Clinical Orthopaedics and Related Research®

, Volume 468, Issue 3, pp 782–788 | Cite as

The Geometry of the Trochlear Groove

  • Farhad Iranpour
  • Azhar M. Merican
  • Wael Dandachli
  • Andrew A. Amis
  • Justin P. Cobb
Clinical Research



In the natural and prosthetic knees the position, shape, and orientation of the trochlea groove are three of the key determinants of function and dysfunction, yet the rules governing these three features remain elusive.


The aim was to define the three-dimensional geometry of the femoral trochlea and its relation to the tibiofemoral joint in terms of angles and distances.


Forty CT scans of femurs of healthy patients were analyzed using custom-designed imaging software. After aligning the femur using various axes, the locations and orientations of the groove and the trochlear axis were examined in relation to the conventional axes of the femur.


The trochlear groove was circular and positioned laterally in relation to the mechanical, anatomic, and transcondylar axes of the femur; it was not aligned with any of these axes. We have defined the trochlear axis as a line joining the centers of two spheres fitted to the trochlear surfaces lateral and medial to the trochlear groove. When viewed after aligning the femur to this new axis, the trochlear groove appeared more linear than when other methods of orientation were used.


Our study shows the importance of reliable femoral orientation when reporting the shape of the trochlear groove.


  1. 1.
    Aglietti P, Buzzi R, Gaudenzi A. Patellofemoral functional results and complications with the posterior stabilized total condylar knee prosthesis. J Arthroplasty. 1988;3:17–25.CrossRefPubMedGoogle Scholar
  2. 2.
    Arima J, Whiteside LA, McCarthy DS, White SE. Femoral rotational alignment, based on the anteroposterior axis, in total knee arthroplasty in a valgus knee: a technical note. J Bone Joint Surg Am. 1995;77:1331–1334.PubMedGoogle Scholar
  3. 3.
    Barink M, van de Groes S, Verdonschot N, de Waal Malefijt M. The trochlea is bilinear and oriented medially. Clin Orthop Relat Res. 2003;411:288–295.CrossRefPubMedGoogle Scholar
  4. 4.
    Barink M, Meijerink H, Verdonschot N, van Kampen A, de Waal Malefijt M. Asymmetrical total knee arthroplasty does not improve patella tracking: a study without patella resurfacing. Knee Surg Sports Traumatol Arthrosc. 2007;15:184–191.CrossRefPubMedGoogle Scholar
  5. 5.
    Bull AM, Katchburian MV, Shih YF, Amis AA. Standardisation of the description of patellofemoral motion and comparison between different techniques. Knee Surg Sports Traumatol Arthrosc. 2002;10:184–193.CrossRefPubMedGoogle Scholar
  6. 6.
    Callahan CM, Drake BG, Heck DA, Dittus RS. Patient outcomes following tricompartmental total knee replacement: a meta-analysis. JAMA. 1994;271:1349–1357.CrossRefPubMedGoogle Scholar
  7. 7.
    Clayton ML, Thirupathi R. Patellar complications after total condylar arthroplasty. Clin Orthop Relat Res. 1982;170:152–155.PubMedGoogle Scholar
  8. 8.
    Dennis DA. Patellofemoral complications in TKA: a literature review. Am J Knee Surg. 1992;5:156–161.Google Scholar
  9. 9.
    Eckhoff DG, Bach JM, Spitzer VM, Reinig KD, Bagur MM, Baldini TH, Rubinstein D, Humphries S. Three-dimensional morphology and kinematics of the dorsal part of the femur viewed in virtual reality: Part II. J Bone Joint Surg Am. 2003;85(suppl 4):97–104.PubMedGoogle Scholar
  10. 10.
    Eckhoff DG, Burke BJ, Dwyer TF, Pring ME, Spitzer VM, VanGerwen DP. The Ranawat Award. Sulcus morphology of the distal femur. Clin Orthop Relat Res. 1996;331:23–28.CrossRefPubMedGoogle Scholar
  11. 11.
    Feinstein WK, Noble PC, Kamaric E, Tullos HS. Anatomic alignment of the patellar groove. Clin Orthop Relat Res. 1996;331:64–73.CrossRefPubMedGoogle Scholar
  12. 12.
    Freeman MA, Samuelson KM, Elias SG, Mariorenzi LJ, Gokcay EI, Tuke M. The patellofemoral joint in total knee prostheses: design considerations. J Arthroplasty. 1989;4(suppl):S69–S74.CrossRefPubMedGoogle Scholar
  13. 13.
    Fulkerson JP, Hungerford DS. Normal anatomy. In: Fulkerson JP, Hungerford DS, eds. Disorders of the Patellofemoral Joint. Baltimore, MD: Williams & Wilkins; 1990:1–24.Google Scholar
  14. 14.
    Fulkerson JP, Hungerford DS. Biomechanics of the patellofemoral joint. In: Fulkerson JP, Hungerford DS, eds. Disorders of the Patellofemoral Joint. Baltimore, MD: Williams & Wilkins; 2004:25–41Google Scholar
  15. 15.
    Henckel J, Richards R, Lozhkin K, Harris S, Baena FM, Barrett AR, Cobb JP. Very low-dose computed tomography for planning and outcome measurement in knee replacement: the Imperial knee protocol. J Bone Joint Surg Br. 2006;88:1513–1518.CrossRefPubMedGoogle Scholar
  16. 16.
    Huo MH, Sculco TP. Complications in primary total knee arthroplasty. Orthop Rev. 1990;19:781–788.PubMedGoogle Scholar
  17. 17.
    Kulkarni SK, Freeman MA, Poal-Manresa JC, Asencio JI, Rodriguez JJ. The patellofemoral joint in total knee arthroplasty: is the design of the trochlea the critical factor? J Arthroplasty. 2000;15:424–429.CrossRefPubMedGoogle Scholar
  18. 18.
    Lonner JH. Modular bicompartmental knee arthroplasty with robotic arm assistance. Am J Orthop. 2009;38(2 suppl):28–31.PubMedGoogle Scholar
  19. 19.
    Noble PC, Conditt MA, Cook KF, Mathis KB. The John Insall Award. Patient expectations affect satisfaction with total knee arthroplasty. Clin Orthop Relat Res. 2006;452:35–43.CrossRefPubMedGoogle Scholar
  20. 20.
    Rolston L, Siewert K. Assessment of knee alignment after bicompartmental knee arthroplasty. J Arthroplasty. 2009;24:1111–1114.CrossRefPubMedGoogle Scholar
  21. 21.
    Senavongse W, Amis AA. The effects of articular, retinacular, or muscular deficiencies on patellofemoral joint stability. J Bone Joint Surg Br. 2005;87:577–582.PubMedGoogle Scholar
  22. 22.
    Shih YF, Bull AM, Amis AA. The cartilaginous and osseous geometry of the femoral trochlear groove. Knee Surg Sports Traumatol Arthrosc. 2004;12:300–306.CrossRefPubMedGoogle Scholar
  23. 23.
    Stäubli HU, Dürrenmatt U, Porcellini B, Rauschning W. Anatomy and surface geometry of the patellofemoral joint in the axial plane. J Bone Joint Surg Br. 1999;81:452–458.CrossRefPubMedGoogle Scholar
  24. 24.
    Yoshino N, Takai S, Ohtsuki Y, Hirasawa Y. Computed tomography measurement of the surgical and clinical transepicondylar axis of the distal femur in osteoarthritic knees. J Arthroplasty. 2001;16:493–497.CrossRefPubMedGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2009

Authors and Affiliations

  • Farhad Iranpour
    • 1
    • 4
  • Azhar M. Merican
    • 1
    • 2
  • Wael Dandachli
    • 1
  • Andrew A. Amis
    • 1
    • 3
  • Justin P. Cobb
    • 1
  1. 1.Department of Musculoskeletal SurgeryImperial College London, Charing Cross HospitalLondonUK
  2. 2.University of Malaya Medical CentreKuala LumpurMalaysia
  3. 3.Mechanical Engineering DepartmentImperial College LondonLondonUK
  4. 4.Division of Surgery, Oncology, Reproductive Biology and AnaestheticsImperial College London, 7th Floor, Charing Cross HospitalLondonUK

Personalised recommendations