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Lateral trochlear inclination measured by the transepicondylar axis holds potential for evaluating trochlear dysplasia in patients with lateral patellar dislocation

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To verify that lateral trochlear inclination (LTI) measured by the transepicondylar axis can reliably be used to evaluate trochlear dysplasia (TD) on MRI and can serve as an objective indication of trochleoplasty for patients with lateral patellar dislocation (LPD).

Methods

Eighty patients with recurrent LPD and eighty healthy subjects were included. TD, posterior condylar angle (PCA), and LTI measured by the posterior condylar reference line (LTIp), surgical transepicondylar axis (LTIs), and anatomical transepicondylar axis (LTIa) were assessed on MRI. The intraclass correlation coefficient (ICC) and Bland–Altman analysis were performed, the correlations and differences amongst the parameters were identified, and a binary logistic regression model was established.

Results

Each measurement had excellent inter- and intra-observer agreement. The LTIp, LTIs and LTIa were smaller in the study group than in the control group, with mean differences of 9.0°, 7.2° and 7.0°, respectively (P < 0.001). The PCA was larger in patients with LPD than in the control group (P < 0.001). LTIp was associated with PCA in the study group (r = − 0.41, P < 0.001). The pathological values of LTIp, LTIs and LTIa were 11.7°, 15.3° and 17.4°, respectively. LTIs and LTIa were independent risk factors for LPD, with ORs of 7.33 (95% CI [1.06–52.90], P = 0.048) and 10.29 (95% CI [1.38–76.96], P = 0.023), respectively.

Conclusion

The LTI can be reliably measured by MRI, but LTIp could potentially decrease the recorded value from the actual inclination angle. LTIs and LTIa are more appropriate to serve as trochleoplasty indications for patients with LPD, which could help orthopedists with surgical decision-making.

Level of evidence

Level III.

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Code availability

Not applicable.

Data availability

The data used to support the findings of this study are available from the corresponding author upon request.

Abbreviations

AEA:

Anatomical transepicondylar axis

IQR:

Interquartile range

LOA:

Limits of agreement

LPD:

Lateral patellar dislocation

LTI:

Lateral trochlea inclination

LTL:

A line subtended from the cartilaginous surface of the lateral trochlea

PCA:

Posterior condylar angle

PCRL:

Posterior condylar reference line

SEA:

Surgical transepicondylar axis

TD:

Trochlear dysplasia

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Funding

The authors did not receive support from any organisation for the submitted work.

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Authors and Affiliations

  1. Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China

    Jiaxing Chen, Qiaochu Li, Jian Zhang, Zhengxue Quan & Aiguo Zhou

  2. Orthopedic Laboratory of Chongqing Medical University, Chongqing, 400016, China

    Jiaxing Chen, Qiaochu Li, Jian Zhang, Zhengxue Quan & Aiguo Zhou

  3. Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China

    Xinyi Li

  4. Medical Education Department, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China

    Yi Feng

  5. Department of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, 100191, China

    Zijie Xu

  6. Department of Orthopedics, Peking University Third Hospital, Beijing, 100191, China

    Linbang Wang

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  1. Jiaxing Chen
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection was performed by JC, XL and QL, supervised by YF. Statistical analysis was conducted by JC. The first draft of the manuscript was written by JC and modified by ZX and LW. JZ, AZ and ZQ provided theoretical supports and revised the manuscript. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Zhengxue Quan or Aiguo Zhou.

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Conflict of interest

The authors declare they have no financial interests.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Ethics Committee of the First Affiliated Hospital of Chongqing Medical University. (Number: 2022-K36).

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The informed consent was waived by the Ethics Committee of the First Affiliated Hospital of Chongqing Medical University.

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Chen, J., Li, X., Feng, Y. et al. Lateral trochlear inclination measured by the transepicondylar axis holds potential for evaluating trochlear dysplasia in patients with lateral patellar dislocation. Knee Surg Sports Traumatol Arthrosc 31, 5611–5620 (2023). https://doi.org/10.1007/s00167-023-07614-6

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