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Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 22, Issue 10, pp 2357–2363 | Cite as

A validated cadaveric model of trochlear dysplasia

  • L. D. LattEmail author
  • M. Christopher
  • A. Nicolini
  • D. R. Burk
  • B. Dezfuli
  • B. J. Serack
  • D. C. Fithian
Knee

Abstract

Purpose

Despite the high prevalence of trochlear dysplasia among patients with patellar instability, it is not well studied and is infrequently addressed surgically. The lack of a validated cadaveric model of trochlear dysplasia may be a contributing factor. The goal of this study was to develop a simple, reproducible, and realistic cadaveric model of trochlear dysplasia by surgically modifying cadaveric femora with normal anatomy and then to validate this model through the use of mechanical and fluoroscopic measurements.

Methods

The floor of the trochlear groove was surgically elevated using an inflatable bone tamp in eight cadaveric femora. The trochlear depth (TD) was measured with a custom-designed measuring device, and radiographic markers of dysplasia (sulcus angle, crossing sign, and prominence) were assessed before and after surgical modification.

Results

The average TD was 3.6 ± 1.4, 4.6 ± 1.1, and 5.1 ± 1.0 mm prior to reverse trochleoplasty (RT) and 1.0 ± 1.8, 2.3 ± 1.3, and 3.3 ± 2.5 mm following RT at 0°, 20°, and 40° of flexion, respectively. These direct measurements of TD were confirmed with fluoroscopy. The sulcus angle averaged 141° prior to RT and 157° after RT. The average prominence across all specimens was 3.3 ± 0.7 mm before RT, and 5.5 ± 1.5 mm after RT. Finally, the crossing sign was found to be absent in all knees prior to RT and present in 7 of the 8 after RT.

Conclusions

The results of this study show that elevation of the trochlear floor with an inflatable bone tamp can reproducibly create a simulated dysplastic trochlea. This model may be useful in biomechanical studies of treatments for patellofemoral instability.

Keywords

Patellar instability Trochlear dysplasia Trochlear depth Trochleoplasty Cadaveric biomechanics Cadaveric model 

Notes

Acknowledgments

This project was funded in part by a Resident Excellence and Leadership Scholarship from the University of Arizona Office of Graduate Medical Education.

References

  1. 1.
    Amis AA, Oguz C, Bull AMJ, Senavongse W, Dejour D (2008) The effect of trochleoplasty on patellar stability and kinematics: a biomechanical study in vitro. J Bone Joint Surg (Br) 90(7):864–869CrossRefGoogle Scholar
  2. 2.
    Amis AA, Senavongse W, Bull AM (2006) Patellofemoral kinematics during knee flexion–extension: an in vitro study. J Orthop Res 24(12):2201–2211PubMedCrossRefGoogle Scholar
  3. 3.
    Bollier M, Fulkerson JP (2011) The role of trochlear dysplasia in patellofemoral instability. J Am Acad Orthop Surg 19(1):8–16PubMedGoogle Scholar
  4. 4.
    Davies AP, Costa ML, Shepstone L, Glasgow MM, Donell S (2000) The sulcus angle and malalignment of the extensor mechanism of the knee. J Bone Joint Surg (Br) 82(8):1162–1166CrossRefGoogle Scholar
  5. 5.
    Dejour D, Saggin P (2010) The sulcus deepening trochleoplasty-the Lyon’s procedure. Int Orthop 34(2):311–316PubMedCrossRefPubMedCentralGoogle Scholar
  6. 6.
    Dejour H, Walch G, Nove-Josserand L, Guier C (1994) Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc 2(1):19–26PubMedCrossRefGoogle Scholar
  7. 7.
    Eckhoff DG, Burke BJ, Dwyer TF, Pring ME, Spitzer VM, VanGerwen DP (1996) The Ranawat Award. Sulcus morphology of the distal femur. Clin Orthop 331:23–28PubMedCrossRefGoogle Scholar
  8. 8.
    Fithian DC, Neyret P (2007) Patellar instability: the lyon experience. Tech Knee Surg 6(2):1–12CrossRefGoogle Scholar
  9. 9.
    Fulkerson JP (1983) Anteromedialization of the tibial tuberosity for patellofemoral malalignment. Clin Orthop 177:176–181PubMedGoogle Scholar
  10. 10.
    Henry JH, Goletz TH, Williamson B (1986) Lateral retinacular release in patellofemoral subluxation. Indications, results, and comparison to open patellofemoral reconstruction. Am J Sports Med 14(2):121–129PubMedCrossRefGoogle Scholar
  11. 11.
    Koeter S, Bongers EM, de Rooij J, van Kampen A (2006) Minimal rotation aberrations cause radiographic misdiagnosis of trochlear dysplasia. Knee Surg Sports Traumatol Arthrosc 14(8):713–717PubMedCrossRefGoogle Scholar
  12. 12.
    Kuroda R, Kambic H, Valdevit A, Andrish J (2002) Distribution of patellofemoral joint pressures after femoral trochlear osteotomy. Knee Surg Sports Traumatol Arthrosc 10(1):33–37PubMedCrossRefGoogle Scholar
  13. 13.
    Nelitz M, Lippacher S, Reichel H, Dornacher D (2014) Evaluation of trochlear dysplasia using MRI: correlation between the classification system of Dejour and objective parameters of trochlear dysplasia. Knee Surg Sports Traumatol Arthrosc 22(1):120–127PubMedCrossRefGoogle Scholar
  14. 14.
    Remy F, Chantelot C, Fontaine C, Demondion X, Migaud H, Gougeon F (1998) Inter- and intraobserver reproducibility in radiographic diagnosis and classification of femoral trochlear dysplasia. Surg Rad Anat 20(4):285–289CrossRefGoogle Scholar
  15. 15.
    Steiner TM, Torga-Spak R, Teitge RA (2006) Medial patellofemoral ligament reconstruction in patients with lateral patellar instability and trochlear dysplasia. Am J Sports Med 34(8):1254–1261PubMedCrossRefGoogle Scholar
  16. 16.
    Verdonk R, Jansegers E, Stuyts B (2005) Trochleoplasty in dysplastic knee trochlea. Knee Surg Sports Traumatol Arthrosc 13(7):529–533PubMedCrossRefGoogle Scholar
  17. 17.
    Yoshioka Y, Siu D, Cooke TD (1987) The anatomy and functional axes of the femur. J Bone Joint Surg (Am) 69(6):873–880Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • L. D. Latt
    • 1
    • 2
    Email author
  • M. Christopher
    • 1
  • A. Nicolini
    • 2
  • D. R. Burk
    • 1
  • B. Dezfuli
    • 1
  • B. J. Serack
    • 1
  • D. C. Fithian
    • 3
  1. 1.Department of Orthopaedic SurgeryUniversity of ArizonaTucsonUSA
  2. 2.Department of Biomedical EngineeringUniversity of ArizonaTucsonUSA
  3. 3.Kaiser Permanente San DiegoSan DiegoUSA

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