Top

Knee Surgery, Sports Traumatology, Arthroscopy

Published in:

01-12-2020 | Magnetic Resonance Imaging | KNEE

Femoral trochlear morphology is associated with anterior cruciate ligament injury in skeletally immature patients

Authors: Yoon Hae Kwak, Ji-Hoon Nam, Yong-Gon Koh, Byoung-Kyu Park, Kee-Bum Hong, Kyoung-Tak Kang

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 12/2020

Abstract

Purpose

Knee joint morphology is a known contributor to anterior cruciate ligament (ACL) injury, and the shape of the distal femur condyle is one of the associated factors. However, the relationship between femoral trochlear morphology and ACL injury is unclear, especially in pediatric patients. Therefore, the present study aimed to evaluate the effect of femoral trochlear morphology on ACL injury in pediatric patients and investigate the possibility of gender differences.

Methods

In total, 116 skeletally immature children aged 3–18 years with primary ACL injuries were matched with a control group of 116 skeletally immature children. Lateral trochlear inclination, trochlear facet asymmetry, trochlear depth, and sulcus angle were evaluated using magnetic resonance imaging (MRI). Differences between patient groups and gender were investigated. Receiver-operating characteristic (ROC) curves were constructed to obtain the sensitivity and specificity of all parameters.

Results

A significant difference was observed in the sulcus angle and trochlear inclination between the ACL injury and control groups (p < 0.05). No significant difference was observed between the ACL injury and control groups with respect to the anatomic patellar instability risk factors. All parameters showed an area under the curve of 0.6 in the ROC analysis, indicative of failure of the diagnostic test.

Conclusions

There was a significant association between femoral trochlear morphology and increased risk of ACL injury in pediatric patients. No gender difference was found except in the trochlear depth. It was showed that the difference in trochlear morphology should be considered between normal children and pediatric patients with ACL injury to increase the awareness regarding ACL injuries.

Level of evidence

III.

Askenberger M, Janarv PM, Finnbogason T, Arendt EA (2017) Morphology and anatomic patellar instability risk factors in first-time traumatic lateral patellar dislocations: a prospective magnetic resonance imaging study in skeletally immature children. Am J Sports Med 45:50–58CrossRef

Bayer S, Meredith SJ, Wilson K, de Sa D, Pauyo T, Byrne K, McDonough CM, Musahl V (2020) Knee morphological risk factors for anterior cruciate ligament injury: a systematic review. J Bone Jt Surg Am 102:703–718CrossRef

Biedert RM, Bachmann M (2009) Anterior-posterior trochlear measurements of normal and dysplastic trochlea by axial magnetic resonance imaging. Knee Surg Sports Traumatol Arthrosc 17:1225–1230CrossRef

Bisson LJ, Gurske-DePerio J (2010) Axial and sagittal knee geometry as a risk factor for noncontact anterior cruciate ligament tear: a case-control study. Arthroscopy 26:901–906CrossRef

Botchu R, Obaid H, Rennie WJ (2013) Correlation between trochlear dysplasia and anterior cruciate ligament injury. J Orthop Surg (Hong Kong) 21:185–188CrossRef

Botchu R, Obaid H, Rennie WJ (2013) Correlation between trochlear dysplasia and the notch index. J Orthop Surg (Hong Kong) 21:290–293CrossRef

Brandon ML, Haynes PT, Bonamo JR, Flynn MI, Barrett GR, Sherman MF (2006) The association between posterior-inferior tibial slope and anterior cruciate ligament insufficiency. Arthroscopy 22:894–899CrossRef

Chen M, Qin L, Li M, Shen J (2020) Correlation analysis between femoral trochlear dysplasia and anterior cruciate ligament injury based on CT measurement. Quant Imaging Med Surg 10:847–852CrossRef

Dare DM, Fabricant PD, McCarthy MM, Rebolledo BJ, Green DW, Cordasco FA, Jones KJ (2015) Increased lateral tibial slope is a risk factor for pediatric anterior cruciate ligament injury: an MRI-based case-control study of 152 patients. Am J Sports Med 43:1632–1639CrossRef

10.

Dartnell J, Hui JH (2013) Commentary: Correlation between trochlear dysplasia and anterior cruciate ligament injury. J Orthop Surg (Hong Kong) 21:141CrossRef

11.

Dejour H, Walch G, Nove-Josserand L, Guier C (1994) Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc 2:19–26CrossRef

12.

Delanois RE, McGrath MS, Ulrich SD, Marker DR, Seyler TM, Bonutti PM, Mont MA (2008) Results of total knee replacement for isolated patellofemoral arthritis: when not to perform a patellofemoral arthroplasty. Orthop Clin North Am 39:381–388CrossRef

13.

Greiwe RM, Saifi C, Ahmad CS, Gardner TR (2010) Anatomy and biomechanics of patellar instability. Oper Tech Sports Med 18:62–67CrossRef

14.

Hashemi J, Chandrashekar N, Gill B, Beynnon BD, Slauterbeck JR, Schutt RC Jr, Mansouri H, Dabezies E (2008) The geometry of the tibial plateau and its influence on the biomechanics of the tibiofemoral joint. J Bone Jt Surg Am 90:2724–2734CrossRef

15.

Hasler RM, Gal I, Biedert RM (2014) Landmarks of the normal adult human trochlea based on axial MRI measurements: a cross-sectional study. Knee Surg Sports Traumatol Arthrosc 22:2372–2376CrossRef

16.

Hoshino Y, Kuroda R, Nishizawa Y, Nakano N, Nagai K, Araki D, Oka S, Kawaguchi S, Nagamune K, Kurosaka M (2018) Stress distribution is deviated around the aperture of the femoral tunnel in the anatomic anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 26:1145–1151PubMed

17.

Houseworth SW, Mauro VJ, Mellon BA, Kieffer DA (1987) The intercondylar notch in acute tears of the anterior cruciate ligament: a computer graphics study. Am J Sports Med 15:221–224CrossRef

18.

Hsiao M, Owens BD, Burks R, Sturdivant RX, Cameron KL (2010) Incidence of acute traumatic patellar dislocation among active-duty United States military service members. Am J Sports Med 38:1997–2004CrossRef

19.

Kim HK, Shiraj S, Anton C, Horn PS (2014) The patellofemoral joint: do age and gender affect skeletal maturation of the osseous morphology in children? Pediatr Radiol 44:141–148CrossRef

20.

Koh YG, Nam JH, Chung HS, Chun HJ, Kim HJ, Kang KT (2020) Morphometric study of gender difference in osteoarthritis posterior tibial slope using three-dimensional magnetic resonance imaging. Surg Radiol Anat 42:667–672CrossRef

21.

Krych AJ, Johnson NR, Mohan R, Dahm DL, Levy BA, Stuart MJ (2018) Partial meniscectomy provides no benefit for symptomatic degenerative medial meniscus posterior root tears. Knee Surg Sports Traumatol Arthrosc 26:1117–1122PubMed

22.

Liu X, Ji G, Wang X, Kang H, Wang F (2017) CT-based morphological analysis of the posterior femoral condyle in patients with trochlear dysplasia. Knee 24:231–236CrossRef

23.

Mundy A, Ravindra A, Yang J, Adler BH, Klingele KE (2016) Standardization of patellofemoral morphology in the pediatric knee. Pediatr Radiol 46:255–262CrossRef

24.

Newman JH (2007) Patellofemoral arthritis and its management with isolated patellofemoral replacement: a personal experience. Orthopedics 30:58–61PubMed

25.

Ntagiopoulos PG, Bonin N, Sonnery-Cottet B, Badet R, Dejour D (2014) The incidence of trochlear dysplasia in anterior cruciate ligament tears. Int Orthop 38:1269–1275CrossRef

26.

Prakash J, Seon JK, Woo SH, Jin C, Song EK (2016) Comparison of radiological parameters between normal and patellar dislocation groups in Korean population: a rotational profile CT-based study. Knee Surg Relat Res 28:302–311CrossRef

27.

Schneider A, Si-Mohamed S, Magnussen RA, Lustig S, Neyret P, Servien E (2018) Tibiofemoral joint congruence is lower in females with ACL injuries than males with ACL injuries. Knee Surg Sports Traumatol Arthrosc 26:1375–1383CrossRef

28.

Seeley MA, Knesek M, Vanderhave KL (2013) Osteochondral injury after acute patellar dislocation in children and adolescents. J Pediatr Orthop 33:511–518CrossRef

29.

Shambaugh JP, Klein A, Herbert JH (1991) Structural measures as predictors of injury basketball players. Med Sci Sports Exerc 23:522–527CrossRef

30.

Souryal TO, Freeman TR (1993) Intercondylar notch size and anterior cruciate ligament injuries in athletes. A prospective study. Am J Sports Med 21:535–539CrossRef

31.

Stefancin JJ, Parker RD (2007) First-time traumatic patellar dislocation: a systematic review. Clin Orthop Relat Res 455:93–101CrossRef

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 4:2325967116669490CrossRef

33.

Wahl CJ, Westermann RW, Blaisdell GY, Cizik AM (2012) An association of lateral knee sagittal anatomic factors with non-contact ACL injury: sex or geometry? J Bone Jt Surg Am 94:217–226CrossRef

Title: Femoral trochlear morphology is associated with anterior cruciate ligament injury in skeletally immature patients
Authors: Yoon Hae Kwak
Ji-Hoon Nam
Yong-Gon Koh
Byoung-Kyu Park
Kee-Bum Hong
Kyoung-Tak Kang
Publication date: 01-12-2020
Publisher: Springer Berlin Heidelberg
Keywords: Magnetic Resonance Imaging
Magnetic Resonance Imaging
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 12/2020
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-020-06267-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Femoral trochlear morphology is associated with anterior cruciate ligament injury in skeletally immature patients

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

Please log in to get access to this content

Other articles of this Issue 12/2020

Difficult primary total knee arthroplasty requiring a varus–valgus constrained implant is at higher risk of periprosthetic infection

Low femoral component prominence negatively influences early revision rate in robotic unicompartmental knee arthroplasty

Increased survival rate in extension stemmed TKA in obese patients at minimum 2 years follow-up

Excellent survival and outcomes with fixed-bearing medial UKA in young patients (≤ 60 years) at minimum 10-year follow-up

Excellent mid-term osseointegration and implant survival using metaphyseal sleeves in revision total knee arthroplasty

Sexual and ethnic polymorphism result in considerable mismatch between native trochlear geometry and off-the-shelf TKA prostheses