Short lateral posterior condyle is associated with trochlea dysplasia and patellar dislocation

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Abstract

Purpose

Surgeons mainly consider the anterior anatomy of the distal femur in the treatment of patellar instability (PI) with trochlear dysplasia (TD). Through this research, the idea was to analyse the posterior femoral condyle length in TD. The research team posited the presence of morphological differences in the posterior part of the femoral epiphysis in TD compared to a control group. They also postulated that the posterior bicondylar angle (PCA), in the axial plane, was increased in TD.

Methods

This is a single-centre morphological study of 100 patients who had a computed tomography (CT) using the same protocol. 50 patients with PI (25 dysplasias A and 25 B-C-D according to the Dejour classification), and 50 controls were included. All patients presenting a clinical PI were considered for the study. None of these patients had undergone a surgical treatment prior to imaging. Demographic characteristics, BMI, and laterality were comparable in all patients. 20 pilot CT scans were used to establish the methodology. The following measurements were performed: anterior bicondylar angle, PCA, and condylar lengths with respect to the surgical transepicondylar axis. Ratios were calculated in relation to the femoral width. TD was classified according to the Dejour classification in grade A or grades B–C–D. An analysis of variance and a linear model were performed within some groups to investigate which parameters correlated with the classification’s grade.

Results

This study showed a link between TD and the PCA: control group (1.4 ± 0.2°), type A group (1.6 ± 0.3°), and types B, C, D group (2.6 ± 0.3°) (p = 0.01). The difference between the control group and types B, C, D TD group was significant (p = 0.002). In groups B, C, D, the PCA was more important, which proves that in these groups the posterior part of the lateral condyle was relatively shorter compared to the medial condyle. The greater the dysplasia, the longer the medial condyle was in the anterior posterior (p = 0.02).

Conclusions

This study shows not only an anterior but also a posterior anomaly in PI with TD. There is a correlation between the severity of the anterior deformation and the PCA: in other words, the knee is placed in valgus in flexure which promotes the external dislocation of the patella. This anatomical study could open a field of research on the development of surgical treatments based on the correction of posterior condylar femoral anomalies in PI.

Level of evidence

III.

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Change history

  • 13 March 2019

    Unfortunately, the author name was incorrectly published in the original publication as Sébatien Lustig insted of Séba<Emphasis Type="Bold">s</Emphasis>tien Lustig. The author name is corrected here by this Erratum. The original article has been corrected.

Abbreviations

PI:

Patellar instability

TD:

Trochlear dysplasia

TD:

Group trochlear dysplastic group

EPD:

Episodic patellar dislocation

AP:

Anteroposterior

ML:

Mediolateral

sTEA:

Surgical transepicondylar axis

TL:

Anterior bicondylar line

PCL:

Posterior condylar line

PCA:

Posterior condylar angle

FME:

Femoral medial epicondyle

FLE:

Femoral lateral epicondyle

FMCP:

Femoral medial condyle posterior (AP)

FLCP:

Femoral lateral condyle posterior (AP)

FMCA:

Femoral medial condyle anterior (AP)

FLCA:

Femoral lateral condyle anterior (AP)

CM:

Total medial condyle (AP)

CL:

Total lateral condyle (AP)

mLDFA:

Mechanical lateral distal femoral angle

SE:

Standard error to the mean

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Acknowledgements

We would like to thank the research team, and our administrative and secretarial support who actively contributed to data collection. We thank Fanny Blanchon (Associate Professor of English) and Oriane Di Marco who provided medical writing services. We thank Camille Chesnel and Philippe Wagner who provided statistical services.

Funding

No funding source.

Author information

Affiliations

Authors

Contributions

JR performed the statistical analysis and drafted the manuscript. JR, SL, and CFB carried out the radiologic studies. JR, SC, SL, PHN, and ES carried out in the writing of the manuscript. SL, PHN and ES participated in the design of the study. ES, SL, and PHN conceived the study, coordinated and helped to draft the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Julien Roger.

Ethics declarations

Conflict of interest

JR: No conflict of interest. SL: consultant: Smith Nephew, Medacta; institutional support: Amplitude, Corin. SC: No conflict of interest. CFB: No conflict of interest. PHN: board membership: Effort Board; consultancy: Latilini; employment: Healthpoint; expert testimony: Healthpoint, Latilini; Royalties: Tornier; travel, accommodations: Latilini, Amplitude. ES: No conflict of interest.

Ethical approval

The Ethics Committee of the Hospices Civils de Lyon approved the study (Groupement Hospitalier Est, Boulevard Pinel, 69,500 BRON). The ID number of the approval was 17-02.

Additional information

The original version of this article was revised: Author name was incorrectly published as Sébatien Lustig instead of Sébastien Lustig in the original publication.

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Roger, J., Lustig, S., Cerciello, S. et al. Short lateral posterior condyle is associated with trochlea dysplasia and patellar dislocation. Knee Surg Sports Traumatol Arthrosc 27, 731–739 (2019). https://doi.org/10.1007/s00167-018-5023-2

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Keywords

  • Distal femur morphology
  • Condylar length
  • Patellar instability
  • Trochlear dysplasia
  • Transepicondylar axis
  • CT measurements