The Effect of Trochlear Dysplasia on Patellofemoral Biomechanics

Haver, Annemieke Van; Roo, Karel De; Beule, Matthieu De; Labey, Luc; Baets, Patrick De; Dejour, David; Claessens, Tom; Verdonk, Peter

doi:10.1177/0363546515572143

Cited by 150 publications

(64 citation statements)

References 28 publications

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“…Computational reconstruction of in vivo function studies have indicated that, for subjects with patellar instability, the level of trochlear dysplasia and the lateral position of the tibial tuberosity are correlated with lateral patellar tracking, particularly at low flexion angles [37, 38]. An in vitro simulation of knee function study also indicated that trochlear dysplasia is associated with increased contact pressures [39]. Without accounting for these anatomical factors, the simulated in vitro function does not produce lateral tracking or elevated contact pressures to the degree noted for symptomatic knees.…”

Section: Summary Of Results and Limitationsmentioning

confidence: 99%

Biomechanical Analysis of Tibial Tuberosity Medialization and Medial Patellofemoral Ligament Reconstruction

Elias¹,

Smith

Daney

2017

Sports Medicine and Arthroscopy Review

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Biomechanical studies are commonly performed to evaluate the influence of medial patellofemoral ligament (MPFL) reconstruction and tibial tuberosity medialization on patellar tracking and patellofemoral contact pressures. The most common method is in vitro simulation of knee function, but computational simulation of knee function and computational reconstruction of in vivo motion can also be utilized. The current review of the biomechanical literature indicates that MPFL reconstruction and tibial tuberosity medialization reduce lateral patellar tracking. Decreased lateral patellofemoral contact pressures have also been noted. For MPFL reconstruction, the most commonly noted biomechanical concerns are graft over-tensioning and non-anatomical attachment on the femur leading to over-constraint of the patella and elevated medial contact pressures. For tuberosity medialization, the influence of altered tibiofemoral kinematics on post-operative function is unknown. Future biomechanical studies should emphasize inclusion of anatomical features and tracking patterns related to patellar instability, with comparison between the surgical approaches for continued development of treatment guidelines.

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Section: Summary Of Results and Limitationsmentioning

confidence: 99%

Biomechanical Analysis of Tibial Tuberosity Medialization and Medial Patellofemoral Ligament Reconstruction

Elias¹,

Smith

Daney

2017

Sports Medicine and Arthroscopy Review

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“…In the axial plane, a shallower/wider trochlea and a patella that is more laterally displaced or tilted are associated with more severe patellofemoral OA features 12 , and trochlear morphology is associated with patellofemoral alignment 13, 14 . Theoretically, trochlear dysplasia may cause patellar instability and result in malalignment and/or aberrant movement patterns at the patellofemoral joint.…”

Section: Introductionmentioning

confidence: 99%

“…Theoretically, trochlear dysplasia may cause patellar instability and result in malalignment and/or aberrant movement patterns at the patellofemoral joint. Patellofemoral malalignment reduces contact area which increases joint stress during activities of daily living 13, 15 , potentially leading to OA. To date, our understanding is limited as to what extent patellofemoral alignment and trochlear morphology contribute - either independently or together - to the onset or progression of patellofemoral OA 16,17 .…”

Section: Introductionmentioning

confidence: 99%

Patellofemoral morphology and alignment: reference values and dose–response patterns for the relation to MRI features of patellofemoral osteoarthritis

Macri

Felson

Zhang

et al. 2017

Osteoarthritis and Cartilage

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Objective We aimed to (i) determine reference values for trochlear morphology and patellofemoral (PF) alignment in adults without MRI-defined PF full thickness cartilage damage or knee pain; and (ii) evaluate dose-response patterns for these measures with prevalent MRI-defined PF structural damage and/or knee pain. Design The Framingham Community Cohort is a population-based sample of ambulatory adults aged ≥50 years. We evaluated six morphology and alignment measures using MRI (n=985), and reported reference values (mean ±2SD) in a subsample without MRI-defined PF full thickness cartilage damage or knee pain (n=563). With restricted cubic spline Poisson regression, we evaluated dose-response patterns of each of the six measures with prevalent MRI-defined PF structural damage or joint pain. Our primary outcome was full thickness cartilage damage. Results For dose-response curves, prevalence ratios increased monotonically for all measures except patellar tilt, which rose with both lateral and medial tilt. Associations were generally strongest in the lateral PF compartment. Prevalence ratios (PR) for the strongest predictors of full thickness cartilage damage reached clinical relevance (PR>1.5) at sulcus angle ≥135.0°; patellar tilt angle at ≤1.0° and ≥15.0°; and bisect offset ≥57.0%. Lateral trochlear inclination achieved PR>1.5 at ≤23.0° for full thickness cartilage damage with pain. Conclusions Sulcus angle, patellar tilt, and bisect offset were most strongly associated with full thickness cartilage damage. Lateral trochlear inclination, patellar tilt and bisect offset had stronger associations with the addition of pain. These findings contribute to better identifying a subset of patients who may benefit from mechanically based interventions.

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“…20 Increased patellar lateral tilt, lateral tracking and external rotation were found in the dysplastic models compared with the normal joint, especially for type D dysplasia in open-chain activity simulation. Also, an increased patellofemoral pressure and a reduced patellofemoral contact area were reported in trochlear dysplasia, more pronounced in B and D types.…”

Section: Biomechanics Of Dysplasiamentioning

confidence: 92%

The patellofemoral joint: from dysplasia to dislocation

et al. 2017

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Patellofemoral dysplasia is a major predisposing factor for instability of the patellofemoral joint. However, there is no consensus as to whether patellofemoral dysplasia is genetic in origin, caused by imbalanced forces producing maltracking and remodelling of the trochlea during infancy and growth, or due to other unknown and unexplored factors.The biomechanical effects of patellofemoral dysplasia on patellar stability and on surgical procedures have not been fully investigated. Also, different anatomical and demographic risk factors have been suggested, in an attempt to identify the recurrent dislocators. Therefore, a comprehensive evaluation of all the radiographic, MRI and CT parameters can help the clinician to assess patients with primary and recurrent patellar dislocation and guide management.Patellofemoral dysplasia still represents an extremely challenging condition to manage. Its controversial aetiology and its complex biomechanical behaviour continue to pose more questions than answers to the research community, which reflects the lack of universally accepted guidelines for the correct treatment. However, due to the complexity of this condition, an extremely personalised approach should be reserved for each patient, in considering and addressing the anatomical abnormalities responsible for the symptoms.Cite this article: EFORT Open Rev 2017;2. DOI: 10.1302/2058-5241.2.160081. Originally published online at www.efortopenreviews.org

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The Effect of Trochlear Dysplasia on Patellofemoral Biomechanics

Cited by 150 publications

References 28 publications

Biomechanical Analysis of Tibial Tuberosity Medialization and Medial Patellofemoral Ligament Reconstruction

Biomechanical Analysis of Tibial Tuberosity Medialization and Medial Patellofemoral Ligament Reconstruction

Patellofemoral morphology and alignment: reference values and dose–response patterns for the relation to MRI features of patellofemoral osteoarthritis

The patellofemoral joint: from dysplasia to dislocation

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