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

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

A Correction to this article was published on 13 March 2019

This article has been updated

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

References

  1. Abadie P, Galaud B, Michaut M, Fallet L, Boisrenoult P, Beaufils P (2009) Distal femur rotational alignment and patellar subluxation: a CT scan in vivo assessment. Orthop Traumatol Surg Res OTSR 95:267–271

    Article  CAS  PubMed  Google Scholar 

  2. Amaranath JE, Moopanar TR, Sorial RM (2014) Defining distal femoral anatomy for rotational alignment in total knee arthroplasty: a magnetic resonance imaging-based study. ANZ J Surg 84:852–855

    Article  PubMed  Google Scholar 

  3. Biedert RM, Bachmann M (2009) Anterior-posterior trochlear measurements of normal and dysplastic trochlea by axial magnetic resonance imaging. Knee Surg Sports Traumatol Arthrosc 17:1225–1230

    Article  PubMed  Google Scholar 

  4. Bonnin MP, Saffarini M, Bossard N, Dantony E, Victor J (2016) Morphometric analysis of the distal femur in total knee arthroplasty and native knees. Bone Jt J 98-B:49–57

    Article  CAS  Google Scholar 

  5. Brilhault J, Preyssas P, Favard L, Burdin P (2002) Dimensions of the lateral condyle in non-arthritic valgus knees. A cadaver study. Rev Chir Orthop Reparatrice Appar Mot 88:686–690

    CAS  PubMed  Google Scholar 

  6. Dejour D, Le Coultre B (2018) Osteotomies in Patello-Femoral Instabilities. Sports Med Arthrosc Rev 26:8–15

    Article  PubMed  Google Scholar 

  7. Dejour D, Reynaud P, Le Coultre B (1998) Douleurs et instabilité rotulienne. Essai de classification. Médecine Hygiène 56:1466–1471

    Google Scholar 

  8. Dejour D, Saggin P (2010) The sulcus deepening trochleoplasty-the Lyon’s procedure. Int Orthop 34:311–316

    Article  PubMed  PubMed Central  Google Scholar 

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

    CAS  PubMed  Google Scholar 

  10. Frosch S, Brodkorb T, Schüttrumpf JP, Wachowski MM, Walde TA, Stürmer KM, Balcarek P (2014) Characteristics of femorotibial joint geometry in the trochlear dysplastic femur. J Anat 225:367–373

    Article  PubMed  PubMed Central  Google Scholar 

  11. Fucentese SF, Zingg PO, Schmitt J, Pfirrmann CWA, Meyer DC, Koch PP (2011) Classification of trochlear dysplasia as predictor of clinical outcome after trochleoplasty. Knee Surg Sports Traumatol Arthrosc 19:1655–1661

    Article  PubMed  Google Scholar 

  12. Gillespie D, Mandziak D, Howie C (2015) Influence of posterior lateral femoral condyle geometry on patellar dislocation. Arch Orthop Trauma Surg 135:1503–1509

    Article  PubMed  Google Scholar 

  13. Kobayashi H, Akamatsu Y, Kumagai K, Kusayama Y, Ishigatsubo R, Muramatsu S, Saito T (2014) The surgical epicondylar axis is a consistent reference of the distal femur in the coronal and axial planes. Knee Surg Sports Traumatol Arthrosc 22:2947–2953

    Article  PubMed  Google Scholar 

  14. Lippacher S, Dejour D, Elsharkawi M, Dornacher D, Ring C, Dreyhaupt J, Reichel H, Nelitz M (2012) Observer agreement on the Dejour trochlear dysplasia classification: a comparison of true lateral radiographs and axial magnetic resonance images. Am J Sports Med 40:837–843

    Article  PubMed  Google Scholar 

  15. Liu X, Ji G, Wang X, Kang H, Wang F (2017) CT-based morphological analysis of the posterior femoral condyle in patients with trochlear dysplasia. Knee 24:231–236

    Article  PubMed  Google Scholar 

  16. Lustig S, Lavoie F, Selmi TAS, Servien E, Neyret P (2008) Relationship between the surgical epicondylar axis and the articular surface of the distal femur: an anatomic study. Knee Surg Sports Traumatol Arthrosc 16:674–682

    Article  PubMed  Google Scholar 

  17. Nagamine R, Miura H, Inoue Y, Urabe K, Matsuda S, Okamoto Y, Nishizawa M, Iwamoto Y (1998) Reliability of the anteroposterior axis and the posterior condylar axis for determining rotational alignment of the femoral component in total knee arthroplasty. J Orthop Sci Off J Jpn Orthop Assoc 3:194–198

    CAS  Google Scholar 

  18. Nelitz M, Dreyhaupt J, Williams SRM, Dornacher D (2015) Combined supracondylar femoral derotation osteotomy and patellofemoral ligament reconstruction for recurrent patellar dislocation and severe femoral anteversion syndrome: surgical technique and clinical outcome. Int Orthop 39:2355–2362

    Article  PubMed  Google Scholar 

  19. Pfirrmann CW, Zanetti M, Romero J, Hodler J (2000) Femoral trochlear dysplasia: MR findings. Radiology 216:858–864

    Article  CAS  PubMed  Google Scholar 

  20. Poilvache PL, Insall JN, Scuderi GR, Font-Rodriguez DE (1996) Rotational landmarks and sizing of the distal femur in total knee arthroplasty. Clin Orthop 331:35–46

    Article  Google Scholar 

  21. Servien E, Viskontas D, Giuffrè BM, Coolican MRJ, Parker DA (2008) Reliability of bony landmarks for restoration of the joint line in revision knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 16:263–269

    Article  PubMed  Google Scholar 

  22. Thienpont E, Schwab P-E, Paternostre F, Koch P (2014) Rotational alignment of the distal femur: anthropometric measurements with CT-based patient-specific instruments planning show high variability of the posterior condylar angle. Knee Surg Sports Traumatol Arthrosc 22:2995–3002

    Article  PubMed  Google Scholar 

  23. Van Haver A, De Roo K, De Beule M, Van Cauter S, Audenaert E, Claessens T, Verdonk P (2014) Semi-automated landmark-based 3D analysis reveals new morphometric characteristics in the trochlear dysplastic femur. Knee Surg Sports Traumatol Arthrosc 22:2698–2708

    Article  PubMed  Google Scholar 

  24. Won Y-Y, Cui W-Q, Baek M-H, Yun T-B, Han S-H (2007) An additional reference axis for determining rotational alignment of the femoral component in total knee arthroplasty. J Arthroplasty 22:1049–1053

    Article  PubMed  Google Scholar 

  25. Yu B, Fu M, Zhang Z, Wu P, Huang Z, Sun H (2017) The plane of the distal femur anterior cortex is a useful index for femoral component rotation in total knee arthroplasty. J Orthop 14:59–61

    Article  PubMed  Google Scholar 

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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

Authors and Affiliations

  1. Groupement Hospitalier Nord, Hospices civils de Lyon, Université Claude-Bernard Lyon 1, 103 Grande Rue de la Croix-Rousse, 69004, Lyon, France

    Julien Roger

  2. Groupement Hospitalier Nord, Hospices civils de Lyon, Université Lyon, 103 bvd de la Croix Rousse, 69004, Lyon, France

    Julien Roger, Sébastien Lustig & Elvire Servien

  3. Orthopaedic Surgery, Sports Medicine, Physiotherapy, Casa di Cura Villa Betania Giomi, Via Pio IV, 42, 00165, Rome, Italy

    Simone Cerciello

  4. Department of Orthopaedic and Trauma Surgery, “Magna Graecia” University, Catanzaro, Italy

    Carmine Fabio Bruno

  5. Center A. Trillat, Lyon, France

    Philippe Neyret

  6. FIFA medical center of excellence, Lyon, France

    Elvire Servien

Authors
  1. Julien Roger
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  2. Sébastien Lustig
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  3. Simone Cerciello
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  4. Carmine Fabio Bruno
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  5. Philippe Neyret
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  6. Elvire Servien
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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.

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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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  • DOI: https://doi.org/10.1007/s00167-018-5023-2

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