Prevalence of Trochlear Dysplasia and Associations with Patellofemoral Pain and Instability in a Skeletally Mature Population

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Clarabelle A. DeVries ◽  
James D. Bomar ◽  
Andrew T. Pennock
Keyword(s):  
Trochlear Dysplasia ◽  
Patellofemoral Pain ◽  
Mature Population

scholarly journals Outcomes After Deepening Trochleoplasty and Concomitant Realignment in Patients With Severe Trochlear Dysplasia With Chronic Patellofemoral Pain: Results at 2-Year Follow-up

2021 ◽  
Vol 9 (6) ◽  
pp. 232596712110104
Author(s):  
Felix Zimmermann ◽  
Danko Dan Milinkovic ◽  
Peter Balcarek
Keyword(s):  
Patellofemoral Joint ◽  
Trochlear Dysplasia ◽  
Case Series ◽  
Patellofemoral Pain ◽  
Control Group ◽  
Patellar Tilt ◽  
Level Of Evidence ◽  
Joint Stress ◽  
Kujala Score ◽  
Mri Scans

Background: Abnormal patellofemoral joint stress appears to have major relevance in a subgroup of patients with patellofemoral pain (PFP). Purpose: To evaluate whether patients with chronic PFP and trochlear dysplasia–induced patellofemoral joint malalignment benefit from a deepening trochleoplasty procedure with the aim of improving patellotrochlear congruence. Study Design: Case series; Level of evidence, 4. Methods: Included were 15 patients (male/female, 1/14; mean age, 30.3 years [range, 19-51 years]) with 8.8 years (range, 1-20 years) of chronic PFP and severe trochlear dysplasia. All patients underwent correction of patellotrochlear malalignment with deepening trochleoplasty and concomitant realignment procedures. The Kujala score and a numerical analog scale (0-10) for intensity of pain were used to assess symptoms preoperatively and at 12 and 24 months postoperatively. Pre- and postoperative magnetic resonance imaging (MRI) scans from the patients were compared with the MRI scans of age- and sex-matched controls regarding the patellotrochlear contact area and contact ratio, patellar tilt, patellotrochlear index, and lateral trochlear inclination (LTI) angle. Results: The Kujala score increased from a mean of 55 (range, 15-81) preoperatively to 82.5 (range, 53-98) after 12 months (95% CI, –42.56 to –12.37; P < .001) and to 84.2 (range, 59-99) after 24 months (95% CI, –44.29 to –14.11; P < .001). The intensity of PFP decreased from 5.7 (range, 3-10) preoperatively to 1.4 (range, 0-4) after 12 months (95% CI, 2.57 to 5.96; P < .001) and had a mean of 1.6 (range, 0-6) after 24 months (95% CI, 2.44 to 5.75; P < .001). Preoperatively, parameters in the study group indicated significant patellotrochlear malalignment, which improved and normalized (except for the LTI angle) postoperatively compared with the values of the control group ( P > .05). Conclusion: In a subgroup of patients with chronic PFP due to severe trochlear dysplasia, deepening trochleoplasty and concomitant realignment procedures significantly reduced pain and improved knee joint function while normalizing patellotrochlear congruence.

scholarly journals Prevalence of Trochlear Dysplasia and Associations with Patellofemoral Pathology (166)

2021 ◽  
Vol 9 (10_suppl5) ◽  
pp. 2325967121S0028
Author(s):  
Clarabelle DeVries ◽  
James Bomar ◽  
Andrew Pennock
Keyword(s):  
General Population ◽  
Patellar Instability ◽  
Trochlear Dysplasia ◽  
Patellofemoral Pain ◽  
High Grade ◽  
Sulcus Angle ◽  
Increased Risk ◽  
History Of ◽  
Total Knee ◽  
The Mean

Objectives: Patellar instability is a common condition of adolescents with an incidence of 29 to 43 per 100,000. Trochlear dysplasia has been found in up to 85% of those with recurrent patellar instability and has been found in association with ACL rupture. However, the prevalence of trochlear dysplasia in the general population has not yet been defined. The purpose was to define the prevalence of trochlear dysplasia as defined by ultrasound in a skeletally mature population and characterize associations of trochlear dysplasia with patellofemoral pathology. Methods: Skeletally mature adolescents and parents aged 50 and under presenting to orthopedics clinics were recruited from 2019 to 2020. Those with a history of intra-articular fracture, total knee arthroplasty, and syndromic ligamentous laxity or neuromuscular disease were excluded. Surveys were collected detailing any history of knee symptoms and surgery as well as an abbreviated Anterior Knee Pain Score (AKPS) with a score of 4 or greater being considered positive. Ultrasounds were obtained of bilateral knees and the osseous sulcus angle of the trochlea as well as the trochlear depth were measured (Figure 1). Basic descriptive statistics are reported. Results: One hundred and two patients (203 knees) were studied. The mean osseous sulcus angle was 144.1±6.8° and the mean trochlear depth was 5.5±1.4mm. The distribution of outcomes of interest can be found in Table 1. High grade trochlear dysplasia was defined as two standard deviations from the mean which was shown to be a sulcus angle ≥158˚ or a trochlear depth of ≤3mm. Prevalence of high grade trochlear dysplasia based on sulcus angle was 3.0% and 5.9% based on trochlear depth. In the presence of high grade trochlear dysplasia as defined by osseous sulcus angle, there was a 32 times increased risk of previous patellar instability (p=0.007) and 10 times increased risk of a positive AKPS (p=0.016). All those with high grade trochlear dysplasia as defined by osseous sulcus angle had a history of, or current, patellofemoral pain. Conclusions: The prevalence of trochlear dysplasia in the general population is approximately 6%. There are significant associations of trochlear dysplasia not only with patellar instability but also with patellofemoral pain. Use of ultrasound to diagnose trochlear dysplasia may prove to be a rapid and useful tool in guiding patient education and treatment decisions.

scholarly journals Geometry of Torsional Malalignment Syndrom: Trochlear Dysplasia but not Torsion Predicts Lateral Patellar Instability

2019 ◽  
Vol 7 (6_suppl4) ◽  
pp. 2325967119S0022
Author(s):  
Peter Balcarek ◽  
Dennis Vogel
Keyword(s):  
Inclination Angle ◽  
Patellar Instability ◽  
Trochlear Dysplasia ◽  
Patellofemoral Pain ◽  
Tibial Tuberosity ◽  
Patellar Tracking ◽  
Trochlear Groove ◽  
Type B ◽  
Tibial Torsion ◽  
Torsional Malalignment

Aims and Objectives: To analyze parameters of limb malalignment and patellar tracking in patients with torsional malalignment syndrome presenting with clinical symptoms of either patellofemoral pain or patellar instability. Materials and Methods: Between April 2015 and July 2017, 428 patients were treated for lateral patellar instability (LPD), and 333 patients were treated for patellofemoral pain syndrome (PFPS). Sixty-two patients (14.5%) with patellar instability (LPD group) and 29 patients (8.7%) with patellofemoral pain (PFPS group) had additional torsional malalignment and were included in this study. All patients underwent magnetic resonance imaging assessment of torsional alignment and patellar tracking, including femoral antetorsion, tibial torsion, knee rotation, tibial tuberosity-trochlear groove distance, tibial tuberosity-posterior cruciate ligament distance, Dejour’s classification of trochlear dysplasia, lateral trochlear inclination angle, and patellar height Results: Groups differed significantly in terms of trochlear dysplasia (p<0.001), lateral trochlear inclination angle (p<0.001) and tibial tuberosity-trochlear groove distance (p=0.0167) but did not differ in terms of femoral torsion (LPD group 20.02° +/- 8.8°; PFPS group 20.03° +/- 7.91°; p=0.8545), tibial torsion (LPD group 39.53° +/- 9.23°; PFPS group 41.24° +/- 7.28°; p=0.3616), and knee rotation (LPD group 10.42° +/- 5.16°; PFPS group 8.48° +/- 7.81°; p=0.0163). Only measures of coronal alignment were positively correlated. This was also true for the tibial tuberosity-trochlear groove distance and knee rotation but not for any other parameters of torsional limb alignment. Trochlear dysplasia (type B-D) was identified as the only significant predictor of patellar instability. Conclusion: Torsional malalignment syndrome, represented in this study by two clinical entities - PFPS and LPD - is not characterized by a typical constellation of different malalignment parameters. Between groups, parameters differed significantly only in terms of trochlear dysplasia and the tibial tuberosity-trochlear groove distance, with trochlear dysplasia (type B-D), but not torsion, identified as predictor of lateral patellar instability.

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.

FULL WEIGHT BEARING KINEMATIC MRI STUDY OF TT-TG DISTANCE: COMPARING PATIENTS WITH PATELLOFEMORAL PAIN TO HEALTHY INDIVIDUALS

2015 ◽  
Vol 21 (4.1) ◽  
pp. 638-642
Author(s):  
Andrius Brazaitis ◽  
Algirdas Tamosiunas ◽  
Janina Tutkuviene
Keyword(s):  
Patellar Instability ◽  
Weight Bearing ◽  
Patellofemoral Pain ◽  
Full Weight Bearing ◽  
Trochlear Groove ◽  
Patellar Tilt ◽  
Full Extension ◽  
Low Degrees ◽  
Mri Study ◽  
Kinematic Magnetic Resonance Imaging

Purpose. The aim of the present study was to investigate tibial tuberosity-trochlear groove (TT-TG) distance dynamics in patients with patellofemoral pain (PFP) and pain free individuals by using full weight bearing kinematic magnetic resonance imaging (MRI) And correlation with patellar instability. Materials and methods. 51 female individuals with PFP and 26 pain free female individuals participated in the study. The kinematic MRI was performed with 1,5 T MRI unit and full-weight bearing. TT-TG distance, bissect offset (BSO) and patellar tilt angle (PTA) were measured in steps of 10° between 50° of flexion to full extension. Results. The TT–TG was higher in PFP patients compared to volunteers’ from 40° to full extension. This difference was statistically significant (p<0.01). PFP patients demonstrated statistically significantly greater TT-TG distance increase from 30° to full extension. BSO and PTA were moderately correlated to TT-TG from 20° of flexion to full extension. Conclusion. TT-TG distance is dynamic and increases significantly during extension in patients with PFP and pain free individuals, depending on knee flexion angle. It shows different pattern of dynamics in PFP group. TT-TG distance is associated with patellar instability (BSO and PTA) at low degrees of flexion.

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