Minimal rotation aberrations cause radiographic misdiagnosis of trochlear dysplasia

Koëter, Sander; Bongers, Ernie M.H.F.; Rooij, Jacky de; Kampen, A. van

doi:10.1007/s00167-005-0031-4

Cited by 60 publications

(40 citation statements)

References 13 publications

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“…On a lateral knee radiograph, the “crossing sign” was described, a geometrical abnormality at the cranial portion of the trochlea that prevents proper engagement of the patella during the early phases of knee flexion [22]. However, two-dimensional imaging may lead to misinterpretation of the patellar morphology [7]. Therefore, 3.0T MRI was used in our study for a more detailed analysis of cartilage, tendon and bone marrow and found similar results; individuals with lower trochlear depth showed significantly increased patellofemoral degeneration.…”

Section: Discussionmentioning

confidence: 99%

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Association of trochlear dysplasia with degenerative abnormalities in the knee: data from the Osteoarthritis Initiative

et al. 2013

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Objective To evaluate trochlear morphology as a potential risk factor for patellofemoral osteoarthritis, determined by morphological and quantitative measurements of cartilage degeneration using 3T magnetic resonance imaging (MRI) of the knee. Materials and Methods MR images of right knees of 304 randomly selected subjects, aged 45–60 years, from the Osteoarthritis Initiative (OAI) progression cohort were screened for trochlear dysplasia, defined by an abnormal trochlear depth. Out of 304 subjects, n=85 demonstrated a shallow trochlea (depth ≤3mm; 28%). In these, and also in a random sample of controls with normal trochlear depth (n=50), the facetal ratio and the sulcus angle were calculated and knee structural abnormalities were assessed by using a modified Whole-Organ-MR-Imaging Score (WORMS). Cartilage segmentation was performed and T2 relaxation times and patellar cartilage volume were determined. ANOVA and multivariate regression models were used for statistical analysis of the association of MRI structural measures and trochlear morphology. Results Knees with a shallow trochlea showed higher patellofemoral degeneration (WORMS mean ±standard deviation, 11.2±0.5 versus 5.7±0.6; Multivariate regression, P<0.001) and lower patellar cartilage volume than controls (900±664mm3 versus 1671±671mm3; P<0.001). Knees with an abnormal medial-to-lateral facetal ratio (<0.4) showed increased patellofemoral WORMS scores (12.3±0.9 versus 8.3±0.5; P<0.001). Knees with an abnormal sulcus angle (>170°) also showed increased WORMS scores (12.2±1.1 versus 8.6±0.6; P=0.003). T2 values at the patella were significantly lower in the dysplasia group with a shallow trochlea. However, significance was lost after adjustment for cartilage volume (P=0.673). Conclusion Trochlear dysplasia, defined by a shallow trochlea, was associated with higher WORMS scores and lower cartilage volume, indicating more advanced osteoarthritis at the patellofemoral joint.

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Section: Discussionmentioning

confidence: 99%

“…On plain radiographs, a sulcus angle >150° indicates trochlear dysplasia. However, two-dimensional imaging underestimates the angle and shows substantial differences of about 20° to more accurate MR measurements [7–10]. …”

Section: Introductionmentioning

confidence: 99%

Association of trochlear dysplasia with degenerative abnormalities in the knee: data from the Osteoarthritis Initiative

et al. 2013

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“…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]. Because the dysplastic area on the trochlea is commonly localized at the anterior or proximal aspects, this dysplastic area may not be seen on tangential patellar radiographs taken at 308 or lower flexion [5].…”

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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“…Until today radiographic outcome after trochleoplasty was determined on plain radiographs only [32,39]. As it was shown that minimal rotation aberrations cause misdiagnosis of trochlear dysplasia on plain radiographs [21], it was the aim of this study to describe the trochlear morphology and the patellofemoral relation before and after trochleoplasty on CT images.…”

Section: Discussionmentioning

confidence: 99%

CT changes after trochleoplasty for symptomatic trochlear dysplasia

Fucentese

Schöttle

Pfirrmann

et al. 2006

Knee Surg Sports Traumatol Arthrosc

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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.

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Minimal rotation aberrations cause radiographic misdiagnosis of trochlear dysplasia

Cited by 60 publications

References 13 publications

Association of trochlear dysplasia with degenerative abnormalities in the knee: data from the Osteoarthritis Initiative

Association of trochlear dysplasia with degenerative abnormalities in the knee: data from the Osteoarthritis Initiative

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

CT changes after trochleoplasty for symptomatic trochlear dysplasia

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