Femoral trochlear morphology is associated with anterior cruciate ligament injury in skeletally immature patients



Knee joint morphology is a known contributor to anterior cruciate ligament (ACL) injury, and the shape of the distal femur condyle is one of the associated factors. However, the relationship between femoral trochlear morphology and ACL injury is unclear, especially in pediatric patients. Therefore, the present study aimed to evaluate the effect of femoral trochlear morphology on ACL injury in pediatric patients and investigate the possibility of gender differences.


In total, 116 skeletally immature children aged 3–18 years with primary ACL injuries were matched with a control group of 116 skeletally immature children. Lateral trochlear inclination, trochlear facet asymmetry, trochlear depth, and sulcus angle were evaluated using magnetic resonance imaging (MRI). Differences between patient groups and gender were investigated. Receiver-operating characteristic (ROC) curves were constructed to obtain the sensitivity and specificity of all parameters.


A significant difference was observed in the sulcus angle and trochlear inclination between the ACL injury and control groups (p < 0.05). No significant difference was observed between the ACL injury and control groups with respect to the anatomic patellar instability risk factors. All parameters showed an area under the curve of 0.6 in the ROC analysis, indicative of failure of the diagnostic test.


There was a significant association between femoral trochlear morphology and increased risk of ACL injury in pediatric patients. No gender difference was found except in the trochlear depth. It was showed that the difference in trochlear morphology should be considered between normal children and pediatric patients with ACL injury to increase the awareness regarding ACL injuries.

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Correspondence to Kyoung-Tak Kang.

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Kwak, Y.H., Nam, JH., Koh, YG. et al. Femoral trochlear morphology is associated with anterior cruciate ligament injury in skeletally immature patients. Knee Surg Sports Traumatol Arthrosc 28, 3969–3977 (2020). https://doi.org/10.1007/s00167-020-06267-z

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  • Korean pediatric patients
  • Morphometry
  • Trochlear
  • ACL injury
  • Dysplasia