A landmark-based 3D analysis reveals a narrower tibial plateau and patella in trochlear dysplastic knees

Abstract

Purpose

The trochlear dysplastic femur has a specific morphotype previously characterised by not only dysplastic features of the trochlea but also by specific features of the notch and posterior femur. In this study the morphology of the tibia and patella was investigated to gain further insight in the complete geometrical complexity of the trochlear dysplastic knee.

Methods

Arthro-CT scan-based 3D models of 20 trochlear dysplastic and 20 normal knees were uniformly scaled and landmarks and landmark-based reference planes were created to quantify a series of morphometric characteristics of the tibia and patella.

Results

In the mediolateral direction, the 3D-analysis revealed a 3% smaller medial tibial plateau (30.4 ± 1.6 mm vs 31.5 ± 1.6 mm), a 3% smaller overall width of the tibial plateau (73.6 ± 2.0 mm vs 75.7 ± 2.0 mm), a 16% smaller medial facet (17.3 ± 2.2 mm vs 20.1 ± 1.3 mm) and a 4% smaller overall width of the patella (41.7 ± 2.5 mm vs 43.4 ± 2.3 mm) in trochlear dysplastic knees. In the anteroposterior direction, the lateral tibial plateau of trochlear dysplastic knees was 5% larger (37.2 ± 2.3 mm vs 35.5 ± 3.1 mm). A correlation test between the width of the femur and the width of the tibia revealed that trochlear dysplastic knees show less correspondence between the femur and tibia compared to normal knees.

Conclusion

Significant differences in the morphology of the tibial plateau and patella were detected between trochlear dysplastic and normal knees. Both in the trochlear dysplastic tibial plateau and patella a narrower medial compartment leads to a significant smaller overall mediolateral width. These findings are important for the understanding of knee biomechanics and the design of total knee arthroplasty components.

Level of evidence

III.

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Abbreviations

AP:

Anteroposterior

ML:

Mediolateral

PA:

Patella anterior point

PD:

Proximodistal

PI:

Patella inferior point

PL:

Patella lateral point

PM:

Patella medial point

POI:

Patella odd point inferior

POS:

Patella odd point superior

PP:

Patella posterior point

PRI:

Patella ridge point inferior

PRS:

Patella ridge point superior

PS:

Patella superior point

TD:

Trochlear dysplasia

TKA:

Total knee arthroplasty

TLIE:

Tibial lateral intercondylar eminence

TLPA:

Tibial lateral plateau anterior

TLPP:

Tibial lateral plateau posterior

TMIE:

Tibial medial intercondylareminence

TMPA:

Tibial medial plateau anterior

TMPP:

Tibial medial plateau posterior

TPA:

Tibial plateau anterior

TPL:

Tibial plateau lateral

TPM:

Tibial plateau medial

TT-TG:

Tibial tuberosity-trochlear groove

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Funding

The authors received no specific funding for this work.

Author information

Affiliations

Authors

Contributions

WP designed the study, acquired and analysed the data, interpreted the results, wrote the first draft of the manuscript and revised it based on comments of other authors; PV and AVH contributed substantially to the conception and design of the work, the analysis and interpretation of the data; SVDW contributed substantially to the data acquisition and graphic design. All authors revised the draft manuscript for important intellectual content, approved the final version of the manuscript to be published, and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Wouter Peeters.

Ethics declarations

Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

This study was in accordance with the ethical standards of the institutional committee and with the 1964 Helsinki declaration and its later amendments.

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Appendix

Appendix

Landmarks for morphometric measurements

Tibial plateau

  • Tibial medial intercondylar eminence (TMIE): the most proximal point of the medial intercondylar eminence.

  • Tibial lateral intercondylar eminence (TLIE): the most proximal point of the lateral intercondylar eminence.

  • Tibial medial plateau posterior (TMPP): the most posterior point of the medial tibial plateau on the 3D model of the tibia.

  • Tibial lateral plateau posterior (TLPP): the most posterior point of the lateral tibial plateau on the 3D model of the tibia.

  • Tibial plateau medial (TPM): the most medial point of the tibial plateau on the 3D model of the tibia.

  • Tibial plateau lateral (TPL): the most lateral point of the tibial plateau on the 3D model of the tibia.

  • Tibial plateau anterior (TPA): the most anterior point of the tibial plateau on the 3D model of the tibia.

  • Tibial medial plateau anterior (TMPA): the most anterior point on the cartilage of the medial tibial plateau.

  • Tibial lateral plateau anterior (TLPA): the most anterior point on the cartilage of the lateral tibial plateau.

Patella

  • Patella superior point (PS): the most superior point of the patella.

  • Patella inferior point (PI): the most inferior point of the patella.

  • Patella medial point (PM): the most medial point of the patella.

  • Patella lateral point (PL): the most lateral point of the patella.

  • Patella anterior point (PA): the most anterior point of the patella.

  • Patella posterior point (PP): the most posterior point of the patella.

  • Patella ridge point superior (PRS): the most superior articular point on the border of the medial and lateral facet.

  • Patella ridge point inferior (PRI): the most inferior articular point on the border of the medial and lateral facet.

  • Patella odd point superior (POS): the most superior articular point on the border of the odd facet and paramedian segment.

  • Patella odd point inferior (POI): the most inferior articular point on the border of the add facet and paramedian segment.

Reference planes

Tibia AP direction

  • Plane 1: Posterior tibial plane: plane tangent to TMPP and TLPP and parallel to the posterior tibial cortex.

  • Plane 2: Anterior tibial plane: plane tangent to TPA and parallel to plane 1.

  • Plane 3: Anteromedial tibial plane: plane tangent to TMPA and parallel to plane 1.

  • Plane 4: Anterolateral tibial plane: plane tangent to TLPA and parallel to plane 1.

Tibia ML direction

  • Plane 5: Medial tibial plane: plane tangent to TPM and perpendicular to plane 1.

  • Plane 6: Medial intercondylar eminence plane: plane tangent to TMIE and perpendicular to plane 1.

  • Plane 7: Lateral intercondylar eminence plane: plane tangent to TLIE and perpendicular to plane 1.

  • Plane 8: Lateral tibial plane: plane tangent to TPL and perpendicular to plane 1.

Patella AP direction

  • Plane 9: Vertical transpatellar plane: plane through PS, PI and PM.

  • Plane 10: Anterior patellar plane: plane tangent to PA and parallel to plane 9.

  • Plane 11: Posterior patellar plane: plane tangent to PP and parallel to plane 9.

Patella ML direction

  • Plane 12: Medial patellar plane: plane tangent to PM and perpendicular to plane 9.

  • Plane 13: Patella odd plane: plane through POS and POI and perpendicular to plane 9.

  • Plane 14: Patellar ridge plane: plane through PRS and PRI and perpendicular to plane 9.

  • Plane 15: Lateral patellar plane: plane through PL and perpendicular to plane 9.

Patella PD direction

  • Plane 16: Superior patellar plane: plane tangent to PS and perpendicular to plane 9 and plane 12.

  • Plane 17: Superior articular patellar plane: plane tangent to PRS and parallel to plane 16.

  • Plane 18: Inferior articular patellar plane: plane tangent to PRI and parallel to plane 16.

  • Plane 19: Inferior patellar plane: plane tangent to PI and parallel to plane 16.

Measurements

Tibia

  • Tibial plateau width: distance between TPM and plane 8.

  • Medial tibial plateau width: distance between TPM and plane 6.

  • Lateral tibial plateau width: distance between TPL and plane 7.

  • Intercondylar eminence width: distance between TMIE and plane 7.

  • Tibial plateau depth: distance between TPA and plane 1.

  • Medial tibial plateau depth: distance between TMPA and plane 1.

  • Lateral tibial plateau depth: distance between TLPA and plane 1.

Patella

  • Patella width: distance between PM and plane 15.

  • Medial facet patella width: distance between PM and plane 14.

  • Odd facet patella width: distance between PM and plane 13.

  • Paramedian segment patella width: medial facet patella width minus odd facet patella width.

  • Lateral facet patella width: distance between PL and plane 14.

  • Patella height: distance between PI and plane 16.

  • Distal pole height: distance between PI and plane 18.

  • Articular surface patella height: Patella height minus distal pole height.

  • Patella thickness: distance between PA and plane 11.

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Peeters, W., Van Haver, A., Van den Wyngaert, S. et al. A landmark-based 3D analysis reveals a narrower tibial plateau and patella in trochlear dysplastic knees. Knee Surg Sports Traumatol Arthrosc 28, 2224–2232 (2020). https://doi.org/10.1007/s00167-019-05802-x

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Keywords

  • Patellofemoral joint
  • Tibia
  • Patella
  • Trochlear dysplasia
  • Morphology
  • Three dimensional
  • Measurements