Observer Agreement on the Dejour Trochlear Dysplasia Classification

Lippacher, Sabine; Dejour, David; Elsharkawi, Mohammed; Dornacher, Daniel; Ring, Christina; Dreyhaupt, Jens; Reichel, Heiko; Nelitz, Manfred

doi:10.1177/0363546511433028

Cited by 208 publications

(125 citation statements)

References 29 publications

(39 reference statements)

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“…When the MRI Dejour classification is simplified from a 4-part to a 2-part classification system, in an attempt to differentiate mild and severe trochlear dysplasia, it has been shown to have better reproducibility. 12 This was also found to be true in our population of skeletally immature patients where the simplified 2-part classification was 75% sensitive and 100% specific for identifying patients with patellar instability.…”

Section: Discussionsupporting

confidence: 66%

“…We found that the MRI modification of the Dejour classification had suboptimal reliability. Lippacher et al 12 had similar findings. When the MRI Dejour classification is simplified from a 4-part to a 2-part classification system, in an attempt to differentiate mild and severe trochlear dysplasia, it has been shown to have better reproducibility.…”

Section: Discussionmentioning

confidence: 67%

“…3,5,11 The presence and severity of trochlear dysplasia has commonly been evaluated and categorized based on the Dejour radiographic and magnetic resonance imaging (MRI) classifications, and more recently using more objective measurements, including the lateral trochlear inclination (LTI) and the trochlear depth index (TDI). 2,12,16 …”

mentioning

confidence: 99%

“…7 Additionally, there are inconsistences in the adult literature regarding the inter- and intraobserver agreement of the Dejour classification as well as poor correlation between the objective measurements of trochlear dysplasia and the Dejour classification. 12,13,17 …”

mentioning

confidence: 99%

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Are the Current Classifications and Radiographic Measurements for Trochlear Dysplasia Appropriate in the Skeletally Immature Patient?

Stepanovich

Bomar

Pennock

2016

Orthopaedic Journal of Sports Medicine

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Background:The assessment and classification of trochlear dysplasia in pediatric patients has yet to be well documented or validated.Purpose:To examine several different measurements/classifications of trochlear dysplasia in skeletally immature patients to assess inter- and intraobserver reliability and to determine which best correlates with patellar instability.Study Design:Cohort study (diagnosis); Level of evidence, 3.Methods:Radiographs and magnetic resonance imaging (MRI) scans of 36 skeletally immature patients undergoing surgery for patellar instability were compared with 27 age-matched cohort patients who had similar imaging for an acute knee injury but no clinical evidence of patellar instability. Trochlear dysplasia was measured/classified using the radiographic and MRI Dejour classifications, the trochlear depth index (TDI), the lateral trochlear inclination (LTI), and the medial condyle trochlear offset (MCTO). Additionally, the tibial tubercle–trochlear groove (TT-TG) distance was calculated for all patients. Inter- and intraobserver reliability of each measurement, as well as the ability to discriminate patients with patellar instability, were evaluated.Results:Inadequate radiographs prevented the radiographic Dejour classification from being assessed in 78% of cases. The MRI Dejour classification had the lowest inter- and intraobserver reliabilities (κ = 0.687 and 0.596, respectively); all other measurements were greater than 0.80. The TDI, LTI, and MCTO all significantly differentiated patients with patellar instability compared with those with no instability, with critical cutoffs of 3 mm, 17°, and 1 mm, respectively. Patients with a TDI <3 mm or MCTO <1 mm were 33 and 38 times more likely to have patellar instability, respectively. The TT-TG was directly correlated with trochlear dysplasia severity.Conclusion:Trochlear dysplasia is common in skeletally immature patients with patellar instability. The objective assessment of trochlear dysplasia with axial imaging MRI is reliable. The objective measurements of TDI, LTI, and MCTO are more reproducible than the more subjective Dejour classification. The TDI, LTI, and MCTO all significantly differentiated patients with patellar instability.

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Section: Discussionsupporting

confidence: 66%

Section: Discussionmentioning

confidence: 67%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Are the Current Classifications and Radiographic Measurements for Trochlear Dysplasia Appropriate in the Skeletally Immature Patient?

Stepanovich

Bomar

Pennock

2016

Orthopaedic Journal of Sports Medicine

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“…Trochlear dysplasia was assessed by transverse MRI and classified according to the system described by Dejour et al [14]. To improve the reliability of the trochlear dysplasia classification, we integrated Dejour's 4-grade classification (Type A–D) into a 2-grade classification system that has recently been recommended: low-grade (type A) and high-grade trochlear dysplasia (types B–D) [15]. Patellar height was evaluated using sagittal T1-weighted images according to the Insall and Salvati index, which is a ratio of patellar tendon length to the longest sagittal patellar dimension [16].…”

Section: Methodsmentioning

confidence: 99%

Vastus Medialis Obliquus Muscle Morphology in Primary and Recurrent Lateral Patellar Instability

Balcarek¹,

Oberthür²,

Frosch³

et al. 2014

BioMed Research International

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The morphology of the vastus medialis obliquus (VMO) muscle in the anatomical setting of an unstable patella has not been described. Therefore, the purpose of this study was to investigate the morphological parameters of the VMO muscle that delineate its importance in the maintenance of patellofemoral joint stability. Eighty-two consecutive subjects were prospectively enrolled in this study. The groups were composed of thirty patients with an acute primary patellar dislocation, thirty patients with recurrent patellar dislocation, and twenty-two controls. Groups were adjusted according to sex, age, body mass index, and physical activity. Magnetic resonance imaging was used to measure the VMO cross-sectional area, muscle-fiber angulation, and the craniocaudal extent of the muscle in relation to the patella. No significant difference was found with respect to all measured VMO parameters between primary dislocation, recurrent dislocation, and control subjects with a trend noted for only the VMO cross-sectional area and the VMO muscle-fiber angulation. This finding is notable in that atrophy of the VMO has often been suggested to play an important role in the pathophysiology of an unstable patellofemoral joint.

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The Dejour classification for trochlear dysplasia shows slight interobserver and substantial intraobserver reliability

Martinez‐Cano,

Tuca,

Gallego

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeTrochlear dysplasia is one of the main risk factors for recurrent patellar dislocation. The Dejour classification identifies four categories that can be used to classify trochlear dysplasia. The purpose of this study is to evaluate the inter‐ and intraobserver reliability of the Dejour classification for trochlear dysplasia. The hypothesis was that both intra‐ and interobserver reliability would be at least moderate.MethodsThis is a cross‐sectional, reliability study. Twenty‐eight examiners from the International Patellofemoral Study Group 2022 meeting evaluated lateral radiographs of the knee and axial magnetic resonance images from 15 cases of patellofemoral instability with trochlear dysplasia. They classified each case according to Dejour's classification for trochlear dysplasia (A–D). There were three rounds: one with only computed radiograph (CR), one with only magnetic resonance imaging (MRI) and one with both. Inter‐ and intraobserver reliability were calculated using κ coefficient (0–1).ResultsThe mean age of patients was: 14.6 years; 60% were female and 53% had open physis. The interobserver reliability κ probabilities were 0.2 (CR), 0.13 (MRI) and 0.12 (CR and MRI). The intraobserver reliability κ probabilities were 0.45 (CR), 0.44 (MRI) and 0.65 (CR and MRI).ConclusionThe Dejour classification for trochlear dysplasia has slight interobserver reliability and substantial intraobserver reliability.Level of EvidenceLevel I.

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Observer Agreement on the Dejour Trochlear Dysplasia Classification

Abstract: D. Dejour's classification is valid for typing trochlear dysplasia and is particularly useful in separating low-grade from high-grade dysplasia.

Cited by 208 publications

References 29 publications

Are the Current Classifications and Radiographic Measurements for Trochlear Dysplasia Appropriate in the Skeletally Immature Patient?

Are the Current Classifications and Radiographic Measurements for Trochlear Dysplasia Appropriate in the Skeletally Immature Patient?

Vastus Medialis Obliquus Muscle Morphology in Primary and Recurrent Lateral Patellar Instability

The Dejour classification for trochlear dysplasia shows slight interobserver and substantial intraobserver reliability

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