Objective quantification of trochlear dysplasia: Assessment of the difference in morphology between control and chronic patellofemoral instability patients

The Knee ◽  
2017 ◽  
Vol 24 (5) ◽  
pp. 1247-1255 ◽  
Author(s):  
Andreas Voss ◽  
Sangmin Ryan Shin ◽  
Akira M. Murakami ◽  
Mark P. Cote ◽  
Andrea Achtnich ◽  
...  
Keyword(s):  
Trochlear Dysplasia ◽  
Patellofemoral Instability ◽  
The Difference ◽  
Objective Quantification

The Difference between Cartilaginous and Bony Sulcus Angles for Patients with or without Patellofemoral Instability: A Systematic Review and Meta-Analysis

2019 ◽  
Vol 33 (03) ◽  
pp. 235-241
Author(s):  
Si Heng Sharon Tan ◽  
Kiat Soon Jason Chng ◽  
Beatrice Ying Lim ◽  
Keng Lin Wong ◽  
Chintan Doshi ◽  
...  
Keyword(s):  
Trochlear Dysplasia ◽  
Meta Analysis ◽  
Patellofemoral Instability ◽  
Control Group ◽  
Sulcus Angle ◽  
Trochlea Dysplasia ◽  
The Mean ◽  
The Difference ◽  
Meta Analyses ◽  
Ct And Mri

AbstractThe cartilaginous sulcus angle and bony sulcus angle have been widely used to evaluate trochlea dysplasia. The current review aims to evaluate (1) whether there is a difference in measurement for cartilaginous and bony sulcus angles, (2) whether both the cartilaginous and bony sulcus angles could be used to differentiate between patients with or without trochlear dysplasia, and (3) whether the same cut-off of 145 degrees, originally used for radiographs, can be applied for the cartilaginous and bony sulcus angles measured on CT and MRI. The review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRSIMA) guidelines. A total of 11 publications with 1204 patients were included. All publications reported the sulcus angle to be greater in patients with patellofemoral instability. All publications reported the cartilaginous sulcus angle to be greater than the bony sulcus angle (MD 7.27 degrees; 95% CI: 5.67 – 8.87). The mean cartilaginous sulcus angle for the control group was 141.83 degrees (95% CI: 139.90 – 143.76) while the mean cartilaginous sulcus angle for patients with patellofemoral instability was 156.24 degrees (95% CI: 153.71 – 158.77). The mean bony sulcus angle for the control group was noted to be 133.69 degrees (95% CI: 131.23 – 136.15) while the mean bony sulcus angle for patients with patellofemoral instability was 148.42 (95% CI: 144.02 – 152.82). Both the cartilaginous and bony sulcus angles measured on CT and MRI could therefore be used to differentiate between patients with and without trochlear dysplasia. However, the cartilaginous sulcus angles are significantly higher than that of bony sulcus angles. Different cut off values should therefore be used.

scholarly journals Objective Quantification of Trochlea Dysplasia: Assessment of Morphology Difference Between Control and Chronic Patellofemoral Instability Patients

2017 ◽  
Vol 5 (4_suppl4) ◽  
pp. 2325967117S0013
Author(s):  
Andreas Voss ◽  
Andrea Achtnich ◽  
Shin Sanghin ◽  
Akin M. Murakami ◽  
Cory Edgar
Keyword(s):  
Trochlear Dysplasia ◽  
Patellofemoral Instability ◽  
Volumetric Analysis ◽  
Patella Instability ◽  
Control Cohort ◽  
X Ray ◽  
Significant Difference ◽  
Trochlea Dysplasia ◽  
The Difference ◽  
Gender Based

Aims and Objectives: Trochlear dysplasia is an important risk factor associated with patellofemoral instability, but it remains difficult to classify with consistency. Currently there is no objective way to quantify the dysplasia. The purpose of this study to define and quantify objectively the trochlea morphology by volume and length via computed tomography (CT). Hypothesis: A significant difference in trochlea groove volume and length is present within a cohort of patients with recurrent patellofemoral instability if compared to a control cohort of similar patients. Materials and Methods: One-hundred control patients (136 knees) were retrospectively reviewed and compared to 36 consecutive patients (72 knees) who were treated surgically for recurrent patella instability and known trochlea dysplasia based on a lateral x-ray. Trochlea morphology was analyzed from a pre-operative CT and data presented as trochlear sulcus volume trochlea length. To determine where along the trochlea length dysplasia is most variable, the trochlea length was radiographically divided into thirds, volume was quantified along that section and compared to control trochlea. Results: A significant difference in trochlea morphology exists between cohorts, volume (1.98 vs 3.77 cm3) and length (31.97 vs 34.66 mm). However, there appears to be a gender based difference in trochlea morphology. The trochlea volumetric analysis between the female cohorts (L: 2.02 cm3 vs. 2.94 cm3, R: 1.95 cm3 vs. 2.93 cm3) demonstrated significant less volume in instability patients (p<0.001). The proximal 30% of trochlea contributed the majority of dysplasia difference determined by comparing mean trochlea volume, 95% of the difference. This difference decreased in distal sections, 53% and 32% respectively. The total trochlea length did not appear to be significant (L: p=0.858, R: p=0.913). It appears dysplasia alone may not directly lead to symptoms demonstrated by trochlea volumetric comparisons within symptomatic recurrent patella instability and contralateral asymptomatic patella (p=0.274). Conclusion: The authors believe this reproducible technique can be used to quantify the trochlea morphology into measurements to be used describing the severity of the dysplasia. The data confirms that symptomatic trochlea dysplasia is a “proximal” process affecting early knee flexion contact between patella and trochlea.

Effect of Isolated Medial Patellofemoral Ligament Reconstruction in Patellofemoral Instability Regardless of Predisposing Factors

2020 ◽  
Author(s):  
Jae Ik Lee ◽  
Mohd Shahrul Azuan Jaffar ◽  
Han Gyeol Choi ◽  
Tae Woo Kim ◽  
Yong Seuk Lee
Keyword(s):  
Medial Patellofemoral Ligament ◽  
Trochlear Dysplasia ◽  
Case Series ◽  
Patellofemoral Instability ◽  
International Knee Documentation Committee ◽  
Predisposing Factors ◽  
Mpfl Reconstruction ◽  
Patellar Tilt ◽  
Case Series Study

AbstractThe purpose of this study was to evaluate the outcomes of isolated medial patellofemoral ligament (MPFL) reconstruction, regardless of the presence of predisposing factors. A total of 21 knees that underwent isolated MPFL reconstruction from March 2014 to August 2017 were included in this retrospective series. Radiographs of the series of the knee at flexion angles of 20, 40, and 60 degrees were acquired. The patellar position was evaluated using the patellar tilt angle, sulcus angle, congruence angle (CA), and Caton-Deschamps and Blackburne-Peel ratios. To evaluate the clinical outcome, the preoperative and postoperative International Knee Documentation Committee (IKDC) and Lysholm knee scoring scales were analyzed. To evaluate the postoperative outcomes based on the predisposing factors, the results were separately analyzed for each group. Regarding radiologic outcomes, 20-degree CA was significantly reduced from 10.37 ± 5.96° preoperatively to −0.94 ± 4.11° postoperatively (p = 0.001). In addition, regardless of the predisposing factors, delta values of pre- and postoperation of 20-degree CA were not significantly different in both groups. The IKDC score improved from 53.71 (range: 18–74) preoperatively to 94.71 (range: 86–100) at the last follow-up (p = 0.004), and the Lysholm score improved from 54.28 (range: 10–81) preoperatively to 94.14 (range: 86–100) at the last follow-up (p = 0.010). Isolated MPFL reconstruction provides a safe and effective treatment for patellofemoral instability, even in the presence of mild predisposing factors, such as trochlear dysplasia, increased patella height, increased TT–TG distance, or valgus alignment. This is a Level 4, case series study.

scholarly journals Failure Analysis in Patients With Patellar Redislocation After Primary Isolated Medial Patellofemoral Ligament Reconstruction

2020 ◽  
Vol 8 (6) ◽  
pp. 232596712092617 ◽  
Author(s):  
Matthias J. Feucht ◽  
Julian Mehl ◽  
Philipp Forkel ◽  
Andrea Achtnich ◽  
Andreas Schmitt ◽  
...  
Keyword(s):  
Revision Surgery ◽  
Medial Patellofemoral Ligament ◽  
Femoral Tunnel ◽  
Trochlear Dysplasia ◽  
Patellofemoral Instability ◽  
Tibial Tuberosity ◽  
Mpfl Reconstruction ◽  
Tunnel Position ◽  
Femoral Tunnel Position ◽  
Valgus Malalignment

Background: Reconstruction of the medial patellofemoral ligament (MPFL) has become a popular surgical procedure to address patellofemoral instability. As a consequence of the growing number of MPFL reconstructions performed, a higher rate of failures and revision procedures has been seen. Purpose: To perform a failure analysis in patients with patellar redislocation after primary isolated MPFL reconstruction. Study Design: Case series; Level of evidence, 4. Methods: Patients undergoing revision surgery for reinstability after primary isolated MPFL reconstruction were included. Clinical notes were reviewed to collect demographic data, information on the primary surgery, and the mechanism of patellar redislocation (traumatic vs nontraumatic). Preoperative imaging was analyzed regarding femoral tunnel position and the prevalence of anatomic risk factors (ARFs) associated with patellofemoral instability: trochlear dysplasia (types B through D), patella alta (Caton-Deschamps index >1.2, patellotrochlear index <0.28), lateralization of the tibial tuberosity (tibial tuberosity–trochlear groove distance >20 mm, tibial tuberosity–posterior cruciate ligament [TT-PCL] distance >24 mm), valgus malalignment (mechanical valgus axis >5°), and torsional deformity (internal femoral torsion >25°, external tibial torsion >35°). The prevalence of ARF was compared between patients with traumatic and nontraumatic redislocations and between patients with anatomic and nonanatomic femoral tunnel position. Results: A total of 26 patients (69% female) with a mean age of 25 ± 7 years were included. The cause of redislocation was traumatic in 31% and nontraumatic in 69%. Position of the femoral tunnel was considered nonanatomic in 50% of patients. Trochlear dysplasia was the most common ARF with a prevalence of 50%, followed by elevated TT-PCL distance (36%) and valgus malalignment (35%). The median number of ARFs per patient was 3 (range, 0-6), and 65% of patients had 2 or more ARFs. Patients with nontraumatic redislocations showed significantly more ARFs per patient, and the presence of 2 or more ARFs was significantly more common in this group. No significant difference was observed between patients with anatomic versus nonanatomic femoral tunnel position. Conclusion: Multiple anatomic risk factors and femoral tunnel malposition are commonly observed in patients with reinstability after primary MPFL reconstruction. Before revision surgery, a focused clinical examination and adequate imaging including radiographs, magnetic resonance imaging (MRI), standing full-leg radiographs, and torsional measurement with computed tomography or MRI are recommended to assess all relevant anatomic parameters to understand an individual patient’s risk profile. During revision surgery, care must be taken to ensure anatomic placement of the femoral tunnel through use of anatomic and/or radiographic landmarks.

Isolated Medial Patellofemoral Ligament Reconstruction Can Be an Effective Procedure in Patellofemoral Instability with Risk Factors

2019 ◽  
Vol 33 (10) ◽  
pp. 992-997 ◽  
Author(s):  
Fabian Blanke ◽  
Kathrin Watermann ◽  
Maximilian Haenle ◽  
Andreas Feitenhansl ◽  
Carlo Camathias ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Outcome ◽  
Medial Patellofemoral Ligament ◽  
Trochlear Dysplasia ◽  
Patellofemoral Instability ◽  
Effective Procedure ◽  
Mpfl Reconstruction ◽  
Trochlear Groove ◽  
Severe Problem ◽  
Outcome Scores

AbstractPatellofemoral instability is a severe problem in young and active patients. This pathology is influenced by ligamentous, bony, and neuromuscular parameters. The reconstruction of the medial patellofemoral ligament (MPFL) evolved to a primary procedure, but combined procedures were more frequently performed in the past years. However, additional operative procedures are associated with increased morbidity and no absolute indication can be identified in the literature. This study is intended to clarify whether addressing only ligamentous influence factors (MPFL) in chronic patellofemoral instability is sufficient to produce good clinical outcomes, or whether other risk factors influence the results negatively and should also be treated at some point. In 52 patients with chronic patellofemoral instability patellar height according to Caton-Deschamps, trochlear dysplasia according to Dejour, the leg axis, the femoral antetorsion, tibial tubercle (TT)–trochlear groove, and TT–posterior cruciate ligament distance were evaluated. All patients were treated with isolated MPFL reconstruction. After a minimum follow-up period of 24 months (24–36 months), the clinical outcome results were calculated using the scoring system according to Lysholm and Tegner. Correlation between clinical outcome scores and anatomic risk factors were calculated. The analysis was performed using a standard statistical software package (JMP version 12, SAS Institute, Cary, NC). The average postoperative Lysholm score increased significantly from 57.23 ± 19.9 to 85.9 ± 17.2 points (p < 0.0001) after isolated MPFL reconstruction. Moreover, the Tegner and Lysholm scores significantly improved both in patients without and with different risk factors postoperative. There were no significant differences in the outcome sores between the groups. Even the degree of trochlear dysplasia (types I–III) did not influence the results. Finally, there was no significant correlation found between all collected risk factors and the postoperative outcome scores. Isolated MPFL reconstruction can be an effective procedure in patients with patellofemoral instability and mild to moderate risk factors.

scholarly journals Clinical Outcomes after Isolated Medial Patellofemoral Ligament Reconstruction for Patellar Instability

2017 ◽  
Vol 5 (3_suppl3) ◽  
pp. 2325967117S0012
Author(s):  
Joseph N. Liu ◽  
Jacqueline Munch ◽  
Claire Berdelle Ryan ◽  
Irene L. Kalbian ◽  
Sabrina M. Strickland ◽  
...  
Keyword(s):  
Ligament Reconstruction ◽  
Medial Patellofemoral Ligament ◽  
Trochlear Dysplasia ◽  
Patellofemoral Instability ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Return To Sports ◽  
Medial Patellofemoral Ligament Reconstruction ◽  
Patient Reported

Objectives: Medial patellofemoral ligament (MPFL) reconstruction has become an increasingly popular means to regain stability in the setting of recurrent lateral patellar dislocation, with nearly twice the number of medical centers performing reconstruction of the MPFL and outcomes reported on nearly double the number of patients in recent years. While recent studies have demonstrated improved patient reported outcome measures and a high rate of return to sports, limited literature has explored its effectiveness as an isolated intervention in the context of trochlear dysplasia. The purpose of this study was to determine the efficacy of isolated MPFL reconstruction in treating patellar instability in the setting of trochlear dysplasia. Methods: This was a retrospective review of consecutive patients who underwent unilateral or bilateral medial patellofemoral ligament reconstruction for patellofemoral instability. No osteotomies were included. All patients with minimum 2 year follow up were included. Pre- and postoperative assessment included ligamentous laxity, patellar crepitus, tilt, translation, and apprehension, and radiographic features including tibial tubercle-trochlear groove (TT-TG) ratio, Dejour classification, and Caton Deschamps ratio. Final follow up consisted of patient reported outcome measures including the Kujala score, International Knee Documentation Committee (IKDC) score, Lysholm score, and visual analog scale (VAS). Results: 105 MPFL reconstructions were included. Average age at surgery was 23.8 years (SD 9.7, range 12.1 - 57.0) with an average BMI of 23.4 (SD 4.7, range 16.3-43.6) and an average of 4.4 (SD 6.8) dislocation events prior to surgery. Average follow up was 44 months (range 24-111). 76% of patients were female. Average preoperative TT-TG ratio was 13.5 (SD 3.9, range 3.2-22) and Caton Deschamps ratio was 1.2 (SD 0.2, range 0.9-1.6); 74.5% of patients had Dejour C or D trochlear grooves. Kujala score improved from 54.5 (SD 3.8) preoperatively to 87.2 (SD 2.1) at 2 year follow up (p < 0.0001), Lysholm improved from 57.7 (SD 3.6) to 86.4 (SD 2.0) (p < 0.0001), IKDC improved from 52.1 (SD 3.8) to 79.5 (SD 2.6) (p < 0.0001), and VAS pain score improved from 2.9 (SD 0.3) to 1.7 (SD 0.3) (p<0.017). 78.9% of patients were able to return to sports at 1 year, with 69% returning to the same or higher level of play. At minimum 2-year follow up, only 5 patients reported either a postoperative dislocation or subluxation event. Conclusion: This study is the largest single series to report on the effectiveness of isolated MPFL reconstructions in a cohort of patients with a high incidence of trochlear dysplasia. In patients with normal TT-TG ratios, isolated medial patellofemoral ligament reconstruction provides safe and effective treatment for patellofemoral instability, despite the presence of Dejour class C or D trochlear grooves. Most patients are able to return to sports by 1 year postoperatively at the same or higher level of play.

scholarly journals Morphological Classification of Trochlear Dysplasia Based On Three-Dimensional Models

2021 ◽  
Author(s):  
Jiangfeng Lu ◽  
Yanru Wang ◽  
Gang Ji ◽  
Fei Wang
Keyword(s):  
Trochlear Dysplasia ◽  
Three Dimensional ◽  
Patellofemoral Instability ◽  
Conventional Radiography ◽  
3D Models ◽  
Lateral View ◽  
Lateral Condyle ◽  
Level Of Evidence ◽  
Three Dimensional Models ◽  
Crossing Point

Abstract Background: Trochlear dysplasia (TD) is a common risk factor for the development of patellofemoral instability (PI). Dejour’s classification shows low agreement between conventional radiography and axial magnetic resonance imaging. The present study aimed to evaluate and categorize the true lateral view of three-dimensional (3D) femoral models in patients with TD. Methods: Computed tomography (CT) scans of 96 hip-knee-ankle joints (49 PI patients: 34 female, 15 male; mean age 19.1±6.7 years, range 12–41 years) during 2017–2019 were collected and analyzed. A senior orthopedic surgeon classified the true lateral views of femoral 3D models and raw CT images. The crossing-point site and lateral condyle/facet morphology (lateral condyle bump or supratrochlear spur) were the main criteria. Results: TD cases were classified into four types and their frequencies recorded: type 1 (7.3%) = crossing-point site in the proximal trochlear area and no lateral condyle bump or supratrochlear spur; type 2 (19.8%) = crossing-point site in the proximal trochlear area and presence of a lateral condyle bump or supratrochlear spur; type 3 (13.5%) = crossing-point site in the distal trochlear area and no lateral condyle bump or supratrochlear spur; type 4 (59.4%) = crossing-point site in the distal trochlear area and presence of lateral condyle bump or supratrochlear spur.Conclusion: The presentation of TD varies greatly among PI patients and can be categorized into four types. This new classification, based on true lateral views of 3D femoral models, may provide relatively reliable guidance when using trochleoplasty to treat TD. Level of Evidence: II, development of diagnostic or monitoring criteria in consecutive patients.

Age at Time of Surgery but Not Sex Is Related to Outcomes After Medial Patellofemoral Ligament Reconstruction

2019 ◽  
Vol 47 (7) ◽  
pp. 1638-1644 ◽  
Author(s):  
Laurie A. Hiemstra ◽  
Sarah Kerslake
Keyword(s):  
Quality Of Life ◽  
Medial Patellofemoral Ligament ◽  
Trochlear Dysplasia ◽  
Patellofemoral Instability ◽  
Mpfl Reconstruction ◽  
Linear Regression Models ◽  
Level Of Evidence ◽  
Time Of Surgery ◽  
Patient Reported

Background: Medial patellofemoral ligament (MPFL) reconstruction has become a well-accepted procedure for recurrent patellofemoral instability. Despite a growing volume of research assessing surgical results, the relationship of age and sex to outcomes after MPFL reconstruction surgery is unclear. Purpose: To investigate whether age at the time of surgery or sex influenced patient-reported quality of life and clinical outcome after MPFL reconstruction for recurrent lateral patellofemoral instability. Study Design: Cohort study; Level of evidence, 3. Methods: Between January 2010 and May 2016, 328 patients underwent primary patellofemoral stabilization. Demographic and clinical data were collected preoperatively. Patients completed the Banff Patellofemoral Instability Instrument (BPII) at the pre- and postoperative visits and were assessed clinically at 12 and 24 months. To assess the effects of age at surgery and sex on BPII, multiple linear regression models were fit predicting BPII at 12 and 24 months. An unadjusted regression was applied with the predictors being age at the time of surgery and sex. A second regression model was applied adjusting for age at first dislocation, grade of trochlear dysplasia, knee hyperextension, and the WARPS/STAID score—a measure of the risky patellofemoral instability characteristics of the patient. Results: Of 328 patients, 298 (91%) had complete data and minimum 12-month BPII scores available for analysis. There were 11 redislocations in the cohort (3.4%), all in female patients. When stratified by sex, baseline characteristics were not statistically different except for higher age at first dislocation ( P = .022) as well as higher WARPS/STAID scores ( P = .006) for males. Age at the time of surgery was statistically significant for each postoperative follow-up, with lower BPII scores apparent for each 10-year increase in age at the time of surgery. In the adjusted model, the WARPS/STAID score was significantly associated with the preoperative BPII score. For the 24-month postoperative BPII scores, age at time of surgery and preoperative WARPS/STAID score were both significant. Lower BPII scores were apparent for each 10-year increase in age at the time of surgery, as well as for lower scores on the WARPS/STAID classification. Conclusion: This study demonstrated that when adjusted for risky pathoanatomy, neither age at first dislocation nor sex influences patient-reported quality of life outcomes after MPFL reconstruction. Age at the time of surgery was correlated with outcome, with lower BPII scores apparent for each 10-year increase in age at the time of MPFL reconstruction.

Quality-of-Life Outcomes of Patients following Patellofemoral Stabilization Surgery: The Influence of Trochlear Dysplasia

2017 ◽  
Vol 30 (09) ◽  
pp. 887-893 ◽  
Author(s):  
Laurie Hiemstra ◽  
Mark Lafave ◽  
Sarah Kerslake
Keyword(s):  
Quality Of Life ◽  
Trochlear Dysplasia ◽  
Patellofemoral Instability ◽  
Physical Symptoms ◽  
Low Grade ◽  
High Grade ◽  
Life Outcomes ◽  
Physical Complaints ◽  
Patient Reported

AbstractTrochlear dysplasia is a well-described risk factor for recurrent patellofemoral instability. Despite its clear association with the incidence of patellofemoral instability, it is unclear whether the presence of high-grade trochlear dysplasia influences clinical outcome after patellofemoral stabilization. The purpose of this study was to assess whether trochlear dysplasia influenced patient-reported, disease-specific outcomes in surgically treated patellar instability patients, when risk factors were addressed in accordance with the à la carte surgical approach to the treatment of patellofemoral instability. The study design is of a case series. A total of 318 patellar stabilization procedures were performed during the study period. Of these procedures, 260 had adequate lateral radiographs and complete Banff Patellar Instability Instrument (BPII) scores available for assessment. A Pearson r correlation was calculated between four characteristics of trochlear dysplasia, the BPII total and the BPII symptoms, and physical complaints scores, a mean of 24 months following patellofemoral stabilization. Independent t-tests were performed between stratified trochlear dysplasia groups (no/low grade and high grade) and all BPII measures. There was a statistically significant correlation between measures of trochlear dysplasia and quality-of-life physical symptoms scores, an average of 2 years following patellofemoral stabilization surgery. The BPII symptoms and physical complaints domain score, as well as the individual weakness and stiffness questions, correlated with the classification of trochlear dysplasia as well as the presence of a trochlear bump (p < 0.05). Independent t-tests demonstrated statistically significant differences between the no/low-grade and high-grade dysplasia groups for the BPII stiffness (p = 0.002), BPII weakness (p = 0.05) and BPII symptom, and physical complaints values (p = 0.04). Two additional measures—the 24-month postoperative total BPII score (p = 0.11) and BPII pain score (p = 0.07)—demonstrated trends toward statistical significance. This research has established a statistically significant correlation between trochlear dysplasia and disease-specific quality-of-life outcomes following patellofemoral stabilization surgery. There was a significant correlation between patient-reported physical symptoms after surgery and high-grade trochlear dysplasia.

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