Skip to main content


Log in

Association of trochlear dysplasia with degenerative abnormalities in the knee: data from the Osteoarthritis Initiative

  • Scientific Article
  • Published:
Skeletal Radiology Aims and scope Submit manuscript



To evaluate trochlear morphology as a potential risk factor for patellofemoral osteoarthritis, determined by morphological and quantitative measurements of cartilage degeneration using 3-T magnetic resonance imaging (MRI) of the knee.

Materials and methods

MRI of the right knees of 304 randomly selected subjects, aged 45–60 years, from the Osteoarthritis Initiative (OAI) progression cohort were screened for trochlear dysplasia, defined by an abnormal trochlear depth. Out of 304 subjects, n = 85 demonstrated a shallow trochlea (depth ≤3 mm; 28 %). In these, and also in a random sample of controls with normal trochlear depth (n = 50), the facet ratio and the sulcus angle were calculated and knee structural abnormalities were assessed by using a modified Whole Organ MR Imaging Score (WORMS). Cartilage segmentation was performed and T2 relaxation times and patellar cartilage volume were determined. ANOVA and multivariate regression models were used for statistical analysis of the association of MRI structural measures and trochlear morphology.


Knees with a shallow trochlea showed higher patellofemoral degeneration (WORMS mean ± standard deviation, 11.2 ± 0.5 versus 5.7 ± 0.6; multivariate regression, P < 0.001) and lower patellar cartilage volume than controls (900 ± 664 mm3 versus 1,671 ± 671 mm3; P < 0.001). Knees with an abnormal medial-to-lateral facet ratio (<0.4) showed increased patellofemoral WORMS scores (12.3 ± 0.9 versus 8.3 ± 0.5; P < 0.001). Knees with an abnormal sulcus angle (>170°) also showed increased WORMS scores (12.2 ± 1.1 versus 8.6 ± 0.6; P = 0.003). T2 values at the patella were significantly lower in the dysplasia group with a shallow trochlea. However, significance was lost after adjustment for cartilage volume (P = 0.673).


Trochlear dysplasia, defined by a shallow trochlea, was associated with higher WORMS scores and lower cartilage volume, indicating more advanced osteoarthritis at the patellofemoral joint.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others


  1. Christian SR, Anderson MB, Workman R, Conway WF, Pope TL. Imaging of anterior knee pain. Clin Sports Med. 2006;25(4):681–702.

    Article  PubMed  Google Scholar 

  2. Hedayati B, Saifuddin A. Focal lesions of the patella. Skeletal Radiol. 2009;38(8):741–9.

    Article  PubMed  CAS  Google Scholar 

  3. Tecklenburg K, Dejour D, Hoser C, Fink C. Bony and cartilaginous anatomy of the patellofemoral joint. Knee Surg Sports Traumatol Arthrosc. 2006;14(3):235–40.

    Article  PubMed  CAS  Google Scholar 

  4. Malghem J, Maldague B. Depth insufficiency of the proximal trochlear groove on lateral radiographs of the knee: Relation to patellar dislocation. Radiology. 1989;170(2):507–10.

    PubMed  CAS  Google Scholar 

  5. Grelsamer RP, Tedder JL. The lateral trochlear sign. Femoral trochlear dysplasia as seen on a lateral view roentgenograph. Clin Orthop Relat Res. 1992;281:159–62.

    PubMed  Google Scholar 

  6. Pfirrmann CW, Zanetti M, Romero J, Hodler J. Femoral trochlear dysplasia: MR findings. Radiology. 2000;216(3):858–64.

    PubMed  CAS  Google Scholar 

  7. Koeter S, Bongers EM, de Rooij J, van Kampen A. Minimal rotation aberrations cause radiographic misdiagnosis of trochlear dysplasia. Knee Surg Sports Traumatol Arthrosc. 2006;14(8):713–7.

    Article  PubMed  Google Scholar 

  8. Salzmann GM, Weber TS, Spang JT, Imhoff AB, Schottle PB. Comparison of native axial radiographs with axial MR imaging for determination of the trochlear morphology in patients with trochlear dysplasia. Arch Orthop Trauma Surg. 2010;130(3):335–40.

    Article  PubMed  Google Scholar 

  9. Diederichs G, Issever AS, Scheffler S. MR imaging of patellar instability: Injury patterns and assessment of risk factors. Radiographics. 2010;30(4):961–81.

    Article  PubMed  Google Scholar 

  10. Toms AP, Cahir J, Swift L, Donell ST. Imaging the femoral sulcus with ultrasound, CT, and MRI: Reliability and generalizability in patients with patellar instability. Skeletal Radiol. 2009;38(4):329–38.

    Article  PubMed  Google Scholar 

  11. Fitoussi F, Akoure S, Chouteau Y, Bouger D. Hollow femoral trochlea and femoro-patellar osteoarthritis. Rev Chir Orthop Reparatrice Appar Mot. 1994;80(6):520–4.

    PubMed  CAS  Google Scholar 

  12. Dejour H, Walch G, Neyret P, Adeleine P. Dysplasia of the femoral trochlea. Rev Chir Orthop Reparatrice Appar Mot. 1990;76(1):45–54.

    PubMed  CAS  Google Scholar 

  13. Crema MD, Roemer FW, Marra MD, Burstein D, Gold GE, Eckstein F, et al. Articular cartilage in the knee: Current MR imaging techniques and applications in clinical practice and research. Radiographics. 2011;31(1):37–61.

    Article  PubMed  Google Scholar 

  14. Washburn RA, Smith KW, Jette AM, Janney CA. The physical activity scale for the elderly (PASE): development and evaluation. J Clin Epidemiol. 1993;46(2):153–62.

    Article  PubMed  CAS  Google Scholar 

  15. Peterfy CG, Schneider E, Nevitt M. The osteoarthritis initiative: report on the design rationale for the magnetic resonance imaging protocol for the knee. Osteoarthritis Cartilage. 2008;16(12):1433–41.

    Google Scholar 

  16. Peterfy CG, Guermazi A, Zaim S, Tirman PFJ, Miaux Y, White D, et al. Whole-organ magnetic resonance imaging score (WORMS) of the knee in osteoarthritis. Osteoarthritis Cartilage. 2004;12(3):177–90.

    Article  PubMed  CAS  Google Scholar 

  17. Stehling C, Lane NE, Nevitt MC, Lynch J, McCulloch CE, Link TM. Subjects with higher physical activity levels have more severe focal knee lesions diagnosed with 3T MRI: Analysis of a non-symptomatic cohort of the osteoarthritis initiative. Osteoarthritis Cartilage. 2010;18(6):776–86.

    Article  PubMed  CAS  Google Scholar 

  18. Baum T, Stehling C, Joseph GB, Carballido-Gamio J, Schwaiger BJ, Muller-Hocker C, et al. Changes in knee cartilage T2 values over 24 months in subjects with and without risk factors for knee osteoarthritis and their association with focal knee lesions at baseline: data from the osteoarthritis initiative. J Magn Reson Imaging. 2012;35(2):370–8.

    Article  PubMed  Google Scholar 

  19. Baum T, Joseph GB, Nardo L, Virayavanich W, Arulanandan A, Alizai H, et al. Correlation of magnetic resonance imaging-based knee cartilage T2 measurements and focal knee lesions with body mass index: thirty-six-month followup data from a longitudinal, observational multicenter study. Arthritis Care Res (Hoboken). 2013;65(1):23–33

    Article  Google Scholar 

  20. Stehling C, Baum T, Mueller-Hoecker C, Liebl H, Carballido-Gamio J, Joseph GB, et al. A novel fast knee cartilage segmentation technique for T2 measurements at MR imaging–data from the osteoarthritis initiative. Osteoarthritis Cartilage. 2011;19(8):984–9.

    Article  PubMed  CAS  Google Scholar 

  21. Jungmann P, Kraus M, Nardo L, Liebl H, Alizai H, Joseph G, et al. T2 relaxation time measurements are limited in monitoring progression, once advanced cartilage defects at the knee occur. Longitudinal data from the Osteoarthritis Initiative. J Magn Reson Imaging. 2013; In press.

  22. Dandy DJ. Chronic patellofemoral instability. J Bone Joint Surg Br. 1996;78(2):328–35.

    PubMed  CAS  Google Scholar 

  23. Dejour H, Walch G, Nove-Josserand L, Guier C. Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc. 1994;2(1):19–26.

    Article  PubMed  CAS  Google Scholar 

  24. Fucentese SF, Schottle PB, Pfirrmann CW, Romero J. CT changes after trochleoplasty for symptomatic trochlear dysplasia. Knee Surg Sports Traumatol Arthrosc. 2007;15(2):168–74.

    Article  PubMed  CAS  Google Scholar 

  25. Schottle PB, Fucentese SF, Pfirrmann C, Bereiter H, Romero J. Trochleaplasty for patellar instability due to trochlear dysplasia: a minimum 2-year clinical and radiological follow-up of 19 knees. Acta Orthop. 2005;76(5):693–8.

    Article  PubMed  Google Scholar 

  26. Van Huyssteen AL, Hendrix MR, Barnett AJ, Wakeley CJ, Eldridge JD. Cartilage-bone mismatch in the dysplastic trochlea. An MRI study. J Bone Joint Surg Br. 2006;88(5):688–91.

    PubMed  Google Scholar 

  27. Verdonk R, Jansegers E, Stuyts B. Trochleoplasty in dysplastic knee trochlea. Knee Surg Sports Traumatol Arthrosc. 2005;13(7):529–33.

    Article  PubMed  CAS  Google Scholar 

  28. Dunn TC, Lu Y, Jin H, Ries MD, Majumdar S. T2 Relaxation time of cartilage at MR imaging: comparison with severity of knee osteoarthritis. Radiology. 2004;232(2):592–8.

    Article  PubMed  Google Scholar 

  29. Pan J, Pialat JB, Joseph T, Kuo D, Joseph GB, Nevitt MC, et al. Knee cartilage T2 characteristics and evolution in relation to morphologic abnormalities detected at 3-T MR imaging: a longitudinal study of the normal control cohort from the Osteoarthritis Initiative. Radiology. 2011;261(2):507–15

    Article  PubMed  Google Scholar 

  30. David-Vaudey E, Ghosh S, Ries M, Majumdar S. T2 relaxation time measurements in osteoarthritis. Magn Reson Imaging. 2004;22(5):673–82.

    Article  PubMed  Google Scholar 

  31. Akizuki S, Mow VC, Muller F, Pita JC, Howell DS. Tensile properties of human knee joint cartilage. II. Correlations between weight bearing and tissue pathology and the kinetics of swelling. J Orthop Res. 1987;5(2):173–86.

    Article  PubMed  CAS  Google Scholar 

  32. Li X, Kuo D, Theologis A, Carballido-Gamio J, Stehling C, Link TM, et al. Cartilage in anterior cruciate ligament-reconstructed knees: MR imaging T1{rho} and T2–initial experience with 1-year follow-up. Radiology. 2011;258(2):505–14.

    Article  PubMed  Google Scholar 

Download references


This study was funded by NIH U01 AR059507 and P50 AR060752 as well as through the OAI, which is a public–private partnership comprising five contracts (N01-AR-2-2258; N01-AR-2-2259; N01-AR-2-2260; N01-AR-2-2261; N01-AR-2-2262) funded by the National Institutes of Health, a branch of the Department of Health and Human Services, and conducted by the OAI Study Investigators. Private funding partners include Merck Research Laboratories; Novartis Pharmaceuticals Corporation, GlaxoSmithKline; and Pfizer, Inc. Private sector funding for the OAI is managed by the Foundation for the National Institutes of Health.

Conflict of interest

No conflict of interest to declare for any of the authors.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Pia M. Jungmann.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Jungmann, P.M., Tham, SC., Liebl, H. et al. Association of trochlear dysplasia with degenerative abnormalities in the knee: data from the Osteoarthritis Initiative. Skeletal Radiol 42, 1383–1392 (2013).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: