Osteotomies in Patello-Femoral Instabilities

Dejour, David; Coultre, Bertrand Le

doi:10.1097/jsa.0000000000000183

Cited by 116 publications

(132 citation statements)

References 15 publications

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“…[29,30] Second, we found that similar morphologic anomalies of the trochlear aspect, as encoded by similar HP parameters, are actually attributed to different severity grades in the Dejour classification. [14] This finding is in agreement with recent works in the literature reporting that morphometric parameters can optimistically discriminate between the Grade A and the three remaining grades. [15,16] Equivalently, the Dejour classification was shown to be meaningfully effective in separating low-grade from high-grade cases.…”

Section: Main Findingssupporting

confidence: 83%

“…[11][12][13] One of the most applied clinical approach to score the morphologic anomalies of the trochlear surface (TS) is based on the Dejour classification, which encompasses four different qualitative Grades (A, B, C, D) of increasing severity. [14,15] Based on radiological assessment, the evaluation is performed by means of clinical signs, such as the shape of the groove, the roundness of the two facets and their absolute and relative sizes. Specifically, the four grades encode the 'shallow trochlear groove', 'flat trochlea', 'medial hypoplasia with potential lateral convexity', and 'excessive asymmetry of the trochlear facets', respectively.…”

Section: Introductionmentioning

confidence: 99%

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Patient-specific modeling of the trochlear morphologic anomalies by means of hyperbolic paraboloids

Cerveri

Baroni

Confalonieri

et al. 2016

Computer Assisted Surgery

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Diagnostic and therapeutic purposes are issuing pressing demands to improve the evaluation of the dysplasia condition of the femoral trochlea. The traditional clinical assessment of the dysplasia, based on Dejour classification, recognized 4 increasing (A, B, C, D) levels of severity. It has been extensively questioned in the literature that this classification methodology can be defective suggesting that quantitative measures can ensure more reliable criteria for the dysplasia severity assessment. This study reports on a novel technique to model the trochlear surface (TS), digitally reconstructed by 3D volumetric imaging, using three hyperbolic paraboloids (HP), one to describe the global trochlear aspect, two to represent the local aspects of the medial and lateral compartments, respectively. Results on a cohort of 43 patients, affected by aspecific anterior knee pain, demonstrate the consistency of the estimated model parameters with the morphologic aspect of the TS. The obtained small fitting error (on average lower than 0.80 mm) demonstrated that the ventral aspect of the trochlear morphology can be modeled with high accuracy by HPs. We also showed that HP modeling provides a continuous representation of morphologic variations in shape parameter space while we found that similar morphologic anomalies of the trochlear aspect are actually attributed to different severity grades in the Dejour classification. This finding is in agreement with recent works in the literature reporting that morphometric parameters can only optimistically be used to discriminate between the Grade A and the remaining three grades. In conclusion, we can assert that the proposed methodology is a further step toward modeling of anatomical surfaces that can be used to quantify deviations to normality on a patient-specific basis.

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Section: Main Findingssupporting

confidence: 83%

Section: Introductionmentioning

confidence: 99%

Patient-specific modeling of the trochlear morphologic anomalies by means of hyperbolic paraboloids

Cerveri

Baroni

Confalonieri

et al. 2016

Computer Assisted Surgery

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“…6,38 We would therefore agree with the their conclusions, along with those of Fulkerson et al and Dejour et al, who have implied Merchant projections may be preferred over sunrise projections for evaluating trochlear depth. 1,25,34,37,39 To our knowledge, this experiment provides the first objective validation of such. However, on the basis of these data, we would also challenge providers to consider altering the beam orientation angle in this view by 20 degrees (from 60 to 40 degrees caudally) if they are intending to evaluate trochlear depth radiographically.…”

Section: Discussionmentioning

confidence: 81%

A Cadaveric Analysis of the Optimal Radiographic Angle for Evaluating Trochlear Depth

et al. 2016

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Disorders of the patellofemoral joint are common. Diagnosis and management often involves the use tangential imaging of the patella and trochlear grove, with the sunrise projection being the most common. However, imaging protocols vary between institutions, and limited data exist to determine which radiographic projections provide optimal visualization of the trochlear groove at its deepest point. Plain radiographs of 48 cadaveric femora were taken at various beam-femur angles and the maximum trochlear depth was measured; a tilt-board apparatus was used to elevate the femur in 5-degree increments between 40 and 75 degrees. A corollary experiment was undertaken to investigate beam-femur angles osteologically: digital representations of each bone were created with a MicroScribe digitizer, and trochlear depth was measured on all specimens at beam-femur angles from 0 to 75 degrees. The results of the radiographic and digitizer experiments showed that the maximum trochlear grove depth occurred at a beam-femur angle of 50 degrees. These results suggest that the optimal beam-femur angle for visualizing maximum trochlear depth is 50 degrees. This is significantly lower than the beam-femur angle of 90 degrees typically used in the sunrise projection. Clinicians evaluating trochlear depth on sunrise projections may be underestimating maximal depth and evaluating a nonarticulating portion of the femur.

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“…In the first classification of Dejour, TD was divided into three types. After improvements, a more precise four‐type classification of TD was proposed. In addition, three different patellar types were described by Wiberg; a fourth type (the “Jaegerhut” patella) was later described by Baumgartl.…”

Section: Discussionmentioning

confidence: 99%

Changes in Cartilage and Subchondral Bone of Femoral Trochlear Groove After Patellectomy in Growing Rabbits

Wang

et al. 2020

Orthopaedic Surgery

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Objective: To explore the effects of patellectomy on the bony and cartilaginous morphology of the trochlear groove in growing rabbits.Methods: Forty-eight 4-week-old New Zealand white rabbits were randomly assigned to two groups. The control group underwent a sham surgical procedure, whereas the patellectomy group underwent patella excision surgery. Half of the rabbits in each group were sacrificed 3 months postoperatively; the rest were sacrificed 6 months postoperatively. Hematoxylin and eosin staining was performed on collected samples. Measurements included the bony and cartilaginous sulcus angles of the trochlear groove. In addition, the thickness of the articular cartilage at the deepest sulcus position (central thickness) and at the mid-position of the medial and lateral facets was measured and compared between groups.Results: Three months after surgery, histological images revealed significant differences between the control group and the patellectomy group in cartilaginous sulcus angle (144.2 AE 1.5 vs 151.9 AE 2.4 , respectively; P < 0.001). No obvious difference in bony sulcus angle was found between the groups. Six months after surgery, significant between-group differences were observed in cartilaginous sulcus angle (136.3 AE 2.5 in control group vs 160.7 AE 3.0 in patellectomy group, P < 0.001) and bony sulcus angle (136.2 AE 2.2 in control group vs 160.4 AE 2.6 in patellectomy group, P < 0.001). However, there were no significant intra-group differences between cartilaginous and bony sulcus angles in either group. Three months after surgery, significant between-group differences were detected in articular cartilage thickness at the three different positions (medial facet: 324.3 AE 14.0 μm in control group vs 391.7 AE 98.8 μm in patellectomy group, P = 0.029; central position: 362.1 AE 13.6 μm in control group vs 730.3 AE 76.8 μm in patellectomy group, P < 0.001; lateral facet: 324.6 AE 12.7 μm in control group vs 358.5 AE 38.7 μm in patellectomy group, P = 0.009). No between-group differences in cartilage thickness were found at 6 months.Conclusions: Abnormal mechanical stress (patellectomy) during a rabbit's development can cause flattening of the femoral trochlear cartilage, followed by changes in the subchondral osseous layer. Abnormal mechanical stress is a crucial factor in the development of trochlear groove dysplasia.

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Osteotomies in Patello-Femoral Instabilities

Cited by 116 publications

References 15 publications

Patient-specific modeling of the trochlear morphologic anomalies by means of hyperbolic paraboloids

Patient-specific modeling of the trochlear morphologic anomalies by means of hyperbolic paraboloids

A Cadaveric Analysis of the Optimal Radiographic Angle for Evaluating Trochlear Depth

Changes in Cartilage and Subchondral Bone of Femoral Trochlear Groove After Patellectomy in Growing Rabbits

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