PURPOSE: Despite the high prevalence of trochlear dysplasia among patients with patellar instability, it is not well studied and is infrequently addressed surgically. The lack of a validated cadaveric model of trochlear dysplasia may be a contributing factor. The goal of this study was to develop a simple, reproducible, and realistic cadaveric model of trochlear dysplasia by surgically modifying cadaveric femora with normal anatomy and then to validate this model through the use of mechanical and fluoroscopic measurements. METHODS: The floor of the trochlear groove was surgically elevated using an inflatable bone tamp in eight cadaveric femora. The trochlear depth (TD) was measured with a custom-designed measuring device, and radiographic markers of dysplasia (sulcus angle, crossing sign, and prominence) were assessed before and after surgical modification. RESULTS: The average TD was 3.6±1.4, 4.6±1.1, and 5.1±1.0 mm prior to reverse trochleoplasty (RT) and 1.0±1.8, 2.3±1.3, and 3.3±2.5 mm following RT at 0°, 20°, and 40° of flexion, respectively. These direct measurements of TD were confirmed with fluoroscopy. The sulcus angle averaged 141° prior to RT and 157° after RT. The average prominence across all specimens was 3.3±0.7 mm before RT, and 5.5±1.5 mm after RT. Finally, the crossing sign was found to be absent in all knees prior to RT and present in 7 of the 8 after RT. CONCLUSIONS: The results of this study show that elevation of the trochlear floor with an inflatable bone tamp can reproducibly create a simulated dysplastic trochlea. This model may be useful in biomechanical studies of treatments for patellofemoral instability.
PURPOSE: Despite the high prevalence of trochlear dysplasia among patients with patellar instability, it is not well studied and is infrequently addressed surgically. The lack of a validated cadaveric model of trochlear dysplasia may be a contributing factor. The goal of this study was to develop a simple, reproducible, and realistic cadaveric model of trochlear dysplasia by surgically modifying cadaveric femora with normal anatomy and then to validate this model through the use of mechanical and fluoroscopic measurements. METHODS: The floor of the trochlear groove was surgically elevated using an inflatable bone tamp in eight cadaveric femora. The trochlear depth (TD) was measured with a custom-designed measuring device, and radiographic markers of dysplasia (sulcus angle, crossing sign, and prominence) were assessed before and after surgical modification. RESULTS: The average TD was 3.6±1.4, 4.6±1.1, and 5.1±1.0 mm prior to reverse trochleoplasty (RT) and 1.0±1.8, 2.3±1.3, and 3.3±2.5 mm following RT at 0°, 20°, and 40° of flexion, respectively. These direct measurements of TD were confirmed with fluoroscopy. The sulcus angle averaged 141° prior to RT and 157° after RT. The average prominence across all specimens was 3.3±0.7 mm before RT, and 5.5±1.5 mm after RT. Finally, the crossing sign was found to be absent in all knees prior to RT and present in 7 of the 8 after RT. CONCLUSIONS: The results of this study show that elevation of the trochlear floor with an inflatable bone tamp can reproducibly create a simulated dysplastic trochlea. This model may be useful in biomechanical studies of treatments for patellofemoral instability.
Authors: Sander Koëter; Ernie M H F Bongers; Jacky de Rooij; Albert van Kampen Journal: Knee Surg Sports Traumatol Arthrosc Date: 2006-01-05 Impact factor: 4.342