Inter- and intraobserver reproducibility in radiographic diagnosis and classification of femoral trochlear dysplasia

Rémy, François; Chantelot, Christophe; Fontaine, C.; Demondion, Xavier; Migaud, H.; Gougeon, F.

doi:10.1007/s00276-998-0285-x

Cited by 14 publications

(19 citation statements)

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“…In order to identify the ''crossing sign'' on radiographs, knee should be given a true lateral position along with fluoroscopy. Moreover, classification of the trochlear dysplasia on radiographs to determine the severity level, was shown to be a difficult issue [3,21]. During whole lateral knee radiography, even a 58 rotation mistake has been reported to cause false positive or negative values for trochlear dysplasia [16].…”

Section: Discussionmentioning

confidence: 99%

Is there a relationship between anterior knee pain and femoral trochlear dysplasia? Assessment of lateral trochlear inclination by magnetic resonance imaging

Keser

Savranlar

Bayar

et al. 2008

Knee Surg Sports Traumatol Arthr

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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 11 masculine. 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 17.32 masculine and 21.5 masculine, 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.

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Section: Discussionmentioning

confidence: 99%

Is there a relationship between anterior knee pain and femoral trochlear dysplasia? Assessment of lateral trochlear inclination by magnetic resonance imaging

Keser

Savranlar

Bayar

et al. 2008

Knee Surg Sports Traumatol Arthr

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“…Slight rotational deviations may cause misdiagnosis. The crossing sign is reliable and reproducible [17].…”

Section: Methodsmentioning

confidence: 99%

Trochlear osteotomy for patellar instability: satisfactory minimum 2-year results in patients with dysplasia of the trochlea

Koëter

Pakvis

Loon

et al. 2006

Knee Surg Sports Traumatol Arthrosc

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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.

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“…c Intermediate trochleas: type A1, the trochlear groove ends near the anterior border of the condyles but without crossing; Type B2, the trochlear groove crosses the anterior border of the medial condyle, but does not cross the lateral condyle. From Remy et al (1998) Reliability of radiographic morphology of the dysplastic femoral trochlea. Surg Radiol Anat 20:285-289, with permission from the publisher Fig.…”

Section: Methodsmentioning

confidence: 99%

“…According to Dejour patellofemoral disorders can be categorised in four categories: objective patellar instability (OPI) with recurrent patellar (sub)luxations, potential patellar instability with anatomic abnormalities, patellofemoral pain syndromes without patellofemoral anatomical abnormalities and patellofemoral arthritis [3,4]. Conventional radiologic (CR), computed tomography (CT) and magnetic resonance imaging (MRI) scanning methods are currently used to study the patellofemoral articulation [1][2][3][4][5][6][7][8][9]12]. Lateral CR with the knee in 30°of flexion are generally used to diagnose trochlear dysplasia.…”

Section: Introductionmentioning

confidence: 99%

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Minimal rotation aberrations cause radiographic misdiagnosis of trochlear dysplasia

Koëter

Bongers

Rooij

et al. 2006

Knee Surg Sports Traumatol Arthrosc

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Radiologic criteria are commonly used to diagnose femoral trochlear dysplasia causing patellofemoral (sub)luxations. A dysplastic trochlea can be identified on conventional radiographs when the line of the trochlear groove crosses the anterior border of one or both condyles. The aim of this study was to establish the influence of rotation on the precision of these radiographic criteria as classified on a true lateral conventional radiograph. In a radiological in vitro study using two different distal femurs we found that rotation deviations of the distal femur can simulate femoral trochlear dysplasia in a normal knee. In case of trochlear dysplasia, rotational deviations can simulate a normal trochlear shape with crossing of the trochlear groove with the anterior border of the femoral condyle. Even a rotation deviation of 5 degrees can cause a false-positive or false-negative diagnosis. We recommend the use of fluoroscopy to obtain a true lateral view (with both condyles overlapping on the posterior side) in order to correctly classify trochlear dysplasia and would strongly urge that no surgery should be performed on the basis of rotated conventional radiographs.

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Inter- and intraobserver reproducibility in radiographic diagnosis and classification of femoral trochlear dysplasia

Cited by 14 publications

References 0 publications

Is there a relationship between anterior knee pain and femoral trochlear dysplasia? Assessment of lateral trochlear inclination by magnetic resonance imaging

Is there a relationship between anterior knee pain and femoral trochlear dysplasia? Assessment of lateral trochlear inclination by magnetic resonance imaging

Trochlear osteotomy for patellar instability: satisfactory minimum 2-year results in patients with dysplasia of the trochlea

Minimal rotation aberrations cause radiographic misdiagnosis of trochlear dysplasia

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