°) and was vertical in one specimen (0.3°). Applying an external rotation up to 6° resulted in noticeable lateral translation of the trochlear groove and facets, but negligible posterior translation. CONCLUSIONS The study presented a detailed description of previously overlooked TKA design parameters and revealed that some femoral components exhibit characteristics of trochlear dysplasia. The clinical relevance of this descriptive study is that surgeons should be aware of such design limitations to improve choice of implant for patients with history of PF disorders and to adapt surgical techniques as necessary to optimize PF tracking. LEVEL OF EVIDENCE Case-control study, Level III.
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Affiliation(s)
- David Dejour
- Lyon-Ortho-Clinic, Clinique de la Sauvegarde, Avenue Ben Gourion, Lyon, France,
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Arthroscopic evaluation of trochlear dysplasia as an aid in decision making for the treatment of patellofemoral instability. Knee Surg Sports Traumatol Arthrosc 2014; 22:2788-94. [PMID: 23824254 DOI: 10.1007/s00167-013-2586-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2012] [Accepted: 06/24/2013] [Indexed: 01/11/2023]
Abstract
PURPOSE Trochlear dysplasia is an important aetiological factor for the development of patellofemoral instability (PFI). The aim of the study was to identify the arthroscopic morphology of trochlear dysplasia that can be helpful when planning operative treatment for PFI. METHODS Magnetic resonance imaging (MRI) scans and strict lateral radiographs of 46 patients treated for PFI were assigned according to Dejour and matched with arthroscopic views from the lateral superior arthroscopic portal. On arthroscopy, signs of trochlear dysplasia were identified and classified into two types. Intra- and inter-observer agreements of the arthroscopic evaluation were assessed. RESULTS Arthroscopically, 2 major types of trochlear dysplasia could be distinguished. Type I shows a flat trochlear groove with an elevated trochlear floor in relation to the anterior femoral cortex. In type II, the proximal trochlea was convex with a lateral trochlear bump. Arthroscopic evaluation was not consistent with the Dejour's radiographic and axial MRI classification. Arthroscopic grading showed excellent intra- and inter-observer agreements (81-92%). CONCLUSION Arthroscopic evaluation can give additional information about the severity of trochlear dysplasia. This additional information can be used as an aid in decision making for the treatment of PFI. LEVEL OF EVIDENCE II.
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Saffarini M, Ntagiopoulos PG, Demey G, Le Negaret B, Dejour DH. Evidence of trochlear dysplasia in patellofemoral arthroplasty designs. Knee Surg Sports Traumatol Arthrosc 2014; 22:2574-81. [PMID: 24696005 DOI: 10.1007/s00167-014-2967-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 03/19/2014] [Indexed: 01/25/2023]
Abstract
PURPOSE The design of the trochlear compartment is crucial in patellofemoral arthroplasty (PFA), because 78% of patients with isolated patellofemoral arthritis present concomitant trochlear dysplasia with patellar maltracking and therefore remain predisposed to post-operative patellar subluxation and dislocation. The study investigated whether current PFA implants are designed with anatomic trochlear parameters such as the sulcus angle, lateral facet height and groove orientation. METHODS Five trochlear components of commercially available PFA implants were scanned, and the generated three-dimensional surfaces were measured using engineering design software. The mediolateral trochlear profiles were plotted at various flexion angles (0°, 15°, 30° and 45°) to deduce the following variables: sulcus angle, height of lateral facet and trochlear groove orientation. RESULTS Four specimens had sulcus angle>144° in the 45° of flexion, and all five specimens had sulcus angle>143° in 30° of flexion. Three specimens had a facet<5 mm high through the entire range of early flexion (0°-30°), and two specimens had a facet<5 mm high beyond early flexion (30°-45°). The trochlear groove was oriented laterally in all specimens (range 1.6°-13.5°). CONCLUSION Current PFA trochlear components are not always designed with anatomic parameters, and some models exhibit characteristics of trochlear dysplasia. Surgeons are therefore advised to implant components with a deep sulcus, particularly in patients with history of patellofemoral disorders, and to adapt the surgical technique and extensor mechanism if the component implanted has a shallow sulcus, to ensure normal patellar tracking. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Mo Saffarini
- Accelerate Innovation Management SA, 1 Rue de la Navigation, 1201, Geneva, Switzerland,
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Abstract
The diagnosis and treatment of chronic patellar instability caused by trochlear dysplasia can be challenging. A dysplastic trochlea leads to biomechanical and kinematic changes that often require surgical correction when symptomatic. In the past, trochlear dysplasia was classified using the 4-part Dejour classification system. More recently, new classification systems have been proposed. Future studies are needed to investigate long-term outcomes after trochleoplasty.
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Li H, Qu X, Wang Y, Dai K, Zhu Z. Morphological analysis of the knee joint in patients with hip dysplasia. Knee Surg Sports Traumatol Arthrosc 2013; 21:2081-8. [PMID: 23100046 DOI: 10.1007/s00167-012-2242-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Accepted: 10/05/2012] [Indexed: 01/17/2023]
Abstract
PURPOSE The purpose of this study was to investigate the morphological changes of the knee in patients with untreated developmental dysplasia of the hip. METHODS Morphological analysis of 150 knee joints in 75 patients with developmental dysplasia of the hip was performed by examining computed tomographic (CT) images. Of these patients, 36 had unilateral developmental dysplasia of the hip and 39 had bilateral developmental dysplasia of the hip. Therefore, 36 hips were normal, and 114 hips were dislocated. CT images ranged from the iliac crest to 2 cm inferior to the tibial tuberosity. RESULTS Compared with the knees in patients with normal hips, the femoral condyles in patients with dislocated hips were smaller and exhibited greater medial and lateral condylar asymmetry. The anterior femoral condylar angle of the femur was increased, as was the groove angle, while the trochlear groove was shallower in patients with dislocated hips. Furthermore, the lateral patella shift was reduced and the patellar tilt angle was increased in patients with dislocated hips compared with patients with normal hips. The extent of changes in these variables differed with the degree of dislocation. However, the posterior condylar angle of the femur was not affected by the degree of dislocation. CONCLUSION These findings suggest that developmental dysplasia of the hip is associated with morphological changes in the knee joint. These changes should be considered during hip and knee surgery. LEVEL OF EVIDENCE Prospective study, level II.
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Affiliation(s)
- Huiwu Li
- Department of Orthopaedics, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 639 Zhizaoju Road, Shanghai, 200011, People's Republic of China
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Nelitz M, Dreyhaupt J, Lippacher S. Combined trochleoplasty and medial patellofemoral ligament reconstruction for recurrent patellar dislocations in severe trochlear dysplasia: a minimum 2-year follow-up study. Am J Sports Med 2013; 41:1005-12. [PMID: 23467555 DOI: 10.1177/0363546513478579] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Trochlear dysplasia is an important etiological factor for the development of patellofemoral instability. Because a dislocation of the patella as a result of trochlear dysplasia results in a traumatic disruption of the medial patellofemoral ligament (MPFL), a combined trochleoplasty and patellofemoral ligament reconstruction appears to be the most appropriate procedure to treat patients with severe trochlear dysplasia. HYPOTHESIS Combined trochleoplasty and anatomic reconstruction of the MPFL will prevent redislocations of the patella and will lead to improved knee function. STUDY DESIGN Case series; Level of evidence, 3. METHODS Twenty-three consecutive patients (26 knees) with patellofemoral instability and severe trochlear dysplasia underwent combined trochleoplasty and anatomic reconstruction of the MPFL. Preoperative radiographic examination included anteroposterior and lateral views to assess patella alta. Magnetic resonance imaging was performed to evaluate trochlear dysplasia and the tibial tubercle-trochlear groove (TT-TG) distance. Evaluations included the detection of cartilage injuries, preoperative and postoperative physical examinations, and scores for the visual analog scale (VAS), Kujala knee function, International Knee Documentation Committee (IKDC), activity rating scale (ARS), and Tegner activity scale. RESULTS The mean age at the time of operation was 19.2 years (range, 15.4-23.6 years). The mean follow-up after operation was 2.5 years after surgery (range, 2.0-3.5 years). No recurrent dislocation occurred postoperatively. Kujala scores improved from 79 to 96, IKDC scores from 74 to 90, and VAS scores from 3 to 1. All improvements were highly statistically significant (P < .01). The activity level according to the Tegner activity scale and the ARS decreased but was not statistically significant (P = .06 and P = .21, respectively). There were 95.7% of the patients who were satisfied or very satisfied with the procedure. CONCLUSION Combined anatomic reconstruction of the MPFL and trochleoplasty reliably improved the stability of the patellofemoral joint in patients with severe trochlear dysplasia and no or mild degenerative changes. In addition, the described procedure showed significant improvement of knee function and good patient satisfaction without any episode of redislocations of the patella.
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Affiliation(s)
- Manfred Nelitz
- Orthopaedic Specialty Clinic, MVZ Oberstdorf, Trettachstrasse 16, 87561 Oberstdorf, Germany.
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Charles MD, Haloman S, Chen L, Ward SR, Fithian D, Afra R. Magnetic resonance imaging-based topographical differences between control and recurrent patellofemoral instability patients. Am J Sports Med 2013; 41:374-84. [PMID: 23371940 DOI: 10.1177/0363546512472441] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Plain films and computed tomography (CT)-based imaging were the first to establish measurements that evaluated patellar instability. Limited research has shown the efficacy of magnetic resonance imaging (MRI) in evaluating these established measurements. PURPOSE To identify morphological differences between normal knees and those with patellofemoral instability on MRI to determine what measurements are significant and how MRI-based means differ from historical means based on radiograph and CT imaging. STUDY DESIGN Case control study; Level of evidence, 3. METHODS Eighty-one controls and 40 patients with recurrent patellar instability between 2006 and 2010 were reviewed. The control patients had a history and an examination negative for patellofemoral symptoms. Patients with patellar instability had a history of at least 2 frank patellofemoral joint dislocations (PFJDs). The MRI images were obtained on the nonweightbearing knee in full extension. Measurements of patellar tilt, trochlear morphologic characteristics, and tibial tuberosity-trochlear groove (TTTG) distance were evaluated on axial slices, and patellar height was measured on sagittal images. Trochlear shape was assessed at the proximal and distal trochlea. RESULTS All measurements of patellar tilt (mean ± SD) were found to be significantly different between the 2 groups. For patellar height, the Insall-Salvati ratio (control, 1.08 ± 0.02; PFJD, 1.26 ± 0.03) and Caton-Deschamps ratio (control, 1.13 ± 0.02; PFJD, 1.29 ± 0.03) proved to be significantly different. Trochlear morphologic characteristics had numerous measurements prove to be significantly different proximally and distally. These included classic measurements such as sulcus angle (control, 148.48° ± 0.94°; PFJD, 165.57° ± 2.65°) and lateral trochlear inclination (control, 21.27° ± 0.66°; PFJD, 13.31° ± 1.36°) proximally and less established measurements such as the ratio of external (lateral) trochlea to internal (medial) trochlea (control, 1.51 ± 0.05; PFJD, 2.11 ± 0.17), a measurement of facet asymmetry. CONCLUSION The MRI-based patellar tilt measures proved to be an excellent group of measurements for delineating between controls and those with instability. Patella alta ratios, such as Insall-Salvati and Caton-Deschamps, demonstrated a statistically significant difference between normal and recurrent dislocators. Trochlear measurements proved significantly different at the proximal and distal trochlea. Our findings demonstrate that MRI is appropriate to help discern recognized pathologic abnormalities that characterize patellofemoral instability.
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Affiliation(s)
- Michael D Charles
- University of California, San Diego School of Medicine Medical Center, California, USA
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Akbar M, Farahmand F, Jafari A, Foumani MS. A detailed and validated three dimensional dynamic model of the patellofemoral joint. J Biomech Eng 2012; 134:041005. [PMID: 22667680 DOI: 10.1115/1.4006403] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
A detailed 3D anatomical model of the patellofemoral joint was developed to study the tracking, force, contact and stability characteristics of the joint. The quadriceps was considered to include six components represented by 15 force vectors. The patellar tendon was modeled using four bundles of viscoelastic tensile elements. Each of the lateral and medial retinaculum was modeled by a three-bundle nonlinear spring. The femur and patella were considered as rigid bodies with their articular cartilage layers represented by an isotropic viscoelastic material. The geometrical and tracking data needed for model simulation, as well as validation of its results, were obtained from an in vivo experiment, involving MR imaging of a normal knee while performing isometric leg press against a constant 140 N force. The model was formulated within the framework of a rigid body spring model and solved using forth-order Runge-Kutta, for knee flexion angles between zero and 50 degrees. Results indicated a good agreement between the model predictions for patellar tracking and the experimental results with RMS deviations of about 2 mm for translations (less than 0.7 mm for patellar mediolateral shift), and 4 degrees for rotations (less than 3 degrees for patellar tilt). The contact pattern predicted by the model was also consistent with the results of the experiment and the literature. The joint contact force increased linearly with progressive knee flexion from 80 N to 210 N. The medial retinaculum experienced a peak force of 18 N at full extension that decreased with knee flexion and disappeared entirely at 20 degrees flexion. Analysis of the patellar time response to the quadriceps contraction suggested that the muscle activation most affected the patellar shift and tilt. These results are consistent with the recent observations in the literature concerning the significance of retinaculum and quadriceps in the patellar stability.
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Affiliation(s)
- Mohammad Akbar
- School of Mechanical Engineering, Sharif University of Technology, Azadi Avenue, Tehran 11155, Iran
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Wilcox JJ, Snow BJ, Aoki SK, Hung M, Burks RT. Does landmark selection affect the reliability of tibial tubercle-trochlear groove measurements using MRI? Clin Orthop Relat Res 2012; 470:2253-60. [PMID: 22318667 PMCID: PMC3392393 DOI: 10.1007/s11999-012-2269-8] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Accepted: 01/19/2012] [Indexed: 01/31/2023]
Abstract
BACKGROUND A lateralized tibial tubercle is one potential cause of patellar instability. The tibial tubercle-trochlear groove (TT-TG) distance using CT is a reliable measure and considered the gold standard. Using MRI for this purpose has increased, although the reliability of doing so is not well studied. QUESTIONS/PURPOSES We sought to (1) determine variability in the insertion of the patellar tendon relative to the tibial tubercle and whether this affects the measurement on MRI of the traditional TT-TG distance versus the functional patellar tendon-trochlear groove (PT-TG) distance, (2) determine the reliability of measuring the osseous TT-TG distance, (3) determine the reliability of measuring the soft tissue PT-TG distance, and (4) compare the reliabilities of using osseous (TT-TG) versus soft tissue (PT-TG) landmarks. METHODS Four observers measured the TT-TG and the PT-TG distances of 50 MR images of knees obtained for any reason. Each observer repeated these measurements 30 days later. The interobserver and intraobserver reliabilities, measurements per observer that varied from the group mean by greater than 2 mm, and the limit of agreement were calculated. RESULTS The TT-TG and PT-TG differed by as little as 0.11 mm and by as much as 4.18 mm with an average difference of 1.37 mm. The interobserver and intraobserver reliabilities were greater than 90% for the PT-TG and TT-TG distances. The PT-TG distance was less variable in that this measurement showed interobserver and intraobserver reliabilities of 0.977 and 0.972 respectively, versus 0.913 and 0.961 for the TT-TG measurement. Additionally, the PT-TG measurements resulted in a lower average difference to the mean for each observer, less number of knees per observer where the difference to the mean was greater than 2 mm, and improved limit of agreement. CONCLUSIONS The TT-TG and the PT-TG distances were not identical and differed by as much as 4.18 mm; as such they are not interchangeable when measuring this distance. Both methods are reliable for measuring lateral offset of the extensor mechanism, but the use of soft tissue landmarks is less variable and thus would provide a more reliable measurement for surgical planning. LEVEL OF EVIDENCE Level III, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Jason J. Wilcox
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA USA
| | | | - Stephen K. Aoki
- Department of Orthopaedics, University of Utah, Salt Lake City, UT USA
| | - Man Hung
- Department of Orthopaedics, University of Utah, Salt Lake City, UT USA
| | - Robert T. Burks
- Department of Orthopaedics, University of Utah, Salt Lake City, UT USA
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The 3D analysis of the sagittal curvature of the femoral trochlea in the Chinese population. Knee Surg Sports Traumatol Arthrosc 2012; 20:957-63. [PMID: 21946942 DOI: 10.1007/s00167-011-1679-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Accepted: 09/12/2011] [Indexed: 01/25/2023]
Abstract
PURPOSE An unnatural design of the sagittal geometry of the femoral trochlea may cause abnormal patellofemoral kinematics and complications after knee arthroplasty. Most previous studies examined the sagittal curvature of the femoral trochlea on 2D parasagittal planes, which may not represent the true sagittal curvature of the complex 3D femoral trochlea. METHODS The current study evaluated the sagittal geometry of the femoral trochlea of 100 healthy Chinese subjects (50 women and 50 men) with 3D analysis. A close-fit sphere was generated on the surface of the medial and lateral trochlear articular surface, respectively. The radii of the spheres represented the sagittal radii of the femoral trochlear sagittal curvature. A cylinder was then established and its radius was adjusted to allow the deepest points of the curved trochlear groove touching the cylindrical surface. The radius of the cylinder represented the sagittal radius of the trochlear groove. RESULTS In the men, the average radii of the curvature of the femoral trochlea were 18.8 ± 2.5 mm and 25.5 ± 2.8 mm for the medial and lateral femoral trochleas, respectively. In the women, the average radii of the curvature of the femoral trochlea were 20.2 ± 3.0 mm and 26.6 ± 2.7 mm for the medial and lateral femoral trochleas, respectively. The average radius of the cylinder of the trochlea groove was 19.6 ± 2.0 mm with a circular arc of 123.2° ± 13.0° in the men. In the women, the radius was 20.2 ± 1.7 mm with a circular arc of 127.9° ± 11.7°. CONCLUSION The present study provided a reliable and consistent assessment of the sagittal geometry of the femoral trochlea in the Chinese population. The results of the current study may be helpful to improve the understanding of the knee kinematics and develop the physiological knee prostheses.
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Thaunat M, Bessiere C, Pujol N, Boisrenoult P, Beaufils P. Recession wedge trochleoplasty as an additional procedure in the surgical treatment of patellar instability with major trochlear dysplasia: early results. Orthop Traumatol Surg Res 2011; 97:833-45. [PMID: 22112463 DOI: 10.1016/j.otsr.2011.07.013] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Revised: 05/13/2011] [Accepted: 07/11/2011] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The importance of a dysplastic trochlea as a component of patellar instability has long been recognized. An original trochleoplasty technique consisting in retro-trochlear recession wedge osteotomy was described by Goutallier et al. The aim is not to fashion a groove but to reduce the bump without modifying patellofemoral congruence. PATIENTS AND METHODS This retrospective study reports the operative technique and short-term outcomes of a consecutive case series of 17 patients (19 knees) who underwent recession wedge trochleoplasty for patellofemoral instability associated with severe trochlear dysplasia. Other contributing factors of patellar instability were also corrected as part of the surgical procedure: tibial tuberosity transfer (n=18), MPFL reconstruction (n=8). RESULTS Minimum follow-up was 12 months (mean, 34 months; range, 12 to 71 months). The trochlear prominence was reduced from a mean 4.8mm (range, 0 to 8mm) to -0.8mm (range, -8 to 6mm). Patellar tilt was reduced from a mean 14° (range, 6° to 26°) to 6° (range, -1° to 24°). Two cases showed recurrent patellofemoral instability. Mean Kujala, KOOS and IKDC score were respectively 80 (± 17), 70 (± 18) and 67 (± 17) at last follow-up. Three patients required further operations, apart from removal of metal screws: arthroscopic arthrolysis for stiffness (n=1), revision for tibial tuberosity non-union (n=1), and supratrochlear exostosectomy (n=1). DISCUSSION Recession wedge trochleoplasty is a feasible additional procedure addressing bony trochlear abnormality in the surgical treatment of patellar instability. Our attitude is to perform it never in isolation but associated to realignment of the extensor apparatus according to the à la carte surgery concept. It seems to be effective in preventing future patellar dislocation and reducing anterior knee pain in case of painful patellofemoral instability with a major dysplastic trochlea, or in revision cases when other realignment procedures have failed.
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Affiliation(s)
- M Thaunat
- Orthopaedic Surgery Department, Versailles Hospital Center, André-Mignot Hospital, 177, rue de Versailles, 78157 Le Chesnay, France.
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Varadarajan KM, Freiberg AA, Gill TJ, Rubash HE, Li G. Relationship between three-dimensional geometry of the trochlear groove and in vivo patellar tracking during weight-bearing knee flexion. J Biomech Eng 2011; 132:061008. [PMID: 20887033 DOI: 10.1115/1.4001360] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
It is widely recognized that the tracking of patella is strongly influenced by the geometry of the trochlear groove. Nonetheless, quantitative baseline data regarding correlation between the three-dimensional geometry of the trochlear groove and patellar tracking under in vivo weight-bearing conditions are not available. A combined magnetic resonance and dual fluoroscopic imaging technique, coupled with multivariate regression analysis, was used to quantify the relationship between trochlear groove geometry (sulcus location, bisector angle, and coronal plane angle) and in vivo patellar tracking (shift, tilt, and rotation) during weight-bearing knee flexion. The results showed that in the transverse plane, patellar shift was strongly correlated (correlation coefficient R=0.86, p<0.001) to mediolateral location of the trochlear sulcus (raw regression coefficient β(raw)=0.62) and the trochlear bisector angle (β(raw)=0.31). Similarly, patellar tilt showed a significant association with the trochlear bisector angle (R=0.45, p<0.001, and β(raw)=0.60). However, in the coronal plane patellar rotation was poorly correlated with its matching geometric parameter, namely, the coronal plane angle of the trochlea (R=0.26, p=0.01, β(raw)=0.08). The geometry of the trochlear groove in the transverse plane of the femur had significant effect on the transverse plane motion of the patella (patellar shift and tilt) under in vivo weight-bearing conditions. However, patellar rotation in the coronal plane was weakly correlated with the trochlear geometry.
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Affiliation(s)
- Kartik M Varadarajan
- Bioengineering Laboratory, Orthopaedic Surgery, MGH/Harvard Medical School, Boston, MA 02114, USA
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Abstract
Trochlear dysplasia is characterized by abnormal trochlear morphology and a shallow groove. It is associated with recurrent patellar dislocation, but it is unclear whether the dysplasia is congenital, the result of lateral tracking and chronic instability, or caused by a combination of factors. Lateral radiographs elucidate the crossing sign and characteristic trochlear prominence. Recurrent patellofemoral instability is multifactorial, and each component must be considered in determining treatment. Managing other factors associated with recurrent instability may compensate for a deficient trochlea and provide stability. Medial patellofemoral ligament reconstruction is recommended for patellofemoral instability in the presence of trochlear dysplasia in patients without patella alta or increased tibial tubercle-trochlear groove distance. Trochleoplasty should be reserved for severe dysplasia in which patellofemoral stability cannot otherwise be obtained.
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Koff MF, Stanley DW, Weishaar PJ, Amrami KK, Kaufman KR. Short-term repeatability of joint space width measurements using a magnetic resonance imaging compatible knee positioning device. Proc Inst Mech Eng H 2010; 224:1061-71. [PMID: 21053771 DOI: 10.1243/09544119jeim735] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The purpose of this study was to evaluate a magnetic resonance imaging (MRI) compatible knee positioning device to aid in minimizing intratechnologist and intertechnologist differences of minimum joint space width (JSW) measurements. Five subjects were scanned by two separate technologists, with and without an MRI-compatible positioning device. A semi-automated program calculated the minimum JSW of the tibiofemoral and patellofemoral joints. The scan-to-scan repeatability was evaluated from measurements between serial scans without subject repositioning, and the intratechnologist and intertechnologist repeatabilities were evaluated when the subject was removed from the magnet and repositioned by an individual technologist. The root mean square (RMS) error of the JSW measurements was also calculated. All measures of scan-to-scan repeatability and intratechnologist repeatability were unchanged with the MRI-compatible positioning device. The intertechnologist repeatability decreased from 0.70 to 0.42 mm, and the RMS error was significantly reduced (P = 0.0006) from 0.26 to 0.15 mm for the tibiofemoral joint. The variability of patellofemoral JSW measurements increased when using the positioning device; however, the increases were not statistically significant. The intertechnologist repeatability increased from 1.55 to 1.79 mm, and the RMS error increased from 0.58 to 0.73 mm. The MRI-compatible positioning device was successful at reducing JSW measurement variability at the tibiofemoral joint. The increase in measurement variability at the patellofemoral joint may be due to local incongruities of the articular surfaces. An MRI-compatible positioning device may be beneficial for quantitative longitudinal studies evaluating knee joint health.
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Affiliation(s)
- M F Koff
- Department of Radiology and Imaging, Hospital for Special Surgery, USA
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