Joanne H Wang1, Douglas S Weinberg1, Kouami Amakoutou2, Daniel R Cooperman3, Raymond W Liu4. 1. Department of Orthopedic Surgery, Resident Physician, University Hospitals/Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106, USA. 2. Research Fellow in Pediatric Orthopaedic Surgery, University Hospitals/Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106, USA. 3. Department of Orthopedic Surgery, Professor of Pediatric Orthopedics, Yale-New Haven Children's Hospital, 1 Park Street, New Haven, CT, 06504, USA. 4. Department of Orthopedic Surgery, Victor M. Goldberg Professor in Orthopedic Surgery, University Hospitals/Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106, USA. Raymond.Liu@UHhospitals.org.
Abstract
BACKGROUND: The etiology of patellofemoral disorders is multifactorial. Preoperative patellofemoral anatomy evaluation is of great importance in patients undergoing surgery for patellofemoral disorders. Although anatomical risk factors of patellofemoral disorders have been thoroughly investigated in clinical and radiological studies, there are sparse data regarding the association between trochlear dysplasia with other anatomical parameters. This study sought to explore those associations using a large osteological collection. METHODS: Five-hundred and seventy-nine cadaveric skeletons were obtained from the Hamann-Todd osteological collection. Mechanical lateral distal femoral angle (mLDFA), medial proximal tibial angle (MPTA), femoral version, tibial torsion, lateral position of the tibial tubercle, and femoral length were modeled as predictors of medial and lateral flange height of the distal femur trochlea at various degrees of knee flexion. RESULTS: The average age and standard deviation for the 1158 lower extremities analyzed was 55.9 ± 10.2 years. There were 500 males (86%) and 79 females. Increasing MPTA or tibial valgus predicted increasing lateral femoral flange height at 0, 30, and 50 degrees of knee flexion [(standardized beta 0.111, p = 0.01), (standardized beta 0.129, p < 0.001), and (standardized beta 0.186, p < 0.001), respectively]. Increasing internal tibial torsion predicted increased medial flange height at 30 and 50° [(standardized beta - 0.114, p = 0.006), (standardized beta - 0.108, p = 0.006), respectively]. Increased femoral retroversion predicted increasing lateral flange height at 0 and 30 degrees [(standardized beta - 0.105, p = 0.005), (standardized beta - 0.098, p = 0.004), respectively]. CONCLUSIONS: To maintain the equilibrium necessary for effective patellar tracking, the depth of trochlear groove appears to effectively compensate for some of the anatomical parameters of the proximal tibia associated with patellofemoral disorders, and appears to be less influenced by femoral alignment. The clinical relevance of these findings warrants further investigation, and emphasizes the importance of carefully assessing the lower limb alignment in the management of patellofemoral disorders.
BACKGROUND: The etiology of patellofemoral disorders is multifactorial. Preoperative patellofemoral anatomy evaluation is of great importance in patients undergoing surgery for patellofemoral disorders. Although anatomical risk factors of patellofemoral disorders have been thoroughly investigated in clinical and radiological studies, there are sparse data regarding the association between trochlear dysplasia with other anatomical parameters. This study sought to explore those associations using a large osteological collection. METHODS: Five-hundred and seventy-nine cadaveric skeletons were obtained from the Hamann-Todd osteological collection. Mechanical lateral distal femoral angle (mLDFA), medial proximal tibial angle (MPTA), femoral version, tibial torsion, lateral position of the tibial tubercle, and femoral length were modeled as predictors of medial and lateral flange height of the distal femur trochlea at various degrees of knee flexion. RESULTS: The average age and standard deviation for the 1158 lower extremities analyzed was 55.9 ± 10.2 years. There were 500 males (86%) and 79 females. Increasing MPTA or tibial valgus predicted increasing lateral femoral flange height at 0, 30, and 50 degrees of knee flexion [(standardized beta 0.111, p = 0.01), (standardized beta 0.129, p < 0.001), and (standardized beta 0.186, p < 0.001), respectively]. Increasing internal tibial torsion predicted increased medial flange height at 30 and 50° [(standardized beta - 0.114, p = 0.006), (standardized beta - 0.108, p = 0.006), respectively]. Increased femoral retroversion predicted increasing lateral flange height at 0 and 30 degrees [(standardized beta - 0.105, p = 0.005), (standardized beta - 0.098, p = 0.004), respectively]. CONCLUSIONS: To maintain the equilibrium necessary for effective patellar tracking, the depth of trochlear groove appears to effectively compensate for some of the anatomical parameters of the proximal tibia associated with patellofemoral disorders, and appears to be less influenced by femoral alignment. The clinical relevance of these findings warrants further investigation, and emphasizes the importance of carefully assessing the lower limb alignment in the management of patellofemoral disorders.
Authors: Robert N Steensen; Jared C Bentley; Thai Q Trinh; Jeffrey R Backes; Roger E Wiltfong Journal: Am J Sports Med Date: 2015-01-13 Impact factor: 6.202
Authors: Florian B Imhoff; Victor Funke; Lukas N Muench; Andreas Sauter; Maximilian Englmaier; Klaus Woertler; Andreas B Imhoff; Matthias J Feucht Journal: Knee Surg Sports Traumatol Arthrosc Date: 2019-05-24 Impact factor: 4.342
Authors: Douglas S Weinberg; Braden J Tucker; Joseph P Drain; David M Wang; Allison Gilmore; Raymond W Liu Journal: Knee Date: 2016-04-14 Impact factor: 2.199
Authors: Raymond W Liu; Paul Toogood; Daniel E Hart; Dwight T Davy; Daniel R Cooperman Journal: J Pediatr Orthop Date: 2009 Oct-Nov Impact factor: 2.324
Authors: Matthias J Feucht; Patricia M Lutz; Conrad Ketzer; Marco C Rupp; Matthias Cotic; Andreas B Imhoff; Jonas Pogorzelski Journal: Arch Orthop Trauma Surg Date: 2020-10-30 Impact factor: 3.067