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Standardization of patellofemoral morphology in the pediatric knee

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Abstract

Background

Our understanding of osseous morphology and pathology of the patellofemoral joint continues to improve with the use of magnetic resonance imaging (MRI), but a paucity of data currently exists in the pediatric population.

Objective

We aim to formulate a reproducible means of quantitative assessment of patellofemoral morphology in children using MRI and to describe morphological changes based on sex and age.

Materials and methods

We identified 414 children presenting between 2002 and 2014 who obtained a knee MRI to evaluate for knee pain or clinically suspected knee pathology. After application of inclusion criteria, 144 “normal” MRIs in 131 children (71 boys, 60 girls) were included in the analysis. The following MRI measurements were recorded: lateral trochlear inclination, trochlear facet asymmetry, trochlear depth, tibial tuberosity-trochlear groove distance, sulcus angle and patellar height ratio. To assess intraobserver reliability, measurements in 30 randomly selected children were repeated. Differences between patient age and sex were assessed using independent t-tests and adjusted regression analysis.

Results

All recorded measurements had strong to very strong inter- and intraobserver reliability: lateral trochlear inclination (0.91/0.82), trochlear facet asymmetry (0.81/0.83), trochlear depth (0.83/0.90), tibial tuberosity-trochlear groove distance (0.97/0.87), sulcus angle (0.84/0.78) and patellar height ratio (0.96/0.83). When age and sex were mutually adjusted, statistically significant differences between males and females were observed in trochlear depth (P = 0.0084) and patellar height ratio (P = 0.0035). However, statistically significant age differences were found on all measurements except for lateral trochlear inclination. As expected, mean measurement values approached adult norms throughout skeletal maturation suggestive of age-dependent patellofemoral maturation.

Conclusion

Our data verify the development of patellofemoral morphology with advancing age. We found that six of the most commonly used patellofemoral measurements in adults can be accurately reproduced regardless of age.

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References

  1. Merchant AC, Mercer RL, Jacobsen RH et al (1974) Roentgenographic analysis of patellofemoral congruence. J Bone Joint Surg Am 56:1391–1396

    CAS  PubMed  Google Scholar 

  2. Fucentese SF, Schottle PB, Pfirrmann CW et al (2007) CT changes after trochleoplasty for symptomatic trochlear dysplasia. Knee Surg Sports Traumatol Arthrosc 15:168–174

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  4. Brattstroem H (1964) Shape of the intercondylar groove normally and in recurrent dislocation of patella. A clinical and X-ray-anatomical investigation. Acta Orthop Scand Suppl 68:61–148

    Google Scholar 

  5. Insall J, Salvati E (1971) Patella position in the normal knee joint. Radiology 101:101–104

    Article  CAS  PubMed  Google Scholar 

  6. Muellner T, Funovics M, Nikolic A et al (1998) Patellar alignment evaluated by MRI. Acta Orthop Scand 69:489–492

    Article  CAS  PubMed  Google Scholar 

  7. Kujala UM, Osterman K, Kormano M et al (1989) Patellofemoral relationships in recurrent patellar dislocation. J Bone Joint Surg (Br) 71:788–792

    CAS  Google Scholar 

  8. Wittstein JR, Bartlett EC, Easterbrook J et al (2006) Magnetic resonance imaging evaluation of patellofemoral malalignment. Arthroscopy 22:643–649

    Article  PubMed  Google Scholar 

  9. Shih YF, Bull AM, Amis AA (2004) The cartilaginous and osseous geometry of the femoral trochlear groove. Knee Surg Sports Traumatol Arthrosc 12:300–306

    Article  PubMed  Google Scholar 

  10. Van Huyssteen AL, Hendrix MR, Barnett AJ et al (2006) Cartilage-bone mismatch in the dysplastic trochlea. An MRI study. J Bone Joint Surg (Br) 88:688–691

    Article  Google Scholar 

  11. Staubli HU, Durrenmatt U, Porcellini B et al (1999) Anatomy and surface geometry of the patellofemoral joint in the axial plane. J Bone Joint Surg (Br) 81:452–458

    Article  CAS  Google Scholar 

  12. Miller TT, Staron RB, Feldman F (1996) Patellar height on sagittal MR imaging of the knee. AJR Am J Roentgenol 167:339–341

    Article  CAS  PubMed  Google Scholar 

  13. Pfirrmann CW, Zanetti M, Romero J et al (2000) Femoral trochlear dysplasia: MR findings. Radiology 216:858–864

    Article  CAS  PubMed  Google Scholar 

  14. Bernageau J, Goutallier D, Larde D et al (1981) L’obliquitè de la joue externe de la throclee femorale. Encyclop Med Chir 30:39–42

    Google Scholar 

  15. Carrillon Y, Abidi H, Dejour D et al (2000) Patellar instability: assessment on MR images by measuring the lateral trochlear inclination-initial experience. Radiology 216:582–585

    Article  CAS  PubMed  Google Scholar 

  16. Nietosvaara Y, Aalto K, Kallio PE (1994) Acute patellar dislocation in children: incidence and associated osteochondral fractures. J Pediatr Orthop 14:513–515

    Article  CAS  PubMed  Google Scholar 

  17. Colvin AC, West RV (2008) Patellar instability. J Bone Joint Surg Am 90:2751–2762

    Article  PubMed  Google Scholar 

  18. Dickens AJ, Morrell NT, Doering A et al (2014) Tibial tubercle-trochlear groove distance: defining normal in a pediatric population. J Bone Joint Surg Am 96:318–324

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  20. Charles MD, Haloman S, Chen L et al (2013) Magnetic resonance imaging–based topographical differences between control and recurrent patellofemoral instability patients. Am J Sports Med 41:374–384

    Article  PubMed  Google Scholar 

  21. Pandit S, Frampton C, Stoddart J et al (2011) Magnetic resonance imaging assessment of tibial tuberosity-trochlear groove distance: normal values for males and females. Int Orthop 35:1799–1803

    Article  PubMed Central  PubMed  Google Scholar 

  22. Schoettle PB, Zanetti M, Seifert B et al (2006) The tibial tuberosity-trochlear groove distance; a comparative study between CT and MRI scanning. Knee 13:26–31

    Article  PubMed  Google Scholar 

  23. Alemparte J, Ekdahl M, Burnier L et al (2007) Patellofemoral evaluation with radiographs and computed tomography scans in 60 knees of asymptomatic subjects. Arthroscopy 23:170–177

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  25. 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 22:2372–2376

    Article  CAS  PubMed  Google Scholar 

  26. Ogden JA (1984) Radiology of postnatal skeletal development. X. Patella and tibial tuberosity. Skeletal Radiol 11:246–257

    Article  CAS  PubMed  Google Scholar 

  27. Yao L, Gai N, Boutin RD (2014) Axial scan orientation and the tibial tubercle-trochlear groove distance: error analysis and correction. AJR Am J Roentgenol 202:1291–1296

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Nationwide Children’s Hospital, 700 Children’s Drive Suite A2630, Columbus, OH, 43205-2696, USA

    Andrew Mundy, Jingzhen Yang & Kevin E. Klingele

  2. Department of Orthopaedics, The Ohio State University, Columbus, OH, USA

    Amy Ravindra & Kevin E. Klingele

  3. Department of Radiology, Nationwide Children’s Hospital, Columbus, OH, USA

    Brent H. Adler

Authors
  1. Andrew Mundy
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  2. Amy Ravindra
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  3. Jingzhen Yang
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  4. Brent H. Adler
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  5. Kevin E. Klingele
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Correspondence to Kevin E. Klingele.

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Mundy, A., Ravindra, A., Yang, J. et al. Standardization of patellofemoral morphology in the pediatric knee. Pediatr Radiol 46, 255–262 (2016). https://doi.org/10.1007/s00247-015-3459-9

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  • DOI: https://doi.org/10.1007/s00247-015-3459-9

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