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

Abstract

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.

Arthroscopic Deepening Trochleoplasty: The Technique

“…In addition, we have noted that hypermobile patellae are often associated with trochlear dysplasia, a condition that came to the attention of the authors only after the early development stages of the procedure. In 2008, Keser et al suggested a relationship between AKP and trochlear dysplasia based on a low lateral trochlea inclination angle, 30 confirming the previous findings from Powers. 31 Some patients with AKP who were diagnosed as having hyperpressure syndrome and a tilted patella, do have trochlear dysplasia.…”

Factors associated with patellofemoral pain syndrome: a systematic review

“…In male PFPS patients the superior cartilage thickness was significantly lower compared to male control subjects (MD males: −0.90 95% CI −1.78 to −0.02). Keser et al 38 reported a significantly higher incidence of trochlear dysplasia in knees of the patients with PFPS compared to the knees of the controls (OR 7.12; 95% CI 1.6 to 31.7) and significantly less lateral trochlear inclination in PFPS patients compared to controls (MD −4.20; 95% CI −6.04 to −2.36). None of the other evaluated variables were associated with PFPS 13 33 39 55 60 64 65…”

The incidence of trochlear dysplasia in anterior cruciate ligament tears

“…Dejour et al showed that trochlear dysplasia with a positive 'crossing sign' is present in 96 % of patients with PF disorders, while they recorded it only in 3 % of 194 controls [15]. More recently, Keser et al studied the occurrence of trochlear dysplasia using the lateral trochlea inclination index of Carrillion [18], in patients with AKP with no apparent aetiology, and found that it was present in 16.5 % of the 109 cases and in 2.7 % of the control group, which consisted of patients for meniscal pathology [21]. In this study, the authors recorded the same prevalence of trochlea dysplasia in controls with the study of Dejour, which was published 14 years ago.…”

“…1) [17]. Trochlear dysplasia has been directly associated with both recurrent patellar dislocation [18][19][20] and AKP [21,22] in patients with patellar instability, since it has been observed in 96 % of patients with PF disorders and in only 3 % of controls [15,22]. The surgical correction of trochlear dysplasia is done with the sulcusdeepening trochleoplasty procedure, in which the elevated groove is eliminated and the abnormal sulcus is deepened [23][24][25]; this can also rarely be enriched by the addition of patellar osteotomy in order to achieve a better congruency between the two articulating bones [26].…”