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1.
Trochlear osteotomy for patellar instability: satisfactory minimum 2-year results in patients with dysplasia of the trochlea 总被引:1,自引:0,他引:1
Sander Koëter Dean Pakvis Corne J. M. van Loon Albert van Kampen 《Knee surgery, sports traumatology, arthroscopy》2007,15(3):228-232
Trochlear dysplasia is a predisposing factor for recurrent patellar instability. We evaluated the results of an anterior lateral
femoral condyle open wedge osteotomy for treating patellar instability. A total of 16 consecutive patients (19 knees) with
symptoms of recurrent patellar instability and trochlear dysplasia identified using a true lateral radiograph of the knee
underwent an anterior lateral femoral osteotomy. Outcomes were documented at 2 years minimum follow-up using the Lysholm scale,
the patellofemoral score, WOMAC score and standard conventional radiographs. In 17 knees, patients reported good improvement
in stability (no dislocations) and most patients had a marked improvement in pain and functional scores at follow-up (mean
follow-up 51 months). No serious complications occurred. Anterior femoral osteotomy of the lateral condyle appears to be a
satisfactory and safe method for treating patients with patellofemoral joint instability caused by trochlea dysplasia. In
selected cases this procedure can be used to correct trochlea dysplasia. In our opinion, the key to a successful treatment
of patellofemoral instability is to successfully distinguish the anatomic deficiencies and to correct the anatomical abnormality. 相似文献
2.
Femoral trochlear dysplasia: MR findings 总被引:8,自引:0,他引:8
PURPOSE: To establish quantitative and qualitative magnetic resonance (MR) criteria for the diagnosis of trochlear dysplasia. MATERIALS AND METHODS: MR images were analyzed in 16 consecutive patients with and 23 without trochlear dysplasia. The standard of reference was a true lateral radiograph of the knee. Quantitative and qualitative MR criteria were assessed. RESULTS: In patients with trochlear dysplasia, the trochlear groove was significantly less deep than that in control subjects. The most accurate measurement was 3 cm above the femorotibial joint space (P: <.001), where a trochlear depth of 3 mm or less had a sensitivity of 100% and a specificity of 96%. The ventral trochlear prominence between the supratrochlear femoral cortex and the most ventral point of the trochlear floor (midsagittal section) was always larger than 6.9 mm in dysplastic trochleae. A facet ratio of less than 2:5 (medial to lateral) 3 cm above joint space level had a sensitivity of 100% and a specificity of 96%. A nipplelike anterior prominence at the superior end of the femoral trochlea on midsagittal images was a specific (91%) qualitative criterion. CONCLUSION: Dysplasia of the femoral trochlea can be diagnosed reliably by using quantitative or qualitative criteria on midsagittal or transverse MR images obtained 3 cm above the femorotibial joint space. 相似文献
3.
S. F. Fucentese P. B. Schöttle C. W. A. Pfirrmann J. Romero 《Knee surgery, sports traumatology, arthroscopy》2007,15(2):168-174
Trochlear dysplasia is an important risk factor for patellar instability. Because of a decreased trochlear depth in combination
with a low lateral femoral condyle, the patella cannot engage properly in the trochlea. Trochleoplasty is a surgical procedure,
which strives to correct such bony abnormalities. The aim of this study was to describe morphological features of trochlear
dysplasia and the corrective changes after trochleoplasty on CT scan. The study group consists of 17 knees with trochlear
dysplasia having undergone trochleoplasty for recurrent patellofemoral dislocation at a mean age of 22.4 years. The evaluation
consisted in pre- and postoperative measurements on the proximal and distal trochlea on transverse CT scans in order to determine
the morphological features. We measured the transverse position and depth of the trochlear groove, the transverse position
of the patella, the ratio between the posterior patellar edge and the trochlear groove, the lateral patellar inclination angle,
the sulcus angle, and the lateral trochlear slope. The trochlear groove lateralised a mean of 6.1 mm in the proximal aspect
and 2.5 mm in the distal aspect of the trochlea, while the patella medialised a mean of 5 mm. Preoperatively the patella was
lateral in relation to the trochlear groove in 13 cases, neutral in two cases, and medial in two cases. Postoperatively it
was lateral in four cases, in neutral position in seven cases, and medialised in six cases, referenced to the trochlear groove.
The trochlear depth increased from 0 to 5.9 mm postoperatively in the proximal aspect of the trochlea, and from 5.5 to 8.3 mm
postoperatively in the distal trochlea. The lateral patellar inclination angle decreased from a mean of 21.9° to a mean of
7.8°. The sulcus angle decreased from a mean of 172.1° to a mean of 133° in the proximal trochlea and from a mean of 141.9°
to a mean of 121.7° in the distal trochlea. The lateral trochlear slope changed from 2.8° to 22.7° in the proximal and from
14.9° to 26.9° in the distal part of the trochlea. In the CT scan patients with trochlear dysplasia demonstrated a poor depth,
or even a flat or convex trochlea with a greater sulcus and lateral trochlear slope angle, a lateralised patella to the trochlear
groove with poor congruency, and a greater lateral patellar inclination angle. Trochleoplasty can correct the pathological
features of trochlear dysplasia by surgically creating more normal anatomy. The goal of this surgical procedure is to steepen
and lateralise the trochlear groove for a better engagement of the patella. 相似文献
4.
PURPOSE: To propose a simple and reproducible radiological evaluation of patellofemoral instability to enable the orthopaedic surgeon to choose the best therapy. MATERIAL AND METHODS: We have evaluated retrospectively the radiographs and CT examinations of 25 patients, 15 female and 10 male, aged between 18 and 32 years. They underwent surgical treatment for patellar instability in the past 4 years. Lateral retinacular release has been performed in every patient, medial transposition of the anterior tibial tuberosity has been performed in 23 patients and in 5 of them also its distal replacement, proximal Insall's realignement was performed in 20 cases and only 1 patient underwent trochleoplasy. Preoperative conventional radiographs included antero-posterior view, true lateral view (exact superimposition of the posterior trochlear edges) and axial views at 30 degrees of knee flexion. On lateral view, the patellar height was evaluated based on Caton-Deshamps index and trochlear dysplasia assessed using the methods suggested by Dejour. A CT examination of both knees was performed: the images were taken first with knees in extension, with and without quadriceps contraction, then in flexion at 20 degrees. Patellar "bascùle" angles were measured both with quadriceps relaxed and contracted as an index of quadriceps dysplasia; the TAGT in extension was evaluated as an index of the degree of lateral position of the anterior tibial tuberosity. Preoperative conventional and CT findings were compared with those obtained postoperatively at 30.4 months from the surgical intervention. RESULTS: All patients were free from complaints after surgery. In 5 patients a high patella was corrected by distal realignement of anterior tibial tuberosity. A trochlear dysplasia with different degrees of severity was present in all cases and it was not modified by surgical treatment, with the exception of the patient who underwent trochleoplasty. In the 20 patients who underwent proximal Insall's realignment, patellar "bascùle" angles--pathological before surgery--were restored to normal values with the exception of 3 cases. In 23 patients who underwent medial transposition of anterior tibial tuberosity, the values of the TAGT were all normalized: nevertheless, in three patients low values of the TAGT were found after surgery and this condition may predispose to the development of medial patellofemoral by iperpression syndrome. CONCLUSIONS: In patients suffering from patellofemoral instability, a radiological protocol which includes conventional radiographs in two projections and a CT examination both in extension, with and without quadriceps contraction, and in flexion at 20 degrees supplies all the information needed for evaluating patellar height and mobility, trochlear dysplasia, valgism of the knee and the degree of excessive lateral position of the anterior tibial tuberosity. Careful evaluation of such abnormalities is important for selecting the best surgical treatment for each patient. It's a simple, quick, and accurate protocol that may be reproduced, even using different radiographic equipment. The collaboration between the radiologist and the orthopaedic surgeon is crucial for the correct interpretation of radiological findings, which must be evaluated together with clinical findings so that an adequate therapeutical plan could be proposed. 相似文献
5.
Purpose
Trochlear dysplasia is an important aetiological factor for the development of patellofemoral instability (PFI). The aim of the study was to identify the arthroscopic morphology of trochlear dysplasia that can be helpful when planning operative treatment for PFI.Methods
Magnetic resonance imaging (MRI) scans and strict lateral radiographs of 46 patients treated for PFI were assigned according to Dejour and matched with arthroscopic views from the lateral superior arthroscopic portal. On arthroscopy, signs of trochlear dysplasia were identified and classified into two types. Intra- and inter-observer agreements of the arthroscopic evaluation were assessed.Results
Arthroscopically, 2 major types of trochlear dysplasia could be distinguished. Type I shows a flat trochlear groove with an elevated trochlear floor in relation to the anterior femoral cortex. In type II, the proximal trochlea was convex with a lateral trochlear bump. Arthroscopic evaluation was not consistent with the Dejour’s radiographic and axial MRI classification. Arthroscopic grading showed excellent intra- and inter-observer agreements (81–92 %).Conclusion
Arthroscopic evaluation can give additional information about the severity of trochlear dysplasia. This additional information can be used as an aid in decision making for the treatment of PFI.Level of evidence
II. 相似文献6.
Bing Yue Kartik M. Varadarajan Songtao Ai Tingting Tang Harry E. Rubash Guoan Li 《Knee surgery, sports traumatology, arthroscopy》2011,19(1):80-88
The goal of this study was to characterize the geometry of the distal femur and proximal tibia in the Chinese population.
Three-dimensional models of twenty female and twenty male knees were constructed using CT images. The morphologic measurements
of the distal femur included mediolateral (ML) and anteroposterior dimension of medial and lateral condyles (MAP, LAP), femoral
aspect ratio (ML/LAP), medial and lateral condylar width, intercondylar notch width, notch width index (NWI), and trochlear
groove orientation. The sagittal profiles of the medial and lateral femoral condyles and tibial plateaus were also characterized.
The results showed that the size of the distal femur of the females was significantly smaller than that of the males. Furthermore,
when normalized by LAP, the females had a significantly narrower distal femur (ML), and a shorter MAP compared to the males.
In the sagittal plane, the radius of the lateral distal circle of the femur was significantly smaller than that of the medial
condyle in both genders. There were no significant gender differences in the proximal tibial geometry. The data of the present
study may enable suitable modification of total knee prosthesis sizing/geometry for Asia-Pacific patients. 相似文献
7.
Huiwu Li Xinhua Qu You Wang Kerong Dai Zhenan Zhu 《Knee surgery, sports traumatology, arthroscopy》2013,21(9):2081-2088
Purpose
The purpose of this study was to investigate the morphological changes of the knee in patients with untreated developmental dysplasia of the hip.Methods
Morphological analysis of 150 knee joints in 75 patients with developmental dysplasia of the hip was performed by examining computed tomographic (CT) images. Of these patients, 36 had unilateral developmental dysplasia of the hip and 39 had bilateral developmental dysplasia of the hip. Therefore, 36 hips were normal, and 114 hips were dislocated. CT images ranged from the iliac crest to 2 cm inferior to the tibial tuberosity.Results
Compared with the knees in patients with normal hips, the femoral condyles in patients with dislocated hips were smaller and exhibited greater medial and lateral condylar asymmetry. The anterior femoral condylar angle of the femur was increased, as was the groove angle, while the trochlear groove was shallower in patients with dislocated hips. Furthermore, the lateral patella shift was reduced and the patellar tilt angle was increased in patients with dislocated hips compared with patients with normal hips. The extent of changes in these variables differed with the degree of dislocation. However, the posterior condylar angle of the femur was not affected by the degree of dislocation.Conclusion
These findings suggest that developmental dysplasia of the hip is associated with morphological changes in the knee joint. These changes should be considered during hip and knee surgery.Level of evidence
Prospective study, Level II. 相似文献8.
Peter Balcarek Tim Alexander WaldeStephan Frosch Jan P. SchüttrumpfMartin M. Wachowski Klaus M. StürmerKarl-Heinz Frosch 《European journal of radiology》2011,79(3):415-420
Purpose
The first aim was to compare medial patellofemoral ligament injury patterns in children and adolescents after first-time lateral patellar dislocations with the injury patterns in adults. The second aim was to evaluate the trochlear groove anatomy at different developmental stages of the growing knee joint.Materials and methods
Knee magnetic resonance (MR) images were collected from 22 patients after first-time patellar dislocations. The patients were aged 14.2 years (a range of 11-15 years). The injury pattern of the medial patellofemoral ligament was analysed, and trochlear dysplasia was evaluated with regard to sulcus angle, trochlear depth and trochlear asymmetry. The control data consisted of MR images from 21 adult patients who were treated for first-time lateral patellar dislocation.Results
After patellar dislocation, injury to the medial patellofemoral ligament was found in 90.2% of the children and in 100% of the adult patients. Injury patterns of the medial patellofemoral ligament were similar between the study group and the control group with regard to injury at the patellar attachment site (Type I), to the midsubstance (Type II) and to injury at the femoral origin (Type III) (all p > 0.05). Combined lesions (Type IV) were significantly less frequently observed in adults when compared to the study group (p = 0.02). The magnitude of trochlear dysplasia was similar in children, adolescents and adults with regard to all three of the measured parameter-values (all p > 0.05). In addition, the articular cartilage had a significant effect on the distal femur geometry in both paediatrics and adults.Conclusion
First, the data from our study indicated that the paediatric medial patellofemoral ligament injury patterns, as seen on MR images, were similar to those in adults. Second, the trochlear groove anatomy and the magnitude of trochlear dysplasia, respectively, did not differ between adults and paediatrics with patellar instability. Thus, physicians are confronted with similar anatomical risk factors and similar injuries to the medial soft-tissue restraints in children when compared to adults with patellar instability. 相似文献9.
10.
Hyung-Min Ji Dong San Jin Jun Han Ho-Sik Choo Ye-Yeon Won 《Knee surgery, sports traumatology, arthroscopy》2016,24(8):2402-2406
Purpose
Accurate rotational alignment of the femoral component is of vital importance for successful total knee arthroplasty (TKA). Two anatomical references located on the anterior femur were recently introduced. To determine which is more reliable reference axis for the femoral component rotation in female patients receiving TKA, the trochlear anterior line was compared with the femoral anterior tangent line.Materials and methods
Preoperative computed tomography in 76 patients receiving TKA for varus deformity was performed, and the images were reconstructed into three-dimensional models. The trochlear anterior line was defined as the line connecting the most anterior portion of the lateral and medial femoral condyles and the femoral anterior tangent line as the line parallel to distal anterior femoral surface. The two angles between these reference axes and the surgical transepicondylar axis (TEA) in three-dimensional images (trochlear anterior line/TEA, femoral anterior tangent line/TEA) were measured. The correlation between these two angles was computed. We investigated to see whether a significant difference in variance existed.Results
The trochlear anterior line was internally rotated by 6.1° ± 2.5° with respect to TEA, whereas the femoral anterior tangent line by 9.5° ± 3.8°. The trochlear anterior line was externally rotated by 3.4° ± 3.3° with respect to the femoral anterior tangent line. There was a significant correlation between the trochlear anterior line/TEA and the femoral anterior tangent line/TEA.Conclusions
The variance of the trochlear anterior line/TEA was significantly smaller than that of the femoral anterior tangent line/TEA demonstrating a more consistent distribution. When conventional reference axes such as the posterior condylar axis or the anteroposterior axis are unclear or differ, surgeons can rely on these alternative references. When trochlear anterior line and femoral anterior tangent line contradicts, the former might be more reliable for the rotational alignment of the femoral component in female patients.Level of evidence
Case series with no comparison group, Level IV.11.
Yong In Chae-Gwan Kong Yoo-Joon Sur Sun-Sin Choi 《Knee surgery, sports traumatology, arthroscopy》2009,17(3):254-259
Permanent post-traumatic patellar dislocation is a rare condition, and total knee arthroplasty (TKA) can be performed for
osteoarthritic knees with this condition. There have been only a few reports about using the standard medial parapatellar
approach and extensive lateral release or extensor mechanism realignment for patients with permanent post-traumatic patellar
dislocation. We performed two TKAs with using a subvastus approach and lateral release for osteoarthritic knees with permanent
post-traumatic patellar dislocation. The patients were well satisfied with their results. The patellae tracked very well in
the femoral trochlear groove throughout the full range of motion after the operations. Bone scans were done 1 year postoperatively
on both patients, and the scans showed normal vascularity for the patella. 相似文献
12.
Depth insufficiency of the proximal trochlear groove on lateral radiographs of the knee: relation to patellar dislocation 总被引:9,自引:0,他引:9
The depth of the trochlear groove was frequently noted to be insufficient in knees with patellar instability, particularly in the proximal portion of the trochlea. To confirm this observation, the depth of the trochlear groove of the femur was measured on lateral radiographs of 218 knees: 40 knees in 20 asymptomatic subjects, 116 knees in 69 patients undergoing radiography for various symptoms (96 without and 20 with patellar subluxation, determined on axial radiographs), and 62 knees in 34 patients who underwent surgery for recurrent dislocation or subluxation of one or both patellae (40 treated and 22 contralateral knees). In the 40 knees that had been operated on, the proximal trochlear depth (measured 1 cm below the upper limit of the trochlear groove) was 2.74 mm +/- 1.35, in contrast to 5.94 mm +/- 1.74 in the asymptomatic subjects and 5.84 mm +/- 1.53 in the patients with symptoms but no patellar instability. Recognition of depth insufficiency in the proximal portion of the trochlea should prompt a search for patellar instability. Axial views made with 30 degrees of knee flexion and lateral rotation of the leg are particularly helpful. 相似文献
13.
On lateral roentgenograms, the articular surfaces of the knee are characterized by specific landmarks that enable to differentiate them. We looked for the incidence of these characteristics on lateral views of the knees in 40 unselected patients. In our observations, several signs are virtually constant: the visualisation of the external portion of the lateral patellar facet (100%), the concave configuration of the medial tibial condyle (100%), the groove of the middle third of the lateral femoral condyle (90%), and--as a new sign--the sharper aspect of the lateral border of the patellar surface of the femur in comparison with the medial border (87.5%). Other characteristics, less constant but also useful, are the convex configuration of the lateral tibial condyle (62.5%), the more cranial extension of the lateral border of the patellar surface of the femur in comparison with the medial (57.5%), and the groove in the anterior part of the medial femoral condyle (47.5%). These anatomic characteristics are linked with the specific functional characteristics of each compartment. For instance, the lateral preponderance of patello-femoral stresses accounts for the better visualization of both the lateral patellar facet and the lateral border of the patellar surface of the femur; the great anteroposterior mobility of the lateral femoral condyle on the corresponding tibial condyle during the rotatory motion of the knee is facilitated by the convex configuration of both; finally, the femoral condylar grooves are the mirrors of the anterior part of the tibial condyles with which they make contact when the knee is full extended (with meniscal interposition in the lateral but not in the medial compartment, as it was proved by 20 full extended arthrographic views). Besides, it seems that the development of some inconstant anatomic details is probably correlated with knee laxity. 相似文献
14.
Peter Balcarek Annika Terwey Klaus Jung Tim Alexander Walde Stephan Frosch Jan Philipp Schüttrumpf Martin Michael Wachowski Henning Dathe Klaus Michael Stürmer 《Knee surgery, sports traumatology, arthroscopy》2013,21(9):2155-2163
Purpose
The geometry of the tibial plateau and its influence on the biomechanics of the tibiofemoral joint has gained increased significance. However, no quantitative data are available regarding the inclination of the medial and lateral tibial slope in patients with patellar instability. It was therefore the purpose of this study to evaluate tibial slope characteristics in patients with patellar dislocations and to assess the biomechanical effect of medial-to-lateral tibial slope asymmetry on lateral patellar instability.Methods
Medial and lateral tibial slope was measured on knee magnetic resonance images in 107 patients and in 83 controls. The medial-to-lateral tibial slope asymmetry was assessed as the intra-individual difference between the medial and lateral tibial plateau inclination considering severity of trochlear dysplasia. The effect of tibial slope asymmetry on femoral rotation was calculated by means of radian measure.Results
Severity of trochlear dysplasia was significantly associated with an asymmetric inclination of the tibial plateau. Whereas the medial tibial slope showed identical values between controls and study patients (n.s.), lateral tibial plateau inclination becomes flatter with increasing severity of trochlear dysplasia (p < 0.01). Consequently, the intra-individual tibial slope asymmetry increased steadily (p < 0.01) and increased internal femoral rotation in 20° and 90° of knee flexion angles in patients with severe trochlear dysplasia (p < 0.01). In addition, the extreme values of internal femoral rotation were more pronounced in patients with patellar instability, whereas the extreme values of external femoral rotation were more pronounced in control subjects (p = 0.024).Conclusion
Data of this study indicate an association between tibial plateau configuration and internal femoral rotation in patients with lateral patellar instability and underlying trochlear dysplasia. Thereby, medial-to-lateral tibial slope asymmetry increased internal femoral rotation during knee flexion and therefore might aggravate the effect of femoral antetorsion in patients with patellar instability.Level of evidence
III. 相似文献15.
Selçuk Keser Ahmet Savranlar Ahmet Bayar Ahmet Ege Egemen Turhan 《Knee surgery, sports traumatology, arthroscopy》2008,16(10):911-915
It may be very difficult to diagnose the pathology in patients with anterior knee pain. Patients with chronic anterior knee
pain have been reviewed for the study. Our aim was to delineate the presence of subtle trochlear dysplasia by measuring lateral
trochlear inclination (LTI) in axial magnetic resonance imaging (MRI) scans. While there were 109 knees in the study group
with anterior knee pain (AKP), control group consisted of 74 knees without AKP. The LTI measurements were performed at the
level of proximal cartilaginous area of trochlear groove in axial scans. The condition was termed to be trochlear dysplasia
when LTI was below 11o. Parameters in both groups were statistically analyzed and compared for their association with LTI.
There was no significant difference between LTI values of male and female subjects in each group. The mean LTI values in anterior
knee pain and control groups were 17.32o and 21.5o, respectively, and the difference was statistically significant (P < 0.05). The ratio of knees with trochlear dysplasia was 16.5% in AKP group, which was only 2.7% in control. In the AKP group,
the ratio of trochlear dysplasia was significantly high (P < 0.05). Although trochlear dysplasia has been generally detected in cases with patellar instability, this study revealed
that the frequency of this finding in patients with other causes of anterior knee pain was also considerably high. Measurement
of lateral trochlear inclination in axial MRI scans with radiologic assessment seems to be a valuable diagnostic criterion,
especially in patients in whom etiology of anterior knee pain could not be identified. 相似文献
16.
17.
Daniel Dornacher Heiko Reichel Sabine Lippacher 《Knee surgery, sports traumatology, arthroscopy》2014,22(10):2382-2387
Purpose
Excessive tibial tuberosity–trochlear groove distance (TT–TG) is considered as one of the major risk factors in patellofemoral instability (PFI). TT–TG characterises the lateralisation of the tibial tuberosity and the medialisation of the trochlear groove in the case of trochlear dysplasia. The aim of this study was to assess the inter- and intraobserver reliability of the measurement of TT–TG dependent on the grade of trochlear dysplasia.Methods
Magnetic resonance imaging (MRI) scans of 99 consecutive knee joints were analysed retrospectively. Hereof, 61 knee joints presented with a history of PFI and 38 had no symptoms of PFI. After synopsis of the axial MRI scans with true lateral radiographs of the knee, the 61 knees presenting with PFI were assessed in terms of trochlear dysplasia. The knees were distributed according to the four-type classification system described by Dejour.Results
Regarding interobserver correlation for the measurements of TT–TG in trochlear dysplasia, we found r = 0.89 (type A), r = 0.90 (type B), r = 0.74 (type C) and 0.62 (type D) for Pearson’s correlation coefficient. Regarding intraobserver correlation, we calculated r = 0.89 (type A), r = 0.91 (type B), r = 0.77 (type C) and r = 0.71 (type D), respectively. Pearson’s correlation coefficient for the measurement of TT–TG in normal knees resulted in r = 0.87 for interobserver correlation and r = 0.90 for intraobserver correlation.Conclusion
Decreasing inter- and intraobserver correlation for the measurement of TT–TG with increasing severity of trochlear dysplasia was detected. In our opinion, the measurement of TT–TG is of significance in low-grade trochlear dysplasia. The final decision to perform a distal realignment procedure based on a pathological TT–TG in the presence of high-grade trochlear dysplasia should be reassessed properly.Level of evidence
Retrospective study, Level II. 相似文献18.
19.
20.
A. J. Barnett N. R. Howells B. J. Burston A. Ansari D. Clark J. D. Eldridge 《Knee surgery, sports traumatology, arthroscopy》2012,20(12):2380-2384