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Patellar osteochondritis dissecans: maturation-dependent patellofemoral joint characteristics

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Abstract

Background

The likelihood of healing of osteochondritis dissecans decreases with skeletal maturity and there are theories that abnormal biomechanical forces contribute to the development and progression of these lesions.

Objective

To characterize, according to regional skeletal maturity, the morphology and alignment indices of the patellofemoral joint on MRI in patients with patellar osteochondritis dissecans.

Materials and methods

MRI examinations of patients with patellar osteochondritis dissecans obtained between January 2008 and May 2023 were retrospectively reviewed to determine regional skeletal maturity, osteochondritis dissecans lesion size and location, patellar and trochlear morphology (Wiberg/Dejour classifications), and to calculate trochlear sulcus angles, trochlear depth index, lateral trochlear inclination, Insall-Salvati index, Caton-Deschamps index, patellar tendon-lateral trochlear ridge, and tibial tubercle-trochlear groove distances. Values were compared between skeletally immature and mature groups.

Results

Sixty-eight children (22 girls, 46 boys, age: 14.0 ± 1.7 years) yielded 74 knees with patellar osteochondritis dissecans lesions, 14 (19%) of which were skeletally mature. The most common anatomic location was over the central patella [median ridge (34/74 − 46%) on the axial images and over the middle third (45/74 − 61%) on the sagittal images]. Overall, mean trochlear sulcus angle (high, 151 ± 11°), trochlear depth index (low, 2.8 ± 1.4 mm), and Insall-Salvati index (borderline, 1.3 ± 0.1) were abnormal for the entire sample. Skeletally mature knees were significantly more likely to have higher (more dysplastic) Dejour types when compared to skeletally immature knees (p < 0.01). Knees in the mature group, compared to immature, had significantly more abnormal mean lateral trochlear inclination (15 ± 8° vs. 19 ± 6°, p = 0.03) and patellar tendon-lateral trochlear ridge distance (5.55 ± 4.31 mm vs. 2.89 ± 4.69 mm, p = 0.04). Half of the knees had ≥ 4 abnormal features that predispose to patellofemoral maltracking; mature knees were significantly (p = 0.02) more likely to have a higher number of abnormal features (> 6 features, 7/14, 50.0%) versus immature knees (0–3 features, 33/60, 55.0%).

Conclusion

In children with patellar osteochondritis dissecans, abnormal patellofemoral morphology and alignment indices were common in all patients and more severe in mature knees.

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Data availability

The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Department of Radiology, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA

    Jie C. Nguyen & Vandan Patel

  2. Department of Orthopedic Surgery, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Vandan Patel, Sara N. Kiani, Ryan Guzek, Brendan A Williams & Theodore J. Ganley

  3. University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA

    Jie C. Nguyen, Brendan A Williams & Theodore J. Ganley

  4. Drexel University College of Medicine, Philadelphia, PA, USA

    Vandan Patel

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  1. Jie C. Nguyen
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Correspondence to Jie C. Nguyen.

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Nguyen, J.C., Patel, V., Kiani, S.N. et al. Patellar osteochondritis dissecans: maturation-dependent patellofemoral joint characteristics. Pediatr Radiol 54, 977–987 (2024). https://doi.org/10.1007/s00247-024-05914-8

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  • DOI: https://doi.org/10.1007/s00247-024-05914-8

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