A landmark-based 3D analysis reveals a narrower tibial plateau and patella in trochlear dysplastic knees

  • Wouter PeetersEmail author
  • Annemieke Van Haver
  • Sander Van den Wyngaert
  • Peter Verdonk



The trochlear dysplastic femur has a specific morphotype previously characterised by not only dysplastic features of the trochlea but also by specific features of the notch and posterior femur. In this study the morphology of the tibia and patella was investigated to gain further insight in the complete geometrical complexity of the trochlear dysplastic knee.


Arthro-CT scan-based 3D models of 20 trochlear dysplastic and 20 normal knees were uniformly scaled and landmarks and landmark-based reference planes were created to quantify a series of morphometric characteristics of the tibia and patella.


In the mediolateral direction, the 3D-analysis revealed a 3% smaller medial tibial plateau (30.4 ± 1.6 mm vs 31.5 ± 1.6 mm), a 3% smaller overall width of the tibial plateau (73.6 ± 2.0 mm vs 75.7 ± 2.0 mm), a 16% smaller medial facet (17.3 ± 2.2 mm vs 20.1 ± 1.3 mm) and a 4% smaller overall width of the patella (41.7 ± 2.5 mm vs 43.4 ± 2.3 mm) in trochlear dysplastic knees. In the anteroposterior direction, the lateral tibial plateau of trochlear dysplastic knees was 5% larger (37.2 ± 2.3 mm vs 35.5 ± 3.1 mm). A correlation test between the width of the femur and the width of the tibia revealed that trochlear dysplastic knees show less correspondence between the femur and tibia compared to normal knees.


Significant differences in the morphology of the tibial plateau and patella were detected between trochlear dysplastic and normal knees. Both in the trochlear dysplastic tibial plateau and patella a narrower medial compartment leads to a significant smaller overall mediolateral width. These findings are important for the understanding of knee biomechanics and the design of total knee arthroplasty components.

Level of evidence



Patellofemoral joint Tibia Patella Trochlear dysplasia Morphology Three dimensional Measurements 







Patella anterior point




Patella inferior point


Patella lateral point


Patella medial point


Patella odd point inferior


Patella odd point superior


Patella posterior point


Patella ridge point inferior


Patella ridge point superior


Patella superior point


Trochlear dysplasia


Total knee arthroplasty


Tibial lateral intercondylar eminence


Tibial lateral plateau anterior


Tibial lateral plateau posterior


Tibial medial intercondylareminence


Tibial medial plateau anterior


Tibial medial plateau posterior


Tibial plateau anterior


Tibial plateau lateral


Tibial plateau medial


Tibial tuberosity-trochlear groove


Author contributions

WP designed the study, acquired and analysed the data, interpreted the results, wrote the first draft of the manuscript and revised it based on comments of other authors; PV and AVH contributed substantially to the conception and design of the work, the analysis and interpretation of the data; SVDW contributed substantially to the data acquisition and graphic design. All authors revised the draft manuscript for important intellectual content, approved the final version of the manuscript to be published, and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.


The authors received no specific funding for this work.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

This study was in accordance with the ethical standards of the institutional committee and with the 1964 Helsinki declaration and its later amendments.


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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019

Authors and Affiliations

  1. 1.Antwerp Orthopaedic CenterAZ Monica HospitalsAntwerpBelgium
  2. 2.MoRe InstituteAntwerpBelgium
  3. 3.Department of RadiologyAZ Monica HospitalsAntwerpBelgium
  4. 4.Department of Orthopaedic SurgeryAntwerp University HospitalAntwerpBelgium

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