Julien Roger1,2, Sébastien Lustig3, Simone Cerciello4, Carmine Fabio Bruno5, Philippe Neyret6, Elvire Servien3,7. 1. Groupement Hospitalier Nord, Hospices civils de Lyon, Université Claude-Bernard Lyon 1, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France. julien.roger@chu-lyon.fr. 2. Groupement Hospitalier Nord, Hospices civils de Lyon, Université Lyon, 103 bvd de la Croix Rousse, 69004, Lyon, France. julien.roger@chu-lyon.fr. 3. Groupement Hospitalier Nord, Hospices civils de Lyon, Université Lyon, 103 bvd de la Croix Rousse, 69004, Lyon, France. 4. Orthopaedic Surgery, Sports Medicine, Physiotherapy, Casa di Cura Villa Betania Giomi, Via Pio IV, 42, 00165, Rome, Italy. 5. Department of Orthopaedic and Trauma Surgery, "Magna Graecia" University, Catanzaro, Italy. 6. Center A. Trillat, Lyon, France. 7. FIFA medical center of excellence, Lyon, France.
Abstract
PURPOSE: Surgeons mainly consider the anterior anatomy of the distal femur in the treatment of patellar instability (PI) with trochlear dysplasia (TD). Through this research, the idea was to analyse the posterior femoral condyle length in TD. The research team posited the presence of morphological differences in the posterior part of the femoral epiphysis in TD compared to a control group. They also postulated that the posterior bicondylar angle (PCA), in the axial plane, was increased in TD. METHODS: This is a single-centre morphological study of 100 patients who had a computed tomography (CT) using the same protocol. 50 patients with PI (25 dysplasias A and 25 B-C-D according to the Dejour classification), and 50 controls were included. All patients presenting a clinical PI were considered for the study. None of these patients had undergone a surgical treatment prior to imaging. Demographic characteristics, BMI, and laterality were comparable in all patients. 20 pilot CT scans were used to establish the methodology. The following measurements were performed: anterior bicondylar angle, PCA, and condylar lengths with respect to the surgical transepicondylar axis. Ratios were calculated in relation to the femoral width. TD was classified according to the Dejour classification in grade A or grades B-C-D. An analysis of variance and a linear model were performed within some groups to investigate which parameters correlated with the classification's grade. RESULTS: This study showed a link between TD and the PCA: control group (1.4 ± 0.2°), type A group (1.6 ± 0.3°), and types B, C, D group (2.6 ± 0.3°) (p = 0.01). The difference between the control group and types B, C, D TD group was significant (p = 0.002). In groups B, C, D, the PCA was more important, which proves that in these groups the posterior part of the lateral condyle was relatively shorter compared to the medial condyle. The greater the dysplasia, the longer the medial condyle was in the anterior posterior (p = 0.02). CONCLUSIONS: This study shows not only an anterior but also a posterior anomaly in PI with TD. There is a correlation between the severity of the anterior deformation and the PCA: in other words, the knee is placed in valgus in flexure which promotes the external dislocation of the patella. This anatomical study could open a field of research on the development of surgical treatments based on the correction of posterior condylar femoral anomalies in PI. LEVEL OF EVIDENCE: III.
PURPOSE: Surgeons mainly consider the anterior anatomy of the distal femur in the treatment of patellar instability (PI) with trochlear dysplasia (TD). Through this research, the idea was to analyse the posterior femoral condyle length in TD. The research team posited the presence of morphological differences in the posterior part of the femoral epiphysis in TD compared to a control group. They also postulated that the posterior bicondylar angle (PCA), in the axial plane, was increased in TD. METHODS: This is a single-centre morphological study of 100 patients who had a computed tomography (CT) using the same protocol. 50 patients with PI (25 dysplasias A and 25 B-C-D according to the Dejour classification), and 50 controls were included. All patients presenting a clinical PI were considered for the study. None of these patients had undergone a surgical treatment prior to imaging. Demographic characteristics, BMI, and laterality were comparable in all patients. 20 pilot CT scans were used to establish the methodology. The following measurements were performed: anterior bicondylar angle, PCA, and condylar lengths with respect to the surgical transepicondylar axis. Ratios were calculated in relation to the femoral width. TD was classified according to the Dejour classification in grade A or grades B-C-D. An analysis of variance and a linear model were performed within some groups to investigate which parameters correlated with the classification's grade. RESULTS: This study showed a link between TD and the PCA: control group (1.4 ± 0.2°), type A group (1.6 ± 0.3°), and types B, C, D group (2.6 ± 0.3°) (p = 0.01). The difference between the control group and types B, C, D TD group was significant (p = 0.002). In groups B, C, D, the PCA was more important, which proves that in these groups the posterior part of the lateral condyle was relatively shorter compared to the medial condyle. The greater the dysplasia, the longer the medial condyle was in the anterior posterior (p = 0.02). CONCLUSIONS: This study shows not only an anterior but also a posterior anomaly in PI with TD. There is a correlation between the severity of the anterior deformation and the PCA: in other words, the knee is placed in valgus in flexure which promotes the external dislocation of the patella. This anatomical study could open a field of research on the development of surgical treatments based on the correction of posterior condylar femoral anomalies in PI. LEVEL OF EVIDENCE: III.
Authors: Alex E White; Peters T Otlans; Dylan P Horan; Daniel B Calem; William D Emper; Kevin B Freedman; Fotios P Tjoumakaris Journal: Orthop J Sports Med Date: 2021-05-20
Authors: Philip Winnock de Grave; Thomas Luyckx; Kurt Claeys; Thomas Tampere; Jonas Kellens; Jacobus Müller; Paul Gunst Journal: Knee Surg Sports Traumatol Arthrosc Date: 2020-07-31 Impact factor: 4.114