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Association of Trochlear Length on Sagittal MRI to Trochlear Dysplasia in Knees With Patellar Instability

BACKGROUND: Trochlear dysplasia is a primary risk factor for patellar instability and leads to loss of the osteochondral constraint of the patella. Trochleoplasty techniques include the Peterson grooveplasty, which alters the length of the trochlea; however, a radiographic measurement of trochlear l...

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Autores principales: Tanaka, Miho J., LaPorte, Zachary L., Perry, Nicholas P.J., Velasquez Hammerle, Maria V., Nukala, Varun, Liu, Fang
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10280549/
https://www.ncbi.nlm.nih.gov/pubmed/37347028
http://dx.doi.org/10.1177/23259671231169730
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author Tanaka, Miho J.
LaPorte, Zachary L.
Perry, Nicholas P.J.
Velasquez Hammerle, Maria V.
Nukala, Varun
Liu, Fang
author_facet Tanaka, Miho J.
LaPorte, Zachary L.
Perry, Nicholas P.J.
Velasquez Hammerle, Maria V.
Nukala, Varun
Liu, Fang
author_sort Tanaka, Miho J.
collection PubMed
description BACKGROUND: Trochlear dysplasia is a primary risk factor for patellar instability and leads to loss of the osteochondral constraint of the patella. Trochleoplasty techniques include the Peterson grooveplasty, which alters the length of the trochlea; however, a radiographic measurement of trochlear length to support this has not been described. PURPOSE: To describe measurements to quantify trochlear length on sagittal magnetic resonance imaging in patients with and without patellar instability and to correlate trochlear length with measurements of trochlear dysplasia. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: A total of 66 age- and sex-matched knees (36 female and 30 male; mean age, 20.8 ± 4.8 years) were included in this study, of which 33 had patellar instability. Trochlear extension length (TEL) and trochlear alpha angle (TAA) were measured on 3 sagittal magnetic resonance imaging scans (center of the knee, center of the medial condyle, and center of the lateral condyle), and measurements were compared between symptomatic and control knees. Receiver operating characteristic curve analysis was performed, and the area under the curve (AUC) was calculated to describe the accuracy of each measurement to distinguish between knees with and without patellar instability. Linear and multivariate regression analyses were performed to assess the relationship between sagittal measurements and axial measurements of trochlear dysplasia, including lateral trochlear inclination, sulcus angle, and trochlear depth, as well as patient size reflected by the epicondylar distance. RESULTS: In symptomatic knees, the central trochlea extended more proximally than in control knees, as determined by the TEL (14.0 ± 3.0 vs 11.5 ± 2.3 mm, respectively; P < .001) and TAA (68.4° ± 3.8° vs 70.5° ± 3.4°, respectively; P = .017). AUC calculations showed that a TEL ≥11 mm at the central trochlea was predictive of patellar instability in both male and female knees (AUC = 0.83 and 0.77, respectively), as was a TAA ≤67° in female knees (AUC = 0.72). An independent association between the central TEL and sulcus angle was found. The central TEL showed a weak correlation with patient size, as measured by the epicondylar distance, while the TAA did not. CONCLUSION: In knees with symptomatic patellar instability, the central trochlea was found to extend 2.5 mm more proximally than in control knees, and this increase in length correlated with severity of trochlear dysplasia. As radiographic examinations of the trochlea and grooveplasty procedures are often based on the proximal extent of the cartilaginous trochlea, further studies are needed to identify the role of trochlear length in the assessment and treatment of trochlear dysplasia in the setting of patellar instability.
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spelling pubmed-102805492023-06-21 Association of Trochlear Length on Sagittal MRI to Trochlear Dysplasia in Knees With Patellar Instability Tanaka, Miho J. LaPorte, Zachary L. Perry, Nicholas P.J. Velasquez Hammerle, Maria V. Nukala, Varun Liu, Fang Orthop J Sports Med Article BACKGROUND: Trochlear dysplasia is a primary risk factor for patellar instability and leads to loss of the osteochondral constraint of the patella. Trochleoplasty techniques include the Peterson grooveplasty, which alters the length of the trochlea; however, a radiographic measurement of trochlear length to support this has not been described. PURPOSE: To describe measurements to quantify trochlear length on sagittal magnetic resonance imaging in patients with and without patellar instability and to correlate trochlear length with measurements of trochlear dysplasia. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: A total of 66 age- and sex-matched knees (36 female and 30 male; mean age, 20.8 ± 4.8 years) were included in this study, of which 33 had patellar instability. Trochlear extension length (TEL) and trochlear alpha angle (TAA) were measured on 3 sagittal magnetic resonance imaging scans (center of the knee, center of the medial condyle, and center of the lateral condyle), and measurements were compared between symptomatic and control knees. Receiver operating characteristic curve analysis was performed, and the area under the curve (AUC) was calculated to describe the accuracy of each measurement to distinguish between knees with and without patellar instability. Linear and multivariate regression analyses were performed to assess the relationship between sagittal measurements and axial measurements of trochlear dysplasia, including lateral trochlear inclination, sulcus angle, and trochlear depth, as well as patient size reflected by the epicondylar distance. RESULTS: In symptomatic knees, the central trochlea extended more proximally than in control knees, as determined by the TEL (14.0 ± 3.0 vs 11.5 ± 2.3 mm, respectively; P < .001) and TAA (68.4° ± 3.8° vs 70.5° ± 3.4°, respectively; P = .017). AUC calculations showed that a TEL ≥11 mm at the central trochlea was predictive of patellar instability in both male and female knees (AUC = 0.83 and 0.77, respectively), as was a TAA ≤67° in female knees (AUC = 0.72). An independent association between the central TEL and sulcus angle was found. The central TEL showed a weak correlation with patient size, as measured by the epicondylar distance, while the TAA did not. CONCLUSION: In knees with symptomatic patellar instability, the central trochlea was found to extend 2.5 mm more proximally than in control knees, and this increase in length correlated with severity of trochlear dysplasia. As radiographic examinations of the trochlea and grooveplasty procedures are often based on the proximal extent of the cartilaginous trochlea, further studies are needed to identify the role of trochlear length in the assessment and treatment of trochlear dysplasia in the setting of patellar instability. SAGE Publications 2023-06-05 /pmc/articles/PMC10280549/ /pubmed/37347028 http://dx.doi.org/10.1177/23259671231169730 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by-nc-nd/4.0/This article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 License (https://creativecommons.org/licenses/by-nc-nd/4.0/) which permits non-commercial use, reproduction and distribution of the work as published without adaptation or alteration, without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Article
Tanaka, Miho J.
LaPorte, Zachary L.
Perry, Nicholas P.J.
Velasquez Hammerle, Maria V.
Nukala, Varun
Liu, Fang
Association of Trochlear Length on Sagittal MRI to Trochlear Dysplasia in Knees With Patellar Instability
title Association of Trochlear Length on Sagittal MRI to Trochlear Dysplasia in Knees With Patellar Instability
title_full Association of Trochlear Length on Sagittal MRI to Trochlear Dysplasia in Knees With Patellar Instability
title_fullStr Association of Trochlear Length on Sagittal MRI to Trochlear Dysplasia in Knees With Patellar Instability
title_full_unstemmed Association of Trochlear Length on Sagittal MRI to Trochlear Dysplasia in Knees With Patellar Instability
title_short Association of Trochlear Length on Sagittal MRI to Trochlear Dysplasia in Knees With Patellar Instability
title_sort association of trochlear length on sagittal mri to trochlear dysplasia in knees with patellar instability
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10280549/
https://www.ncbi.nlm.nih.gov/pubmed/37347028
http://dx.doi.org/10.1177/23259671231169730
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