scholarly journals TROCHLEAR MORPHOLOGY DEVELOPMENT: STUDY OF NORMAL PEDIATRIC KNEE MRIS

2020 ◽  
Vol 8 (4_suppl3) ◽  
pp. 2325967120S0016
Author(s):  
Myra Trivellas ◽  
Ben Kelley ◽  
Nicole West ◽  
Nicholas Jackson ◽  
Jennifer Beck
Keyword(s):  
Articular Cartilage ◽  
Subchondral Bone ◽  
Trochlear Dysplasia ◽  
Linear Increase ◽  
Left Knee ◽  
Trochlear Groove ◽  
Mean Values ◽  
Morphology Development ◽  
Pediatric Knee ◽  
Trochlear Height

Introduction: Trochlear dysplasia is a known risk factor for patellar dislocations yet normal trochlea development is not well described. This study will define the articular cartilage and subchondral trochlear morphology development in pediatric patients using MRI evaluation. Methods: Retrospective knee MRI review including patients aged 3-16 years with non-patellofemoral related diagnoses. ICD-9/ICD-10 codes identified eligible study patients. Measurements of the trochlea were made based on previously established methods using the axial MRI image just distal to the physis at the deepest portion of the trochlear groove. Three linear (Lateral Trochlear Height (LTH), Medial Trochlear Height (MTH), Central Trochlear Height (CTH)) and three angular (Sulcus Angle (SA), Lateral Trochlear Slope (LTS), Medial Trochlear Slope (MTS)) were made at the Articular Cartilage (AC) and Subchondral Bone (SCB) (Figure 1). Twelve measurements were made independently by two study authors. Interrater reliability was assessed. Trochlea measurements were summarized across age quartiles: 1st (age 5.1 - 8.3y), 2nd (8.3 - 11.5y), 3rd (11.5 - 14.3y), 4th (14.3 - 16.9y). Associations between age and trochlea measures were assessed using linear regression with Huber-White adjusted standard errors. Results: 246 knee MRIs from 230 patients were included in this study. 113 patients (51%) were female while 117 (49%) were male. 116 MRIs (47%) were of the Left knee and 130 (53%) were Right knee. Average patient age was 11.4±3.4 years. Interrater agreement was high (ICC values >0.7). Mean values for measurements are presented by age quartiles (Table 1). LTH, MTH, and CTH showed linear increase with age (range 2 to 2.6 mm per year, p<0.001). SA, LTS, MTS measured at the AC showed no change with age (p>0.05) however LTS and MTS measured at SCB showed significant increases with age (0.6 and 0.9 degrees per year, p<0.001) while SA showed a decrease with age (-1.4 degrees per year, p<0.001). There were no significant differences found in the age associations by laterality, left vs right. There were no gender differences in the age associations for SA, LTS, MTS (p>0.05) however for MTH, LTH, and CTH, males were found to have a significantly greater growth rate (p<0.001). Conclusions: This study found an increase in articular cartilage and subchondral bone MTH, LTH, and CTH over time as well as an increase in subchondral bone LTS, MTS, and SA. However, no significant change in articular cartilage LTS, MTS, or SA was found. This normative data indicates that articular cartilage angles determine final trochlear morphology. [Table: see text][Figure: see text]

Effect of Medialization of the Trochlear Groove and Lateralization of the Tibial Tubercle on TT-TG Distance: A Cross-sectional Study of Dysplastic and Nondysplastic Knees

2021 ◽  
pp. 036354652098781
Author(s):  
Mathias Paiva ◽  
Lars Blønd ◽  
Per Hölmich ◽  
Kristoffer Weisskirchner Barfod
Keyword(s):  
Trochlear Dysplasia ◽  
Cross Sectional Study ◽  
Magnetic Resonance Images ◽  
Tibial Tubercle ◽  
Control Group ◽  
Trochlear Groove ◽  
Sectional Study ◽  
Cross Sectional ◽  
Mean Values ◽  
The Mean

Background: Tibial tubercle–trochlear groove (TT-TG) distance is often used as a measure of lateralization of the TT and is important for surgical planning. Purpose: To investigate if increased TT-TG distance measured on axial magnetic resonance images is due to lateralization of the TT or medialization of the TG. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 84 knees (28 normal [NK], 28 with trochlear dysplasia [TD], and 28 with patellar dislocation without TD [PD]) were examined. The medial border of the posterior cruciate ligament (PCL) was chosen as the central anatomic landmark. The distance from the TT to PCL (TT-PCL) was measured to examine the lateralization of the TT. The distance from the TG to the PCL (TG-PCL) was measured to examine the medialization of the TG. Between-group differences were investigated by use of 1-way analysis of variance. Results: The mean values for TT-TG distance were 8.7 ± 3.6 mm for NK, 12.1 ± 6.0 mm for PD, and 16.7 ± 4.3 mm in the TD group ( P < .01). The mean values for TT-PCL distance were 18.5 ± 3.6 mm for NK, 18.5 ± 4.5 mm for PD, and 21.2 ± 4.2 mm in the TD group ( P = .03). The mean values for TG-PCL distance were 9.6 ± 3.0 mm for NK, 7.1 ± 3.4 mm for PD, and 5.1 ± 3.3 mm in the dysplastic group ( P < .01). Conclusion: The present results indicate that increased TT-TG distance is due to medialization of the TG and not lateralization of the TT. Knees with TD had increased TT-TG distance compared with the knees of the control group and the knees with PD. The TT-PCL distance did not differ significantly between groups, whereas the TG-PCL distance declined with increased TT-TG.

scholarly journals Rat perichondrium transplanted to articular cartilage defects forms articular-like, hyaline cartilage

2020 ◽  
Author(s):  
Zelong Dou ◽  
Daniel Muder ◽  
Marta Baroncelli ◽  
Ameya Bendre ◽  
Alexandra Gkourogianni ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Articular Cartilage ◽  
Subchondral Bone ◽  
Fluorescent Protein ◽  
Bone Marrow Cells ◽  
Hyaline Cartilage ◽  
Cartilage Defects ◽  
Trochlear Groove ◽  
Post Surgery ◽  
Articular Cartilage Defects

AbstractReconstruction of articular surfaces destroyed by infection or trauma is hampered by the lack of suitable graft tissues. Perichondrium autotransplants have been used for this purpose. However, the role of the transplanted perichondrium in the healing of resurfaced joints have not been investigated. Perichondrial and periosteal tissues were harvested from rats hemizygous for a ubiquitously expressed enhanced green fluorescent protein (EGFP) transgene and transplanted into full-thickness articular cartilage defects at the trochlear groove of distal femur in wild-type littermates. As an additional control, cartilage defects were left without a transplant (no transplant control). Distal femurs were collected 3, 14, 56, 112 days after surgery. Transplanted cells and their progenies were readily detected in the defects of perichondrium and periosteum transplanted animals but not in defects left without a transplant. Perichondrium transplants expressed SOX9 and with time differentiated into a hyaline cartilage that expanded and filled out the defects with Col2a1-positive chondrocytes and a matrix rich in proteoglycans. Interestingly, at later timepoints the cartilaginous perichondrium transplants were actively remodeled into bone at the transplant-bone interface and at post-surgery day 112 EGFP-positive perichondrium cells at the articular surface were positive for Prg4. In addition, both perichondrium and periosteum transplants contributed cells to the subchondral bone and bone marrow, suggesting differentiation into osteoblast/osteocytes as well as bone marrow cells. In summary, we found that perichondrium transplanted to articular cartilage defects develops into an articular-like, hyaline cartilage that integrates with the subchondral bone, and is maintained for an extended time. The findings indicate that perichondrium is a suitable tissue for repair and engineering of articular cartilage.

scholarly journals Femoral Trochleoplasty for Recurrent Patellar Dislocation: Treating the Underlying Trochlear Dysplasia

2018 ◽  
Vol 1 (1-3) ◽  
pp. 35-41
Author(s):  
Luís Fernando Jordao Santos ◽  
Pierre Ranger ◽  
Josée Delisle ◽  
Julio C. Fernandes
Keyword(s):  
Subchondral Bone ◽  
Surgical Procedure ◽  
Patellofemoral Joint ◽  
Medial Patellofemoral Ligament ◽  
Soft Tissues ◽  
Trochlear Dysplasia ◽  
Trochlear Groove ◽  
Joint Stability ◽  
Type C ◽  
Dejour Classification

The patellofemoral joint presents a complex biomechanical interaction involving soft tissues and bony structures to maintain joint stability. The most relevant factor is trochlear dysplasia which is present in 85% of patients. Femoral trochleoplasty is a surgical procedure to recreate the trochlear groove. This case report describes a young patient who had all clinical factors of patellar instability and trochlear dysplasia. Radiology studies showed trochlear dysplasia type C according to the Dejour classification. The patient underwent a trochleoplasty with an elevated flap of cartilage and subchondral bone as described by Ryzek and Schöttle [J Knee Surg 2015; 28(4): 297–302], associated with the reconstruction of the medial patellofemoral ligament. Femoral trochleoplasty is a surgical procedure to recreate the trochlear groove by removing subchondral bone to create a new trochlear sulcus, while respecting the kinematics and biomechanics of the patellofemoral joint.

Rectangular Recession Trochleoplasty for Treatment of Patellar Luxation in Dogs and Cats

2000 ◽  
Vol 13 (01) ◽  
pp. 39-43 ◽  
Author(s):  
R. L. Goring ◽  
J. J. de Haan ◽  
K. W. Talcott
Keyword(s):  
Articular Cartilage ◽  
Surgical Treatment ◽  
Subchondral Bone ◽  
Surgical Procedure ◽  
New Technique ◽  
Trochlear Groove ◽  
Osteochondral Autograft ◽  
Press Fit ◽  
A New Technique ◽  
Hyaline Articular Cartilage

SummaryTrochleoplasty is a fundamental component of surgical treatment for patients with inadequate trochlear depth associated with patellar luxation. Traditional methods of trochleoplasty include trochlear resection, chondroplasty and wedge recession trochleoplasty. Each technique has its benefits and limitations. Rectangular recession trochleoplasty (RRT) is a new technique that builds upon the strengths of its predecessors while minimizing their limitations. Rectangular recession utilizes a rectangular osteochondral autograft that is harvested from the trochlear groove and replaced into its recipient bed. Unlike wedge recession, the autograft surfaces are compressed and buttressed within the recipient bed. resulting in secure implantation of the autograft. Rectangular recession achieves maximal preservation of hyaline articular cartilage while minimizing exposure of abrasive subchondral bone. Rectangular recession can be performed on dogs and cats as small as 3 kg and has been clinically effective in treating over 100 cases of patellar luxation.Trochleoplasty is an important surgical procedure for treatment of patellar luxation in the dog and cat. The objective of any trochleoplasty technique is to achieve adequate trochlear depth and width while optimizing preservation of hyaline articular cartilage. Rectangular recession trochleoplasty (RRT) is a new technique that achieves adequate trochlear width and depth utilizing a securely “press-fit” osteochondral autograft that achieves maximal preservation of hyaline articular cartilage.

scholarly journals Sulcus-Deepening Trochleoplasty for Trochlear Dysplasia

2021 ◽  
Vol 1 (3) ◽  
pp. 263502542110111
Author(s):  
Anthony J. Ignozzi ◽  
Zane Hyde ◽  
Scott E. Dart ◽  
David R. Diduch
Keyword(s):  
Patient Satisfaction ◽  
Trochlear Dysplasia ◽  
Recurrent Dislocation ◽  
Trochlear Groove ◽  
Thick Shell ◽  
Absorbable Sutures ◽  
Postoperative Dislocation ◽  
A Prospective Study ◽  
Patellar Stability

Background: Patients who are refractory to initial management of trochlear dysplasia, which consists of bracing and physical therapy, may be candidates for trochleoplasty. Indications: Indications for trochleoplasty include Dejour classification type B or D trochlear dysplasia, supratrochlear spur height ≥7 mm, and a positive J sign on examination. Technique Description: The thick shell sulcus-deepening trochleoplasty technique involves removing the supratrochlear spur by creating a 5-mm–thick osteochondral shell with underlying cavity, dividing the thick shell into medial and lateral leaflets, and securing the leaflets with absorbable sutures. This establishes a new trochlear groove that is flush with the anterior cortex of the femur. Results: A review of 21 studies with length of follow-up from 8.8 months to 15 years found postoperative dislocation was present in 0% to 15% of patients and the patient satisfaction ranged from 81.0% to 94.4%. A prospective study with a minimum 2-year follow-up found no cases of recurrent dislocation, no progression of radiographic arthritis, 84.8% of patients returned to sport, and the patient satisfaction was a 9.1/10. Discussion/Conclusion: Sulcus-deepening trochleoplasty for trochlear dysplasia provides patellar stability and excellent patient satisfaction.

scholarly journals Genetic Deletion of Interleukin-15 Is Not Associated with Major Structural Changes Following Experimental Post-Traumatic Knee Osteoarthritis in Rats

2021 ◽  
Vol 11 (15) ◽  
pp. 7118
Author(s):  
Ermina Hadzic ◽  
Garth Blackler ◽  
Holly Dupuis ◽  
Stephen James Renaud ◽  
Christopher Thomas Appleton ◽  
...  
Keyword(s):  
Articular Cartilage ◽  
Subchondral Bone ◽  
Structural Changes ◽  
Cartilage Damage ◽  
Wild Type ◽  
Significant Difference ◽  
Post Traumatic ◽  
Interleukin 15 ◽  
Joint Trauma ◽  
Surgically Induced

Post-traumatic osteoarthritis (PTOA) is a degenerative joint disease, leading to articular cartilage breakdown, osteophyte formation, and synovitis, caused by an initial joint trauma. Pro-inflammatory cytokines increase catabolic activity and may perpetuate inflammation following joint trauma. Interleukin-15 (IL-15), a pro-inflammatory cytokine, is increased in OA patients, although its roles in PTOA pathophysiology are not well characterized. Here, we utilized Il15 deficient rats to examine the role of IL-15 in PTOA pathogenesis in an injury-induced model. OA was surgically induced in Il15 deficient Holtzman Sprague-Dawley rats and control wild-type rats to compare PTOA progression. Semi-quantitative scoring of the articular cartilage, subchondral bone, osteophyte size, and synovium was performed by two blinded observers. There was no significant difference between Il15 deficient rats and wild-type rats following PTOA-induction across articular cartilage damage, subchondral bone damage, and osteophyte scoring. Similarly, synovitis scoring across six parameters found no significant difference between genetic variants. Overall, IL-15 does not appear to play a key role in the development of structural changes in this surgically-induced rat model of PTOA.

scholarly journals Arthroscopic Articular Cartilage Scores of the Canine Stifle Joint with Naturally Occurring Cranial Cruciate Ligament Disease

2020 ◽  
Author(s):  
Kimberly A. Agnello ◽  
Kei Hayashi ◽  
Dorothy Cimino Brown
Keyword(s):  
Articular Cartilage ◽  
Cruciate Ligament ◽  
Cartilage Damage ◽  
Meniscal Tear ◽  
Trochlear Groove ◽  
Cranial Cruciate Ligament ◽  
Stifle Joint ◽  
Naturally Occurring ◽  
Medial Meniscal Tear ◽  
Severity Scores

Abstract Objective This study aimed to evaluate frequency, location and severity of cartilage pathology in dogs with naturally occurring cranial cruciate ligament (CCL) disease. Study Design Stifle arthroscopic video recordings (n = 120) were reviewed. A modified Outerbridge classification system (MOCS) (0–4) was used to score cartilage at 10 locations in the femorotibial (medial and lateral femoral condyles and tibial plateaus) and patellofemoral compartments (proximal, middle and distal locations of the patella and femoral trochlear groove) of the stifle joint. Synovial pathology was scored and the presence of a medial meniscal tear was recorded. A Kruskal–Wallis test was used to evaluate association of location and synovitis with cartilage score; and presence of meniscal tear with cartilage and synovitis scores. Bonferroni correction was utilized and p < 0.05 was considered significant. Results Cartilage pathology and synovitis were identified in all joints. Overall cartilage severity scores were low (median MOCS 1). The median MOCS of the proximal trochlear groove (2) was significantly higher than all other locations evaluated. Higher synovitis scores were significantly associated with higher cartilage severity scores and a medial meniscal tear had no association with cartilage severity scores or synovitis. Conclusion Arthroscopic articular cartilage lesions are common in dogs with CCL disease at the time of surgical intervention, although the severity of cartilage damage is mild. The proximal trochlear groove of the femur had the most severe cartilage score in the stifle joint.

scholarly journals Early patellofemoral articular cartilage degeneration in a rat model of patellar instability is associated with activation of the NF-κB signaling pathway

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Wei Lin ◽  
Huijun Kang ◽  
Yike Dai ◽  
Yingzhen Niu ◽  
Guangmin Yang ◽  
...  
Keyword(s):  
Articular Cartilage ◽  
Signaling Pathway ◽  
Subchondral Bone ◽  
Patellofemoral Joint ◽  
Patellar Instability ◽  
Cartilage Degeneration ◽  
Control Group ◽  
And Control ◽  
Articular Cartilage Degeneration ◽  
And Cartilage

Abstract Background Patellar instability (PI) often increases the possibility of lateral patellar dislocation and early osteoarthritis. The molecular mechanism of early articular cartilage degeneration during patellofemoral osteoarthritis (PFOA) still requires further investigation. However, it is known that the NF-κB signaling pathway plays an important role in articular cartilage degeneration. The aim of this study was to investigate the relationship between the NF-κB signaling pathway and patellofemoral joint cartilage degeneration. Methods We established a rat model of PI-induced PFOA. Female 4-week-old Sprague-Dawley rats (n = 120) were randomly divided into two groups: the PI (n = 60) and control group (n = 60). The distal femurs of the PI and control group were isolated and compared 4, 8, and 12 weeks after surgery. The morphological structure of the trochlear cartilage and subchondral bone were evaluated by micro-computed tomography and histology. The expression of NF-κB, matrix metalloproteinase (MMP)-13, collagen X, and TNF-ɑ were evaluated by immunohistochemistry and quantitative polymerase chain reaction. Results In the PI group, subchondral bone loss and cartilage degeneration were found 4 weeks after surgery. Compared with the control group, the protein and mRNA expression of NF-κB and TNF-ɑ were significantly increased 4, 8, and 12 weeks after surgery in the PI group. In addition, the markers of cartilage degeneration MMP-13 and collagen X were more highly expressed in the PI group compared with the control group at different time points after surgery. Conclusions This study has demonstrated that early patellofemoral joint cartilage degeneration can be caused by PI in growing rats, accompanied by significant subchondral bone loss and cartilage degeneration. In addition, the degeneration of articular cartilage may be associated with the activation of the NF-κB signaling pathway and can deteriorate with time as a result of PI.

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