Femoral Trochlear Groove Morphometry Assessed on Oblique Coronal MR Images

Yi, Minkyung; Hong, Sung Hwan; Choi, Ja Young; Yoo, Hye Jin; Kang, Yusuhn; Park, Jina; Kang, Heung Sik

doi:10.2214/ajr.15.14398

Cited by 9 publications

(5 citation statements)

References 32 publications

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“…Considering that recurrent patellar dislocation mainly occurs at the proximal level of the trochlear groove within the initial 30°of knee flexion, these results provide evidence supporting the clinical observations [14]. Trochlear depth, represented by TG-TEA in our study, has been extensively analysed in previous twodimensional studies [4,11,27,30,40]. The elevated TG-TEA in the dysplasia group confirms that the loss of concavity is a key characteristic of trochlear dysplasia, as previously reported [9].…”

Section: Discussionsupporting

confidence: 91%

“…Third, the most proximal level of the trochlea involving the hyperextension region, which could be termed ‘plane −15’ or ‘plane −30’, was not covered in the analysis. Because our study was based on CT data, which may not be the optimal imaging modality for cartilage evaluation, the articular margin of the proximal trochlea could not be precisely defined [26, 40]. It is regrettable to report that the supratrochlear spur, a key criterion of the Dejour classification, could not be quantified in our 3D analysis [28].…”

Section: Discussionmentioning

confidence: 99%

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Shallow trochlear groove and narrow medial trochlear width at the proximal trochlea in patients with trochlear dysplasia: A three‐dimensional computed tomography analysis

Lee,

Kim,

Kwon

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeAlthough the Dejour classification is the primary classification system for evaluating trochlear dysplasia, concerns have been raised about its reliability owing to its qualitative criteria and challenges associated with obtaining accurate radiographs. This study aimed to quantify trochlear dysplasia using three‐dimensional (3D) computed tomography (CT) reconstruction with novel parameters related to the transepicondylar axis (TEA).MethodsSixty patients were enrolled, including 20 with trochlear dysplasia and 40 healthy controls. The 3D CT model was generated using the Materialise Interactive Medical Image Control System software. The following six parameters were measured in eight consecutive planes at 15° intervals (planes 0–105): the distance from the TEA to the most cortical point of the lateral condyle (‘LP‐TEA’, where LP stands for lateral peak), medial condyle (‘MP‐TEA’, MP for medial peak) and deepest point of the trochlea (‘TG‐TEA’, TG for trochlear groove). The distances from the medial epicondyle (MEC) to the corresponding TEA points were measured (‘LP‐MEC’, ‘MP‐MEC’ and ‘TG‐MEC’).ResultsIn the dysplasia group, TG‐TEA (planes 0, 15 and 30) and MP‐MEC (planes 0, 15 and 30) were significantly greater than those in the control group (all p < 0.05 for planes of TG‐TEA and MP‐MEC). For type A dysplasia, LP‐MEC (plane 0) was greater than that in the control group. For type B dysplasia, the MP‐MEC (planes 0 and 15) and TG‐TEA (planes 0 and 15) were greater than those of the control group. For type D dysplasia, MP‐MEC (planes 0, 15 and 30) and TG‐TEA (planes 0 and 15) were elevated.ConclusionThe 3D CT reconstruction analysis established a reproducible method for quantifying osseous trochlear morphology. Patients with trochlear dysplasia had a shallow TG and narrow medial trochlear width at tracking angles of 0°–30°. This finding corroborates the clinical manifestations of recurrent patellar instability that occur during early flexion.Level of EvidenceLevel III.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Shallow trochlear groove and narrow medial trochlear width at the proximal trochlea in patients with trochlear dysplasia: A three‐dimensional computed tomography analysis

Lee,

Kim,

Kwon

et al. 2024

Knee surg. sports traumatol. arthrosc.

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“…It is known that the trochlear groove orientation is nearly 45 degree off the axial plane, which complicates the accurate evaluation of the trochlear morphology as the image plane cut is oblique to the anatomical structure of interest. 16 To obtain a more anatomically relevant analysis, an orthogonal trochlear MRI view was suggested by Yi et al 16 This is comprised of an oblique coronal plane cut of the knee orthogonal to the trochlear surface, as a means to assess true trochlear morphology and patellofemoral congruence from the proximal to the distal trochlea.…”

mentioning

confidence: 99%

Femoral Trochlear Geometry in Patients with Trochlear Dysplasia Using MRI Oblique Trochlear View

et al. 2019

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The objective of this study was to evaluate trochlear morphology in patients with trochlear dysplasia using a new oblique trochlear magnetic resonance imaging (MRI) view (OTV) in comparison with standard axial MRI sequences. MRI exam of 73 patients with patellofemoral instability (PFI) and the same number of controls were retrospectively reviewed. The oblique trochlear sequence was acquired by inclining the axial plane parallel to the intercondylar roof of the sagittal image, showing the anterior cruciate ligament (ACL) in its entire length. Trochlear morphology was assessed on axial and oblique trochlear sequences at three levels: level 1 at 25%, level 2 at 50%, and level 3 at 75% of the length of the trochlear groove. Trochlear sulcus angle and sulcus depth were measured at these three levels and compared between the new trochlear and standard axial sequences. Trochlear sulcus angle and sulcus depth were statistically different between axial and oblique trochlear views at all three levels (p < 0,05). Additionally, OTV displayed more uniform sulcus angle and depth along the trochlea. The oblique trochlear view on the MRI can more accurately evaluate trochlear morphology and also better characterize trochlear dysplasia in patients with PFI. This is Level III, retrospective comparative study.

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“…Of the remaining 1,810, a further 1,743 were irrelevant based on their title and/or abstract. Full‐text screening of the remaining 67 eligible studies resulted in exclusion of 37 irrelevant studies [1–3, 5, 6, 8–11, 13, 14, 21, 23–25, 28, 29, 32, 33, 37, 38, 42, 44–46, 51, 55–57, 60, 61, 63, 66–70], five studies that did not report intra‐ or inter‐observer agreement [2, 35, 43, 52, 61], four studies that were conference proceedings [40, 49, 53, 59], two studies that assessed agreement for classification systems other than Dejour classification [34, 48], one study that included skeletally immature patients [15], two studies that expressed inter‐observer agreement only as a percentage [36, 64], three studies that were not in English or French [12, 39, 71] and three studies that could not be retrieved [7, 19, 47]. No additional studies were identified from reference lists, which left ten relevant studies for data extraction [4, 6, 22, 30, 31, 39, 41, 54, 58, 65].…”

Section: Resultsmentioning

confidence: 99%

Inconsistent repeatability of the Dejour classification of trochlear dysplasia due to the variability of imaging modalities: a systematic review

Pineda,

Müller,

Nover

et al. 2023

Knee surg. sports traumatol. arthrosc.

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Purpose The purpose of this systematic review was to critically assess the quality of papers that report on the intra-and inter-observer repeatability of the Dejour classification for trochlear dysplasia, and to identify the possible causes for poor repeatability. Methods Two authors independently conducted an electronic search (four databases) on 8 February 2023 for studies (English or French) that assessed trochlear dysplasia classifications on imaging of skeletally mature participants. Exclusion criteria were reviews of clinical studies, conference proceedings, or editorials. After title, abstract, and full-text screening, characteristics of eligible studies were tabulated (author, year, journal, study design, cohort characteristics, and intra-and/or interobserver agreement coefficients). The methodological quality of studies was assessed using the Joanna Briggs Institute (JBI) checklist for analytical cross-sectional studies. Authors analysed three components of the included studies: (1) classifications based on true lateral radiographs and slice imaging; (2) dysplasia graded into Type A vs B vs C vs D and 3) coefficients of intra-and/or inter-observer agreement. ResultsThe electronic search returned 3,178 references, and after removal of duplicates and irrelevant studies, ten were eligible for data extraction. A second search (31 July 2023) yielded one additional study. Eight studies did not include lateral radiographs, two studies did not explicitly state if radiographs were true lateral views, and one used true lateral radiographs in isolation. Classification of trochlear dysplasia into A vs B vs C vs D using different imaging modalities resulted in moderate to near-perfect intra-observer agreement, and slight to near-perfect inter-observer agreement. Studies distinguished between moderate and severe dysplasia using a variety of combinations: A vs B/C/D, A/B vs C/D and A/C vs B/D. Conclusion This systematic review revealed that the Dejour classification remains the most widely used to assess trochlear dysplasia and that the majority of studies that assessed the reliability of the Dejour classification, reported moderate to nearperfect inter-observer agreement; however, pooling of results for comparison among the included studies was inappropriate due to substantial variation in imaging protocols and non-standardised criteria to distinguish severe from moderate dysplasia. Level of evidence Level IV. Trial registryThe PROSPERO registration number is CRD42023386731.

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Femoral Trochlear Groove Morphometry Assessed on Oblique Coronal MR Images

Abstract: Femoral trochlear indexes measured on oblique coronal knee MR images can be used to assess femoral trochlear dysplasia. Oblique coronal images showed less morphologic distortion of the distal femoral trochlear groove than axial images.

Cited by 9 publications

References 32 publications

Shallow trochlear groove and narrow medial trochlear width at the proximal trochlea in patients with trochlear dysplasia: A three‐dimensional computed tomography analysis

Shallow trochlear groove and narrow medial trochlear width at the proximal trochlea in patients with trochlear dysplasia: A three‐dimensional computed tomography analysis

Femoral Trochlear Geometry in Patients with Trochlear Dysplasia Using MRI Oblique Trochlear View

Inconsistent repeatability of the Dejour classification of trochlear dysplasia due to the variability of imaging modalities: a systematic review

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