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Semi-automated landmark-based 3D analysis reveals new morphometric characteristics in the trochlear dysplastic femur

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The authors hypothesise that the trochlear dysplastic distal femur is not only characterised by morphological changes to the trochlea. The purpose of this study is to describe the morphological characteristics of the trochlear dysplastic femur in and outside the trochlear region with a landmark-based 3D analysis.

Methods

Arthro-CT scans of 20 trochlear dysplastic and 20 normal knees were used to generate 3D models including the cartilage. To rule out size differences, a set of landmarks were defined on the distal femur to isotropically scale the 3D models to a standard size. A predefined series of landmark-based reference planes were applied on the distal femur. With these landmarks and reference planes, a series of previously described characteristics associated with trochlear dysplasia as well as a series of morphometric characteristics were measured.

Results

For the previously described characteristics, the analysis replicated highly significant differences between trochlear dysplastic and normal knees. Furthermore, the analysis showed that, when knee size is taken into account, the cut-off values of the trochlear bump and depth would be 1 mm larger in the largest knees compared to the smallest knees. For the morphometric characteristics, the analysis revealed that the trochlear dysplastic femur is also characterised by a 10 % smaller intercondylar notch, 6–8 % larger posterior condyles (lateral–medial) in the anteroposterior direction and a 6 % larger medial condyle in the proximodistal direction compared to a normal femur.

Conclusions

This study shows that knee size is important in the application of absolute metric cut-off values and that the posterior femur also shows a significantly different morphology.

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Notes

  1. Because the CT scan only captured the knee joint, the longitudinal axis of the femur was estimated by drawing 2 circles on a sagittal view through the shaft of the femur as described by Biedert et al. [6].

Abbreviations

TD group:

Trochlear dysplastic group

AP:

Anteroposterior

PD:

Proximodistal

ML:

Mediolateral

sTEA:

Surgical transepicondylar axis

PCL:

Posterior condylar line

ACL:

Anterior cruciate ligament

FME:

Femoral medial epicondyle

FMS:

Femoral medial sulcus

FLE:

Femoral lateral epicondyle

FMCP:

Femoral medial condyle posterior

FLCP:

Femoral lateral condyle posterior

FMCD:

Femoral medial condyle distal

FLCD:

Femoral lateral condyle distal

FMTA:

Femoral medial trochlea anterior

FLTA:

Femoral lateral trochlea anterior

FMCPP:

Femoral medial condyle posterior proximal

FLCPP:

Femoral lateral condyle posterior proximal

PE:

Proximal edge of the trochlea cartilage

FMCIP:

Femoral medial condyle internal point

FMCEP:

Femoral medial condyle external point

FLCIP:

Femoral lateral condyle internal point

FLCEP:

Femoral lateral condyle external point

PL:

Patella lateral point

PM:

Patella medial point

PS:

Patella superior point

PI:

Patella inferior point

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Acknowledgments

This work was funded by a Research fund of University College Ghent.

Ethical standard

The authors confirm that the study has been approved by the ethics committee and has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All persons gave their informed consent prior to their inclusion in the study.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. BioMech, Department of Mechanics, University College Ghent, Valentin Vaerwijckweg 1, 9000, Ghent, Belgium

    Annemieke Van Haver & Tom Claessens

  2. Department of Production and Construction, Ghent University, 9052, Zwijnaarde, Belgium

    Annemieke Van Haver

  3. Department of Physical Medicine and Orthopaedic Surgery, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium

    Karel De Roo, Emmanuel Audenaert & Peter Verdonk

  4. IBiTech-bioMMeda, Department of Civil Engineering, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium

    Matthieu De Beule, Sofie Van Cauter & Tom Claessens

  5. MoRe Foundation, Orthopaedic Center SPM Monica Hospital, Antwerp, Belgium

    Peter Verdonk

Authors
  1. Annemieke Van Haver
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  2. Karel De Roo
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  3. Matthieu De Beule
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  4. Sofie Van Cauter
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  5. Emmanuel Audenaert
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  7. Peter Verdonk
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Corresponding author

Correspondence to Annemieke Van Haver.

Appendix

Appendix

Landmarks femur for rescaling

  • Femoral medial epicondyle (FME): the most anterior and distal osseous prominence over the medial aspect of the medial femoral condyle [21, 39, 40]

  • Femoral medial sulcus (FMS): depression on the bony surface slightly proximal and posterior to FME [21, 39]

  • Femoral lateral epicondyle (FLE): the most anterior and distal osseous prominence over the lateral aspect of the lateral femoral condyle [22, 39]

  • Femoral medial condyle posterior (FMCP): the most posterior point of the medial condyle on the 3D model of the femur, aligned along the longitudinal axis of the femur

  • Femoral lateral condyle posterior (FLCP): the most posterior point of the lateral condyle on the 3D model of the femur, aligned along the longitudinal axis of the femurFootnote 1

  • Femoral medial condyle distal (FMCD): the most distal point of the medial condyle on the 3D model of the femur, aligned along the longitudinal axis of the femur

  • Femoral lateral condyle distal (FLCD): the most distal point of the lateral condyle on the 3D model of the femur, aligned along the longitudinal axis of the femur

  • Femoral medial trochlea anterior (FMTA): the most anterior point of the medial trochlea on the 3D model of the femur, aligned along the longitudinal axis of the femur

  • Femoral lateral trochlea anterior (FLTA): the most anterior point of the lateral trochlea on the 3D model of the femur, aligned along the longitudinal axis of the femur

  • Femoral medial condyle posterior proximal (FMCPP): the most proximal point of the cartilage on the posterior medial condyle, aligned along the longitudinal axis of the femur

  • Femoral lateral condyle posterior proximal (FLCPP): the most proximal point of the cartilage on the posterior lateral condyle, aligned along the longitudinal axis of the femur

  • Notch: the most anterior point in the middle of the femoral notch on a caudal to cranial view of the femur, aligned along the longitudinal axis of the femur.

Additional landmarks

Femur

  • Deepest point on the trochlea along a plane subtended 15° from the perpendicular to the tangent of the posterior femoral cortex [14]

  • Highest point on the trochlea along a plane subtended 15° from the perpendicular to the tangent of the posterior femoral cortex [14]

  • Proximal edge of the trochlea cartilage (PE) [41]

  • Femoral medial condyle internal point (FMCIP): most lateral point of the cartilage of the medial condyle in the axial view of the notch

  • Femoral medial condyle external point (FMCEP): most medial point of the cartilage of the medial condyle in the axial view of the notch

  • Femoral lateral condyle internal point (FLCIP): most medial point of the cartilage of the lateral condyle in the axial view of the notch

  • Femoral lateral condyle external point (FLCEP): most lateral point of the cartilage of the lateral condyle in the axial view of the notch

  • Femoral lateral trochlea: the most anterior point of the lateral trochlea in the axial slice of the femoral lateral condyle posterior

  • Femoral medial trochlea: the most anterior point of the medial trochlea in the axial slice of the femoral lateral condyle posterior

  • Trochlear deepest point: the deepest point of the trochlea in the axial slice of the femoral lateral condyle posterior

  • Trochlear most prominent point: most prominent point of the trochlear groove.

Patella

  • Patella lateral point (PL): most lateral point of the articular surface of the patella

  • Patella medial point (PM): most medial point of the articular surface of the patella

  • Patella superior point (PS): most superior point of the articular surface of the patella

  • Patella inferior point (PI): most inferior point of the articular surface of the patella

  • Patella ridge: point on the border of the medial and lateral facet of the patella.

Tibia

  • Tuberositas tibiae

  • Most anterior point of the tibial articulating surface of the tibia.

Reference planes

  • Plane 1: anterior sTEA plane: plane tangent to the anterior cortex, parallel to the surgical transepicondylar axis (OF: plane parallel to the surgical transepicondylar axis, parallel to FAAx and through the anterior cortex)

  • Plane 2: posterior sTEA plane: plane tangent to the posterior cortex, parallel to the surgical transepicondylar axis (OF: plane parallel to the surgical transepicondylar axis, parallel to FAAx and through the posterior cortex)

  • Plane 3: PCL plane: plane through FMCP and FLCP and parallel to FAAx

  • Plane 4: distal condylar plane: plane through FMCD and FLCD and perpendicular to FAAx

  • Plane 5: proximal condylar plane: plane through FMCPP and FLCPP and perpendicular to FAAx

  • Plane 6: medial plane: plane through FME, parallel to FAAx and perpendicular to PCL

  • Plane 7: notch plane: plane through the notch, parallel to FAAx and perpendicular to PCL

  • Plane 8: lateral plane: plane through FLE, parallel to FAAx and perpendicular to PCL

  • Plane 9: internal medial condyle plane: plane through FMCIP, parallel to FAAx and perpendicular to PCL

  • Plane 10: external medial condyle plane: plane through FMCEP, parallel to FAAx and perpendicular to PCL

  • Plane 11: internal lateral condyle plane: plane through FLCIP, parallel to FAAx and perpendicular to PCL

  • Plane 12: external lateral condyle plane: plane through FLCEP, parallel to FAAx and perpendicular to PCL

  • Plane 13: trochlear depth plane: plane subtended 15° from the perpendicular to the tangent of the posterior femoral cortex to measure the trochlear depth as defined by Dejour et al. [14].

Measurements

Characteristics of trochlear dysplasia

  • Trochlear depth (mm): distance between the highest and deepest point of the trochlea measured perpendicular to plane 3

  • Sulcus angle (°): the angle formed by the intersection of the medial and lateral trochlear facets measured in the axial slice of FLCP

  • Lateral inclination angle of the trochlea (°): the angle between the posterior condylar line and a line along the lateral facet measured in the axial slice of FLCP

  • Medial inclination angle of the trochlea (°): the angle between the posterior condylar line and a line along the medial facet measured in the axial slice of FLCP

  • Trochlear bump (mm): the distance between plane 1 and the most prominent point of the trochlear groove

  • Trochlear cartilage height (mm): the distance between plane 4 and PE

  • Caton-Deschamps index (−): the ratio of the distance between PI and most anterior point of the tibial articulating surface to the length of the articular surface of the patella

  • Lateral patellar displacement (mm): the distance from PM to the perpendicular to plane 3, passing through the most anterior point of the medial condyle

  • Patellar tilt (°): the angle between the patellar width line (line between PL and PM) and PCL

  • Asymmetry trochlear facets (%): percentage of the medial to the lateral trochlear facet length (medial facet/lateral facet × 100)

  • Asymmetry patellar facets (%): percentage of the medial to the lateral patellar facet length (medial facet/lateral facet length × 100).

Morphometric characteristics

  • Medial femur: distance between the FMTA and plane 3

  • Medial trochlea: distance between FMTA and plane 1

  • Medial posterior condyle: distance between the FMCP and plane 2

  • Lateral femur: distance between FLTA and plane 3

  • Lateral trochlea: distance between FLTA and plane 1

  • Lateral posterior condyle: distance between FLCP condyle and plane 2

  • Medial condyle: distance between FMCPP and plane 4

  • Lateral condyle: distance between FLCPP and plane 4

  • Distal femur: distance between FLE and plane 6

  • Medial condyle: distance between FMCIP and plane 10

  • Lateral condyle: distance between FLCIP and plane 12

  • Notch width: distance between FMCIP and plane 11.

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Van Haver, A., De Roo, K., De Beule, M. et al. Semi-automated landmark-based 3D analysis reveals new morphometric characteristics in the trochlear dysplastic femur. Knee Surg Sports Traumatol Arthrosc 22, 2698–2708 (2014). https://doi.org/10.1007/s00167-013-2573-1

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