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The severity of patellar and trochlear dysplasia are correlated

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Patellar instability is a frequent clinical situation in adolescents and young adults. One of the most important risk factors of this condition is trochlea dysplasia. Few studies have analyzed the role of patellar dysplasia. The objective of this paper was to assess the correlation between trochlear and patellar dysplasia. The hypothesis is that patellar dysplasia increased in parallel with femoral trochlear dysplasia.

Methods

The study included patients operated on at least one knee for patellar instability between 2008 and 2020. For these patients, symptomatic knees (operated or not) were included if they had lateral and patellofemoral skyline radiographs. Two blinded observers categorized each trochlear and patellar dysplasia according to the Dejour and Wiberg classifications. Patellar height was also measured by applying the Caton–Deschamps index.

Results

A total of 100 patients were selected, involving 149 symptomatic knees. A significant correlation between trochlear and patellar dysplasia types was found (0.82; p < 0.0001). Dejour types B and C of trochlear dysplasia were significantly more often associated with patellar dysplasia than Dejour type A (p = 0.033 and p = 0.019, respectively). Moreover, severe Wiberg 3 patellar dysplasia was significantly associated with type D Dejour trochlear dysplasia than with the sum of all other Dejour types taken together (p < 0.0001).

Conclusion

This study confirms a linear correlation between the severity of patellar and trochlear dysplasia. Further studies are needed to evaluate the place of patellar dysplasia in the therapeutic strategy.

Level of evidence

Level IV.

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References

  1. Albee F (1915) Bone graft wedge in the treatment of habitual dislocation of the patella. Med Rec 88:257–259

    Google Scholar 

  2. Ammann E, Meier RL, Rutz E, Vavken P, Studer K, Camathias C (2020) Trochleoplasty improves knee flexion angles and quadriceps function during gait only if performed bilaterally. Knee Surg Sports Traumatol Arthrosc 28(7):2067–2076

    Article  PubMed  Google Scholar 

  3. Beaufils P, Thaunat M, Pujol N, Scheffler S, Rossi R, Carmont M (2012) Trochleoplasty in major trochlear dysplasia: current concepts. Sports Med Arthrosc Rehabil Ther Technol 21:4–7

    Google Scholar 

  4. Biedert RM, Albrecht S (2006) The patellotrochlear index: a new index for assessing patellar height. Knee Surg Sports Traumatol Arthrosc 14:707–712

    Article  PubMed  Google Scholar 

  5. Caton J, Deschamps G, Chambat P, Lerat JL, Dejour H (1982) Patella infera apropos of 128 cases. Rev Chir Orthop Reparatrice Appar Mot 68:317–325

    CAS  PubMed  Google Scholar 

  6. Davis DK, Fithian DC (2002) Techniques of medial retinacular repair and reconstruction. Clin Orthop Relat Res 402:38–52

    Article  Google Scholar 

  7. Dejour H, Walch G, Neyret P, Adeleine P (1990) Dysplasia of the femoral trochlea. Rev Chir Orthop 76:45–54

    CAS  PubMed  Google Scholar 

  8. Dejour D, Le Coultre B (2007) Osteotomies in patello-femoral instabilities. Sports Med Arthrosc 15:39–46

    Article  PubMed  Google Scholar 

  9. Dejour D, Saggin P (2010) The sulcus deepening trochleoplasty. Lyon’s Proced Int Orthop 34:311–316

    Article  Google Scholar 

  10. Fucentese SF, von Roll A, Koch PP, Epari DR, Fuchs B, Schottle PB (2006) The patella morphology in trochlear dysplasia, a comparative MRI study. Knee 13:145–150

    Article  PubMed  Google Scholar 

  11. Geraghty L, Zordan R, Walker P, Chao TW, Talbot S (2021) Patellar dislocation is associated with increased tibial but not femoral rotational asymmetry. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-021-06813-3

    Article  PubMed  Google Scholar 

  12. Gorbaty JD, Varkey DT, Hong IS, Trofa DP, Odum SM, Piasecki DP, Saltzman BM, Fleischli JE (2021) Outcomes and reoperation rates after tibial tubercle transfer and medial patellofemoral ligament reconstruction: higher revision stabilization in patients with trochlear dysplasia and patella alta. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-021-06784-5

    Article  PubMed  Google Scholar 

  13. Goutallier D, Bernageau J, Lecudonnec B (1978) Measurement of the anterior tibial tuberosity-trochlea gap (TT-GT): technique, results, interest. Rev Chir Orthop 64:423–428

    CAS  PubMed  Google Scholar 

  14. Goutallier D, Raou D, Van-Driessche S (2002) Retro-trochlear wedge reduction trochleoplasty for the treatment of painful patella syndrome with protruding trochleae technical note and early results. Rev Chir Orthop 88:678–685

    CAS  PubMed  Google Scholar 

  15. Hiemstra LA, Kerslake S, Lafave M (2017) Assessment of demographic and pathoanatomic risk factors in recurrent patellofemoral instability. Knee Surg Sports Traumatol Arthrosc 25(12):3849–3855

    Article  PubMed  Google Scholar 

  16. Hiemstra LA, Peterson D, Youssef M, Soliman J, Banfield L, Ayeni OR (2019) Trochleoplasty provides good clinical outcomes and an acceptable complication profile in both short and long-term follow-up. Knee Surg Sports Traumatol Arthrosc 27(9):2967–2983

    Article  PubMed  Google Scholar 

  17. Koëter S, Bongers EM, de Rooij J, van Kampen A (2006) Minimal rotation aberrations cause radiographic misdiagnosis of trochlear dysplasia. Knee Surg Sports Traumatol Arthrosc 14:713–717

    Article  PubMed  Google Scholar 

  18. Lippacher S, Dejour D, Elsharkawi M, Dornacher D, Ring C, Dreyhaupt J, Reichel H, Nelitz M (2012) Observer agreement on the dejour trochlear dysplasia classification: a comparison of true lateral radiographs and axial magnetic resonance images. Am J Sports Med 40(4):837–843

    Article  PubMed  Google Scholar 

  19. Longo UG, Vincenzo C, Mannering N, Ciuffreda M, Salvatore G, Berton A, Denaro V (2018) Trochleoplasty techniques provide good clinical results in patients with trochlear dysplasia. Knee Surg Sports Traumatol Arthrosc 26(9):2640–2658

    Article  PubMed  Google Scholar 

  20. Lutz PM, Winkler PW, Rupp MC, Geyer S, Imhoff AB, Feucht MJ (2021) Complex patellofemoral reconstruction leads to improved physical and sexual activity in female patients suffering from chronic patellofemoral instability. Knee Surg Sports Traumatol Arthrosc 29(9):3017–3024

    Article  PubMed  Google Scholar 

  21. Masse Y (1978) Trochleoplasty restoration of the intercondylar groove in subluxations and dislocations of the patella. Rev Chir Orthop Reparatrice Appar Mot 64:3–17

    CAS  PubMed  Google Scholar 

  22. Meynard P, Malatray M, Sappey-Marinier E, Magnussen RA, Bodiou V, Lustig S, Servien E (2021) Medial patellofemoral ligament reconstruction for recurrent patellar dislocation allows a good rate to return to sport. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-021-06815-1

    Article  PubMed  Google Scholar 

  23. Morscher E (1978) Osteotomy of the patella in chondromalacia preliminary report. Arch Orthop Trauma Surg 92:139–147

    Article  CAS  PubMed  Google Scholar 

  24. Nelitz M, Lippacher S, Reichel H, Dornacher D (2014) Evaluation of trochlear dysplasia using MRI: correlation between the classification system of dejour and objective parameters of trochlear dysplasia. Knee Surg Sports Traumatol Arthrosc 22:120–127

    Article  CAS  PubMed  Google Scholar 

  25. Panni AS, Cerciello S, Maffulli N, Di Cesare M, Servien E, Neyret P (2011) Patellar shape can be a predisposing factor in patellar instability. Knee Surg Sports Traumatol Arthrosc 19:663–670

    Article  PubMed  Google Scholar 

  26. Pfirrmann CW, Zanetti M, Romero J, Hodler J (2000) Femoral trochlear dysplasia: MR findings. Radiology 216:858–864

    Article  CAS  PubMed  Google Scholar 

  27. Remy F, Besson A, Migaud H, Cotten A, Gougeon F, Duquennoy A (1998) Reproducibility of the radiographic analysis of dysplasia of the femoral trochlea. Intra-and interobserver analysis of 68 knees. Rev Chir Orthop Reparatrice Appar Mot 84:728–733

    CAS  PubMed  Google Scholar 

  28. Rémy F, Chantelot C, Fontaine C, Demondion X, Migaud H, Gougeon F (1998) Inter-and intraobserver reproducibility in radiographic diagnosis and classification of femoral trochlear dysplasia. Surg Radiol Anat 20:285–289

    Article  PubMed  Google Scholar 

  29. Saragaglia D, Mader R, Blaysat M, Mercier N (2012) Medial facet patelloplasty in patellar instability associated with patellofemoral dysplasia: a report of 26 cases. Orthop Traumatol Surg Res 98:167–172

    Article  CAS  PubMed  Google Scholar 

  30. Servien E, Ait Si Selmi T, Neyret P (2003) Study of the patellar apex in objective patellar dislocation. Rev Chir Orthop Reparatrice Appar Mot 89:605–612

    CAS  PubMed  Google Scholar 

  31. Skelley N, Friedman M, McGinnis M, Smith C, Hillen T, Matava M (2015) Inter- and intraobserver reliability in the MRI measurement of the tibial tubercle-trochlear groove distance and trochlea dysplasia. Am J Sports Med 43:873–878

    Article  PubMed  Google Scholar 

  32. Stepanovich M, Bomar JD, Pennock AT (2016) Are the current classifications and radiographic measurements for trochlear dysplasia appropriate in the skeletally immature patient? Orthop J Sports Med 4:2325967116669490

    Article  PubMed  PubMed Central  Google Scholar 

  33. Tardieu C, Dupont JY (2001) The origin of femoral trochlear dysplasia: comparative anatomy, evolution, and growth of the patellofemoral joint. Rev Chir Orthop Reparatrice Appar Mot 87:373–383

    CAS  PubMed  Google Scholar 

  34. Thaunat M, Bessiere C, Pujol N, Boisrenoult P, Beaufils P (2011) Recession wedge trochleoplasty as an additional procedure in the surgical treatment of patellar instability with major trochlear dysplasia: early results. Orthop Traumatol Surg Res 97:833–845

    Article  CAS  PubMed  Google Scholar 

  35. Tscholl PM, Wanivenhaus F, Fucentese SF (2017) Conventional radiographs and magnetic resonance imaging for the analysis of trochlear dysplasia: the influence of selected levels on magnetic resonance imaging. Am J Sports Med 45:1059–1065

    Article  PubMed  Google Scholar 

  36. van Sambeeck JDP, van de Groes SAW, Verdonschot N, Hannink G (2018) Trochleoplasty procedures show complication rates similar to other patellar-stabilizing procedures. Knee Surg Sports Traumatol Arthrosc 26:2841–2857

    Article  PubMed  Google Scholar 

  37. Von-Knoch F, Bohm T, Burgi ML, Von-Knoch M, Bereiter H (2006) Trochleaplasty for recurrent patellar dislocation in association with trochlear dysplasia. A 4- to 14-year follow-up study. J Bone Joint Surg Br 88:1331–1335

    Article  CAS  PubMed  Google Scholar 

  38. Voss A, Shin SR, Murakami AM, Cote MP, Achtnich A, Herbst E, Schepsis AA, Edgar C (2017) Objective quantification of trochlear dysplasia: assessment of the difference in morphology between control and chronic patellofemoral instability patients. Knee 24:1247–1255

    Article  PubMed  Google Scholar 

  39. Wiberg G (1941) Roentgenographic and anatomic studies on the femoropatellar joint. Acta orthop Scand 12:319–410

    Article  Google Scholar 

  40. Zaffagnini S, Previtali D, Tamborini S, Pagliazzi G, Filardo G, Candrian C (2019) Recurrent patellar dislocations: trochleoplasty improves the results of medial patellofemoral ligament surgery only in severe trochlear dysplasia. Knee Surg Sports Traumatol Arthrosc 27(11):3599–3613

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopedic and Trauma Surgery, Centre Hospitalier de Versailles, André Mignot Hospital, Île-de-France Ouest University, 177 Rue de Versailles, 78150, Le Chesnay, France

    Victor Meissburger, Grégoire Rougereau, Philippe Boisrenoult & Nicolas Pujol

  2. Department of Pediatric Orthopedics, Hôpital des enfants, Toulouse University, Purpan, 31059, Toulouse, France

    Tristan Langlais

  3. Department of Pediatric Orthopedics, Hôpital Armand-Trousseau, AP-HP, Sorbonne University, 26 avenue du Dr-Arnold-Netter, 75012, Paris, France

    Tristan Langlais

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  1. Victor Meissburger
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  2. Grégoire Rougereau
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  4. Philippe Boisrenoult
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  5. Nicolas Pujol
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Contributions

VM and GR participated in the data measurements, and article writing. NP and DD participated in the study design and manuscript revision. TL participated in data interpretation and statistical analysis. Each author has given final approval of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Correspondence to Nicolas Pujol.

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Meissburger, V., Rougereau, G., Langlais, T. et al. The severity of patellar and trochlear dysplasia are correlated. Knee Surg Sports Traumatol Arthrosc 30, 3438–3443 (2022). https://doi.org/10.1007/s00167-022-06945-0

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