Skip to main content
SpringerLink
Log in

Anterior–posterior trochlear measurements of normal and dysplastic trochlea by axial magnetic resonance imaging

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Different surgical techniques have been described to correct trochlear dysplasia, without clear descriptions of the various types of trochlear dysplasia. In describing trochlear dysplasia, there exist no clear criteria to distinguish between decreased trochlear depth (heightened trochlea floor) and flattened lateral and/or medial condylar height. The current study aims to build a database of axial MRI measurements of normal and abnormal trochlear shape to create a foundation for the selection of the necessary surgical correction to more normal trochlear anatomy. We prospectively examined 152 subjects: 30 patients with patellar instability due to trochlea dysplasia and 122 subjects without any symptoms or objective findings related to the patellofemoral joint. MRI was performed in both groups. The height of the medial and lateral condyle, and the center of the trochlea was measured on axial MR images. The height of these different locations was compared to the total width of the femoral condyle and expressed in percentages. The statistical analysis was conducted with the Student’s t test at SPSS software. For intraobserver reliability 20 randomly taken MRI were evaluated twice. The intraobserver reliability was determined by calculating the kappa values investigated parameter. In normal subjects, the height of the lateral condyle was 81% of the width of the femoral condyle (100 units),the trochlear central height was 73%, the medial condylar height was 76%. In patients with patellar instability, the lateral condylar height was 82% and showed no significant difference compared to the normal group (P = 0.082). The trochlear central (77%) and medial condylar height (79%) were significantly different (P < 0.001) compared to the normal subjects. The location of pathology in patients with patellar instability was decreased lateral condylar height in five cases (16.6%) and decreased central/medial height in 25 cases (83.4%). A height of the lateral condyle <77% was documented to be pathologic. There was also a significant difference (P < 0.001) between males and females comparing the different heights of the trochlea to the total width of the femoral condyle. The resultant percentages of all three height measurements, the lateral, central, and medial heights, were greater in males than in females. The intraobserver reliability was perfect for all investigated parameters. In conclusion, (1) the presented measurement scheme on axial MRI is a reliable method to calculate the height of the trochlea in different locations, (2) a more objective assessment of the trochlear pathology is possible, (3) in five of six cases the pathology is located in the center and/or medial trochlea, and (4) in our series of patellofemoral instability patients, most would benefit from a deepening trochleaplasty as the surgical procedure of choice to correct dysplasia.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

Similar content being viewed by others

References

  1. Albee FH (1915) The bone graft wedge in the treatment of habitual dislocation of the patella. Med Rec 88:257–259

    Google Scholar 

  2. Arendt E (2005) Anatomy and malalignment of the patellofemoral joint: its relation to patellofemoral arthrosis. Clin Orthop Relat Res 436:71–75. doi:10.1097/01.blo.0000171543.60966.a6

    Article  PubMed  Google Scholar 

  3. Bereiter H, Gautier E (1994) Die Trochleaplastik als chirurgische Therapie der rezidivierenden Patellaluxation bei Trochleadysplasie des Femurs. Arthroskopie 7:281–286

    Google Scholar 

  4. Biedert RM (2004) Patellofemoral disorders: diagnosis and treatment. Wiley, New York

    Book  Google Scholar 

  5. Biedert RM, Bachmann M (2008) Trochlea dysplasia: too much or not enough? In: Proceedings of the International Patellofemoral Study Group meeting, Stellenbosch, South Africa

  6. Biedert RM (2008) Osteotomien. Orthopade 37:872–883. doi:10.1007/s00132-008-1294-5

    Article  PubMed  CAS  Google Scholar 

  7. Carrillon Y, Abidi H, Dejour D, Fantino O, Moyen B, Tran-Minh VA (2000) Patellar instability: assessment on MR images by measuring the lateral trochlear inclination—initial experience. Radiology 216:582–585

    PubMed  CAS  Google Scholar 

  8. Dejour H, Walch G, Neyret P, Adeleine P (1990) Dysplasia of the femoral trochlea. Rev Chir Orthop Repar Appar Mot 76:45–54

    CAS  Google Scholar 

  9. Dejour H, Walch G, Nove-Josserand L, Guier C (1994) Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc 2:19–26. doi:10.1007/BF01552649

    Article  PubMed  CAS  Google Scholar 

  10. Dejour H, Walch G, Nove-Josserand L, Guier C (1994) Factors of patellar instability: an anatomoradiographic analysis. In: Feagin JA Jr (ed) The crucial ligaments. Diagnosis and treatment of ligament injuries about the knee. Churchill Livingstone, New York, pp 361–367

    Google Scholar 

  11. Dejour D, Le Coultre B (2007) Osteotomies in patellofemoral instabilities. Sports Med Arthrosc Rev 15:39–46. doi:10.1097/JSA.0b013e31803035ae

    Article  Google Scholar 

  12. Donell ST, Joseph G, Hing CB, Marshall TJ (2006) Modified Dejour trochleoplasty for severe dysplasia: operative technique and early clinical results. Knee 13:266–273. doi:10.1016/j.knee.2006.01.004

    Article  PubMed  Google Scholar 

  13. Feinstein WK, Noble PC, Kamaric E, Tullos HS (1996) Anatomic alignment of the patellar groove. Clin Orthop Relat Res 331:64–73. doi:10.1097/00003086-199610000-00009

    Article  PubMed  Google Scholar 

  14. Keser S, Savranlar A, Bayar A, Ege A, Tuhan E (2008) Is there a relationship between anterior knee pain and femoral trochlear dysplasia? Assessment of lateral trochlear inclination by magnetic resonance imaging. Knee Surg Sports Traumatol Arthrosc 16:911–915. doi:10.1007/s00167-008-0571-5

    Article  PubMed  Google Scholar 

  15. Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174. doi:10.2307/2529310

    Article  PubMed  CAS  Google Scholar 

  16. Malaghem J, Maldague B (1989) Depth insufficiency of the proximal trochlear groove on lateral radiographs of the knee: relation to patellar dislocation. Radiology 170:507–510

    Google Scholar 

  17. Masse Y (1978) Trochleoplasty: restoration of the intercondylar groove in subluxations and dislocations of the patella. Rev Chir Orthop Repar Appar Mot 64:3–17

    CAS  Google Scholar 

  18. Servien E, Neyret P, Si Selmi TA, Biedert RM (2004) Radiographs. In: Biedert RM (ed) Patellofemoral disorders: diagnosis and treatment. Wiley, New York, pp 87–100

    Google Scholar 

  19. Siegel S, Castellan NJ Jr (1988) Nonparametric statistics for the behavioral sciences, 2nd edn. McGraw-Hill, New York

    Google Scholar 

  20. Tavernier T, Dejour D (2001) Knee imaging: what is the best modality. J Radiol 82(387–405):407–408

    Google Scholar 

  21. Verdonk R, Jansegers E, Stuyts B (2005) Trochleoplasty in dysplastic knee trochlea. Knee Surg Sports Traumatol Arthrosc 13:529–533. doi:10.1007/s00167-004-0570-0

    Article  PubMed  CAS  Google Scholar 

  22. Von Knoch E, Böhm T, Bürgi ML, Von Knoch M, Bereiter H (2006) Trochleaplasty for recurrent patellar dislocation in association with trochlear dysplasia. J Bone Joint Surg 88B:1331–1335

    Google Scholar 

Download references

Acknowledgments

Authors gratefully thank Eilzabeth A. Arendt, MD, Professor, University of Minnesota, Minneapolis for her help in manuscript preparation.

Author information

Authors and Affiliations

  1. Orthopedics and Sport Traumatology, Sportclinic Villa Linde, 2503, Biel, Switzerland

    Roland M. Biedert & Martin Bachmann

  2. Orthopaedic Surgery, Kantonsspital Liestal, 4410, Liestal, Switzerland

    Martin Bachmann

Authors
  1. Roland M. Biedert
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Martin Bachmann
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Roland M. Biedert.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Biedert, R.M., Bachmann, M. Anterior–posterior trochlear measurements of normal and dysplastic trochlea by axial magnetic resonance imaging. Knee Surg Sports Traumatol Arthrosc 17, 1225–1230 (2009). https://doi.org/10.1007/s00167-009-0824-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-009-0824-y

Keywords

Search

Navigation