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Increased femoral curvature and trochlea flexion in high-grade patellofemoral dysplastic knees

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

High-grade patellofemoral dysplasia is often associated with concomitant axial and frontal leg malalignment. However, curvature of the femur and sagittal flexion of the trochlea has not yet been studied in patellofemoral dysplastic knees. The aim of the study was to quantify the femoral curvature and sagittal flexion of the trochlea in both high-grade patellofemoral dysplastic and healthy knees.

Methods

A retrospective case–control study matched 19 high-grade patellofemoral dysplastic knees (Dejour types C and D) with 19 healthy knees according to sex and body mass index. Three-dimensional (3D) femoral curvature and sagittal trochlea flexion were analysed. To analyse femoral curvature, the specific 3D radius of curvature (ROC) was calculated. Trochlear flexion was quantified through the development of the trochlea flexion angle (TFA), which is a novel 3D measurement in relation to the anatomical and mechanical femur axis and is referred to as 3D TFAanatomic and 3D TFAmech. The influence of age, gender, height, weight and frontal and axial alignment on ROC and TFA was analysed in a multiple regression model.

Results

Overall ROC was significantly smaller in dysplastic knees, compared with the control group [898.4 ± 210.8 mm (range 452.9–1275.1 mm) vs 1308.4 ± 380.5 mm (range 878.3–2315.8 mm), p < 0.001]. TFA was significantly higher in dysplastic knees, compared with the control group, for 3D TFAmech [13.8 ± 7.2° (range 4.4–33.4°) vs 6.5 ± 2.3° (range 0.8–10.2°), p < 0.001] and 3D TFAanatomic [12.5 ± 7.2° (range 3.1–32.2°) vs 6.4 ± 1.9° (range 2.1–9.1°), p = 0.001]. A smaller ROC was associated with smaller height, female gender and higher femoral ante torsion. An increased TFA was associated with valgus malalignment.

Conclusion

High-grade patellofemoral dysplastic knees demonstrated increased femoral curvature and sagittal flexion of the trochlea, compared with healthy knees. The ROC and newly described TFA allowed the quantification of the sagittal femoral deformity. TFA and ROC should be incorporated in future deformity analysis to investigate their potential as a target for surgical correction.

Level of Evidence

Level III.

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Funding

The research is supported by the institutional research fund of Balgrist University Hospital, , University of Zurich.

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Authors and Affiliations

  1. Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland

    Sandro Hodel, Carlos Torrez, Armando Hoch, Lazaros Vlachopoulos & Sandro F. Fucentese

  2. Head of Research in Orthopedic Computer Science (ROCS), University Hospital Balgrist, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland

    Philipp Fürnstahl

Authors
  1. Sandro Hodel
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  2. Carlos Torrez
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  3. Armando Hoch
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  4. Philipp Fürnstahl
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  5. Lazaros Vlachopoulos
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  6. Sandro F. Fucentese
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Corresponding author

Correspondence to Sandro Hodel.

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Conflict of interest

Sandro F. Fucentese is a consultant for Medacta SA (Switzerland), Smith & Nephew (United Kingdom), and Karl Storz SE & Co. KG (Germany).

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Written informed consent was obtained from all patients and ethics protocol was approved by the Cantonal Ethics Committee Zurich (BASEC: 2021-01428).

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Hodel, S., Torrez, C., Hoch, A. et al. Increased femoral curvature and trochlea flexion in high-grade patellofemoral dysplastic knees. Knee Surg Sports Traumatol Arthrosc 31, 1361–1369 (2023). https://doi.org/10.1007/s00167-022-07080-6

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