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Gattu N, Sutton M, Doherty DB, Lanfermeijer ND, Rodriguez-Quintana D, Ismaily SK, Pletka CA, Noble PC, Han S. Variations in Trochlear Morphology of Contemporary and Legacy Total Knee Arthroplasty Prostheses: A Review of 22 Designs. J Arthroplasty 2024; 39:1583-1588. [PMID: 38072096 DOI: 10.1016/j.arth.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 12/05/2023] [Accepted: 12/06/2023] [Indexed: 01/01/2024] Open
Abstract
BACKGROUND The morphology of the trochlear compartment of total knee arthroplasty (TKA) prostheses is a major determinant of postoperative patello-femoral kinematics, particularly with unresurfaced patellae. The objective of this study was to quantify and compare the trochlear morphology of a large series of contemporary and legacy TKA designs. METHODS The 3-dimensional surface models of 22 femoral components (13 contemporary and 9 legacy) were created using high-resolution laser scanning. The trochlear profile of each component was analyzed from proximal to distal in 15° increments around the trochlear axis. In each profile, the following variables were measured: sulcus angle, medio-lateral deviation of the sulcus, the height and width of the facets, and the trochlear groove orientation. RESULTS In the contemporary group, the sulcus angle decreased progressively along the trochlear arc to varying degrees, except for 2 symmetrical designs, whereas the sulcus angle of the legacy designs showed considerable variability. The height of the medial facet was very strongly correlated with that of the lateral facet in the contemporary group (R2 = 0.89), whereas the correlation was weak for the legacy designs (R2 = 0.36). Moreover, the trochlear sulcus deviated laterally from distal to proximal in 10 contemporary designs and 7 legacy designs, resulting in a trochlear groove orientation of 4.2 to 11.1° and 4.3 to 10.5°, respectively. In the remaining 5 designs (3 contemporary and 2 legacy), the sulcus was vertical. CONCLUSIONS There is more consistency in trochlear morphology of contemporary TKA designs compared to that of legacy designs, yet there are still large variations between different designs.
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Affiliation(s)
- Nikhil Gattu
- Department of Orthopedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
| | - Marriah Sutton
- Department of Orthopedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
| | - David B Doherty
- Department of Orthopedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
| | - Nicholas D Lanfermeijer
- Department of Orthopedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
| | - David Rodriguez-Quintana
- Department of Orthopedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
| | - Sabir K Ismaily
- Department of Orthopedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
| | - Camryn A Pletka
- Department of Orthopedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
| | - Philip C Noble
- Department of Orthopedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
| | - Shuyang Han
- Department of Orthopedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
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Pence KB, Sen S, Ormeci T, Caliskan M, Sakul BU. Evaluation of femoral condyle volumes in patients with trochlear dysplasia: a pilot study. Clin Radiol 2024; 79:e475-e481. [PMID: 38145924 DOI: 10.1016/j.crad.2023.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 11/07/2023] [Accepted: 11/18/2023] [Indexed: 12/27/2023]
Abstract
AIM To examine the volumes of the medial and lateral femoral condyles and the trochlear groove, and to determine their relationship with trochlear dysplasia. MATERIALS AND METHODS Computed tomography images of the knees of 21 patients with trochlear dysplasia and 18 healthy individuals were analysed retrospectively. According to the modified Dejour classification, the degree of trochlear dysplasia was recorded, such as type A trochlea being low-grade dysplasia and types B, C, and D trochlea being high-grade dysplasia. Volume of the trochlear groove and medial and lateral femoral condyles were calculated using the three-dimensional (3D) volume-rendering method. RESULTS The volumes of lateral condyle, medial condyle, and trochlear groove were statistically significantly lower in patients with trochlear dysplasia when compared to healthy participants. When compared according to Dejour types, all parameters were statistically significantly lower in both high- and low-grade dysplasia patients (p<0.05). The correlation between femoral condyle volumes and trochlear groove volume was low in the control group, but there was a moderate positive correlation in the patient group (r=0.50-0.75, p<0.05). CONCLUSION In trochlear dysplasia, the volume of the trochlear groove decreases and hypoplasia may occur in both lateral femoral and medial femoral condyles. Therefore, hypoplasia of only one condyle should not be interpreted as trochlear dysplasia. A holistic approach to patients is required.
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Affiliation(s)
- K B Pence
- Department of Anatomy, School of Medicine, Istanbul Medipol University, Ataturk Street. No. 40 Beykoz, Istanbul, Turkey.
| | - S Sen
- Department of Anatomy, School of Medicine, Istanbul Medipol University, Ataturk Street. No. 40 Beykoz, Istanbul, Turkey
| | - T Ormeci
- Department of Radiology, School of Medicine, Istanbul Medipol University, Ataturk Street. No. 40 Beykoz, Istanbul, Turkey
| | - M Caliskan
- Department of Orthopedics and Traumatology, Saglik Bilimleri University Istanbul Kanuni Sultan Suleyman Training and Research Hospital, Atakent Mh. Turgut Özal Blv. No:46/1 Kucukcekmece, Istanbul, Turkey
| | - B U Sakul
- Department of Anatomy, School of Medicine, Istanbul Medipol University, Ataturk Street. No. 40 Beykoz, Istanbul, Turkey
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Pineda T, Dejour D. Inconsistent repeatability of the Dejour classification of trochlear dysplasia due to the variability of imaging modalities: a systematic review. Knee Surg Sports Traumatol Arthrosc 2023; 31:5707-5720. [PMID: 37919443 DOI: 10.1007/s00167-023-07612-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 09/28/2023] [Indexed: 11/04/2023]
Abstract
PURPOSE The purpose of this systematic review was to critically assess the quality of papers that report on the intra- and inter-observer repeatability of the Dejour classification for trochlear dysplasia, and to identify the possible causes for poor repeatability. METHODS Two authors independently conducted an electronic search (four databases) on 8 February 2023 for studies (English or French) that assessed trochlear dysplasia classifications on imaging of skeletally mature participants. Exclusion criteria were reviews of clinical studies, conference proceedings, or editorials. After title, abstract, and full-text screening, characteristics of eligible studies were tabulated (author, year, journal, study design, cohort characteristics, and intra- and/or inter-observer agreement coefficients). The methodological quality of studies was assessed using the Joanna Briggs Institute (JBI) checklist for analytical cross-sectional studies. Authors analysed three components of the included studies: (1) classifications based on true lateral radiographs and slice imaging; (2) dysplasia graded into Type A vs B vs C vs D and 3) coefficients of intra- and/or inter-observer agreement. RESULTS The electronic search returned 3,178 references, and after removal of duplicates and irrelevant studies, ten were eligible for data extraction. A second search (31 July 2023) yielded one additional study. Eight studies did not include lateral radiographs, two studies did not explicitly state if radiographs were true lateral views, and one used true lateral radiographs in isolation. Classification of trochlear dysplasia into A vs B vs C vs D using different imaging modalities resulted in moderate to near-perfect intra-observer agreement, and slight to near-perfect inter-observer agreement. Studies distinguished between moderate and severe dysplasia using a variety of combinations: A vs B/C/D, A/B vs C/D and A/C vs B/D. CONCLUSION This systematic review revealed that the Dejour classification remains the most widely used to assess trochlear dysplasia and that the majority of studies that assessed the reliability of the Dejour classification, reported moderate to near-perfect inter-observer agreement; however, pooling of results for comparison among the included studies was inappropriate due to substantial variation in imaging protocols and non-standardised criteria to distinguish severe from moderate dysplasia. LEVEL OF EVIDENCE Level IV. TRIAL REGISTRY The PROSPERO registration number is CRD42023386731.
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Affiliation(s)
- Tomas Pineda
- Lyon-Ortho-Clinic, Clinique de La Sauvegarde, 29 Avenue des Sources, 69009, Ramsay Santé, Lyon, France
| | - David Dejour
- Lyon-Ortho-Clinic, Clinique de La Sauvegarde, 29 Avenue des Sources, 69009, Ramsay Santé, Lyon, France
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Borukhov I, Esposito CI, Ismailidis P, LiArno S, Lyon JP, McCarthy TF, McEwen P. The trochlear sulcus of the native knee is consistently orientated close to the sagittal plane despite variation in distal condylar anatomy. Knee Surg Sports Traumatol Arthrosc 2023; 31:3618-3626. [PMID: 34291310 PMCID: PMC10435591 DOI: 10.1007/s00167-021-06667-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 07/09/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The aim of this study was to describe the native trochlear orientation of non-arthritic knees in three planes and to quantify the relationship between trochlear and distal condylar anatomy across race and sex. METHODS Computed tomography scans of 1578 femora were included in this study. The mediolateral position of the trochlear sulcus, the distal trochlear sulcus angle (DTSA) the medial sulcus angle (MSA) and the lateral sulcus angle (LSA) as well as the mechanical lateral distal femoral angle (mLDFA) were measured relative to a standard reference coordinate system. Multiple linear regression analyses were performed to account for potential confounding variables. RESULTS The mediolateral position of the trochlear sulcus had minimal mean deviation of the sagittal femoral plane. The mean DTSA was 86.1° (SD 2.2°). Multilinear regression analysis found mLDFA, sex, and age all influence DTSA (p < 0.05), with mLDFA having by far the greatest influence (r2 = 0.55). The medial facet of the trochlear sulcus was found to be flat proximally and more prominent distally. The lateral facet was relatively uniform throughout the arc. CONCLUSION In non-arthritic knees, due to a strong positive correlation between the DTSA and the mLDFA, the trochlear sulcus is consistently orientated in the sagittal femoral plane regardless of distal condylar anatomy. Minor deviations from the sagittal plane occur in a lateral direction in the middle part and in a medial direction at the proximal and distal part of the trochlea. These findings have relevance regarding the biomimetic design of total knee implants.
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Affiliation(s)
| | | | - Petros Ismailidis
- The Orthopaedic Research Institute of Queensland (ORIQL), 7 Turner St, Pimlico Townsville, QLD, Australia.
- Department of Orthopaedics and Traumatology, University Hospital of Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
| | | | | | | | - Peter McEwen
- The Orthopaedic Research Institute of Queensland (ORIQL), 7 Turner St, Pimlico Townsville, QLD, Australia
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Liu Z, Zhou A, Fauveau V, Lee J, Marcadis P, Fayad ZA, Chan JJ, Gladstone J, Mei X, Huang M. Deep Learning for Automated Measurement of Patellofemoral Anatomic Landmarks. Bioengineering (Basel) 2023; 10:815. [PMID: 37508842 PMCID: PMC10376187 DOI: 10.3390/bioengineering10070815] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 06/30/2023] [Accepted: 07/02/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Patellofemoral anatomy has not been well characterized. Applying deep learning to automatically measure knee anatomy can provide a better understanding of anatomy, which can be a key factor in improving outcomes. METHODS 483 total patients with knee CT imaging (April 2017-May 2022) from 6 centers were selected from a cohort scheduled for knee arthroplasty and a cohort with healthy knee anatomy. A total of 7 patellofemoral landmarks were annotated on 14,652 images and approved by a senior musculoskeletal radiologist. A two-stage deep learning model was trained to predict landmark coordinates using a modified ResNet50 architecture initialized with self-supervised learning pretrained weights on RadImageNet. Landmark predictions were evaluated with mean absolute error, and derived patellofemoral measurements were analyzed with Bland-Altman plots. Statistical significance of measurements was assessed by paired t-tests. RESULTS Mean absolute error between predicted and ground truth landmark coordinates was 0.20/0.26 cm in the healthy/arthroplasty cohort. Four knee parameters were calculated, including transepicondylar axis length, transepicondylar-posterior femur axis angle, trochlear medial asymmetry, and sulcus angle. There were no statistically significant parameter differences (p > 0.05) between predicted and ground truth measurements in both cohorts, except for the healthy cohort sulcus angle. CONCLUSION Our model accurately identifies key trochlear landmarks with ~0.20-0.26 cm accuracy and produces human-comparable measurements on both healthy and pathological knees. This work represents the first deep learning regression model for automated patellofemoral annotation trained on both physiologic and pathologic CT imaging at this scale. This novel model can enhance our ability to analyze the anatomy of the patellofemoral compartment at scale.
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Affiliation(s)
- Zelong Liu
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Alexander Zhou
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Valentin Fauveau
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Justine Lee
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Philip Marcadis
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Zahi A. Fayad
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Jimmy J. Chan
- Department of Orthopedics and Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - James Gladstone
- Department of Orthopedics and Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Xueyan Mei
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Mingqian Huang
- Department of Diagnostic, Molecular, and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
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Yu KE, Cooperman DR, Schneble CA, McLaughlin W, Beitler B, Kaliney R, Wang A, Fulkerson JP. Reconceptualization of Trochlear Dysplasia in Patients With Recurrent Patellar Dislocation Using 3-Dimensional Models. Orthop J Sports Med 2022; 10:23259671221138257. [PMID: 36458105 PMCID: PMC9706073 DOI: 10.1177/23259671221138257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 09/08/2022] [Indexed: 11/22/2022] Open
Abstract
Background Common classification schemes, measurements, and surgical planning for trochlear dysplasia are predicated on 2-dimensional imaging views. Purpose To investigate patellofemoral joint osseous anatomy using 3-dimensional (3D) printed models to describe osseous anatomic trochlear variations in patients with recurrent patellar dislocation. Study Design Cross-sectional study; Level of evidence, 3. Methods Computed tomography scans were obtained from 20 patients with recurrent patellar dislocation and 10 healthy control knees, and 3D prints generated from these computed tomography scans were studied with respect to mediolateral positioning of the proximal trochlear groove and groove obliquity as well as changes in the appearance, height, and orientation of the medial and lateral trochlear ridges. Each trochlea was centered with respect to a vertical line perpendicular to the distal femoral condyles and through the central intercondylar notch roof, with the 3D models resting on their posterior femoral condyles. A novel 3D measurement method was devised to assess groove obliquity, termed the entry point-transition point (EP-TP) angle. The EP was defined as the midpoint of the flattened region of the proximal trochlea where the lateral and medial ridges of the proximal trochlea meet, and the TP was the point along the trochlear groove at which the groove shape changes from an oblique orientation proximally to one more vertical distally. Measurements were obtained by 3 reviewers, and reliability analyses were performed. Results With the dysplastic knees arranged according to flattening of the trochleas, increased obliquity of the trochlear grooves was observed, as reflected by increased EP-TP angles as well as more lateral patellar EPs into the proximal trochleas of these recurrent patellar dislocation knees when compared with the control knees. The degree of trochlear dysplasia (according to the Dejour classification and trochlear flatness in the frontal and axial planes) was associated with diminished prominence of the lateral trochlear convexity, increasingly lateralized proximal trochlear EPs, increased trochlear groove obliquity, lateral trochlear curvature, and progressive medial ridge deformity. Conclusion The 3D reproductions enabled unique conceptualization of trochlear deformity associated with recurrent patellar dislocation.
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Affiliation(s)
- Kristin E. Yu
- Kristin E. Yu, MD, Yale School of Medicine, 47 College St, New
Haven, CT 06510, USA () (Twitter:
@kristinyu7)
| | - Daniel R. Cooperman
- Department of Orthopaedics and Rehabilitation, Yale School of
Medicine, New Haven, Connecticut, USA
| | - Christopher A. Schneble
- Department of Orthopaedics and Rehabilitation, Yale School of
Medicine, New Haven, Connecticut, USA
| | - William McLaughlin
- Department of Orthopaedics and Rehabilitation, Yale School of
Medicine, New Haven, Connecticut, USA
| | - Brian Beitler
- Department of Orthopaedics and Rehabilitation, Yale School of
Medicine, New Haven, Connecticut, USA
| | - Ryan Kaliney
- Jefferson Radiology, East Hartford, Connecticut, USA
- Hartford Healthcare Bone and Joint Institute, Hartford, Connecticut,
USA
| | - Annie Wang
- Department of Radiology and Biomedical Imaging, Yale School of
Medicine, New Haven, Connecticut, USA
| | - John P. Fulkerson
- Department of Orthopaedics and Rehabilitation, Yale School of
Medicine, New Haven, Connecticut, USA
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Intraoperative analysis of patellofemoral joint morphology before and after total knee arthroplasty. DER ORTHOPADE 2022; 51:580-589. [PMID: 35254486 PMCID: PMC9249712 DOI: 10.1007/s00132-022-04224-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/01/2022] [Indexed: 12/03/2022]
Abstract
Background Patellofemoral problems after total knee arthroplast (TKA) are frequent and often associated with a change in the geometry of the trochlear groove. Objective The present study aimed to analyze the feasibility of intraoperative examination of the patellofemoral joint geometry before and after the implantation of bicondylar total knee replacements without exposing the patient to radiation. Material and methods The patellofemoral joint morphology geometries of 33 patients before and after implantation of a bicondylar total knee replacement was intraoperatively analyzed using a digital scanning method. Femoral surface geometries were extracted from intraoperatively recorded tactile scanning data using an in-house algorithm. The geometries were then characterized by sulcus height, medial femoral condyle height and lateral femoral condyle height. Results Our preliminary results show that these key geometric parameters are only partially restored after TKA leading to a distinctly different shaped profile of the anterior distal femur. Maximum and minimum mean differences in sulcus height, medial femoral condyle height, and lateral femoral condyle height before and after surgery were 2.00 mm/−3.06 mm, 2.51 mm/−6.25 mm and 2.74 mm/−3.58 mm, respectively. Conclusion A new method for intraoperative analysis of the patellofemoral joint morphology before and after TKA without radiation exposure was developed and utilized. Even with the use of modern total knee designs, the patellofemoral articulation is considerably changed postoperatively as quantified by the key parameters of sulcus height, medial femoral condyle height, and lateral femoral condyle height. This may result in altered knee biomechanics and might explain persistent patellofemoral disorders, which are often reported by patients after TKA.
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Li Z, Liu G, Tian R, Kong N, Li Y, Li Y, Wang K, Yang P. The patellofemoral morphology and the normal predicted value of tibial tuberosity-trochlear groove distance in the Chinese population. BMC Musculoskelet Disord 2021; 22:575. [PMID: 34162383 PMCID: PMC8223279 DOI: 10.1186/s12891-021-04454-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 04/08/2021] [Indexed: 01/11/2023] Open
Abstract
Background Our objective was to obtain normal patellofemoral measurements to analyse sex and individual differences. In addition, the absolute values and indices of tibial tuberosity-trochlear groove (TT-TG) distances are still controversial in clinical application. A better method to enable precise prediction is still needed. Methods Seventy-eight knees of 78 participants without knee pathologies were included in this cross-sectional study. A CT scan was conducted for all participants and three-dimensional knee models were constructed using Mimics and SolidWorks software. We measured and analysed 19 parameters including the TT-TG distance and dimensions and shapes of the patella, femur, tibia, and trochlea. LASSO regression was used to predict the normal TT-TG distances. Results The dimensional parameters, TT-TG distance, and femoral aspect ratio of the men were significantly larger than those of women (all p values < 0.05). However, after controlling for the bias from age, height, and weight, there were no significant differences in TT-TG distances and anterior-posterior dimensions between the sexes (all p values > 0.05). The Pearson correlation coefficients between the anterior femoral offset and other indexes were consistently below 0.3, indicating no relationship or a weak relationship. Similar results were observed for the sulcus angle and the Wiberg index. Using LASSO regression, we obtained four parameters to predict the TT-TG distance (R2 = 0.5612, p < 0.01) to achieve the optimal accuracy and convenience. Conclusions Normative data of patellofemoral morphology were provided for the Chinese population. The anterior-posterior dimensions of the women were thicker than those of men for the same medial-lateral dimensions. More attention should be paid to not only sex differences but also individual differences, especially the anterior condyle and trochlea. In addition, this study provided a new method to predict TT-TG distances accurately. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04454-8.
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Affiliation(s)
- Zhe Li
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Medical College, Xi'an Jiaotong University, Shaanxi, 710004, Xi'an, People's Republic of China
| | - Guanzhi Liu
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Medical College, Xi'an Jiaotong University, Shaanxi, 710004, Xi'an, People's Republic of China
| | - Run Tian
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Medical College, Xi'an Jiaotong University, Shaanxi, 710004, Xi'an, People's Republic of China
| | - Ning Kong
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Medical College, Xi'an Jiaotong University, Shaanxi, 710004, Xi'an, People's Republic of China
| | - Yue Li
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Medical College, Xi'an Jiaotong University, Shaanxi, 710004, Xi'an, People's Republic of China
| | - Yiyang Li
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Medical College, Xi'an Jiaotong University, Shaanxi, 710004, Xi'an, People's Republic of China
| | - Kunzheng Wang
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Medical College, Xi'an Jiaotong University, Shaanxi, 710004, Xi'an, People's Republic of China
| | - Pei Yang
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Medical College, Xi'an Jiaotong University, Shaanxi, 710004, Xi'an, People's Republic of China.
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9
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Gender differences in femoral trochlea morphology. Knee Surg Sports Traumatol Arthrosc 2021; 29:563-572. [PMID: 32232538 DOI: 10.1007/s00167-020-05944-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 03/17/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE This study aimed to analyze the morphology of the anterior femoral condyle using a quantitative three-dimensional reconstruction method. The morphological data were compared between genders. METHODS Computed tomography scans of femurs were taken from 90 healthy subjects and then reconstructed in 3D modeling software. Coaxial cutting planes were created at 10° increments to measure the lateral and medial anterior condylar heights (LACH and MACH, respectively), lateral and medial trochlear groove widths (LTW and MTW, respectively), and for trochlear groove tracking. The absolute values and normalized data were compared between male and female subjects. The sulcus angle and deepest point of the trochlear groove at each cross-section were also analyzed to determine the differences in the depth of the trochlear groove. RESULTS The absolute dimensions of LACH, MACH, LTW, and MTW were significantly smaller in the female subjects, by 10.5%, 36.9%, 10.3%, and 11.0%, respectively, than in the males (p < 0.05). After normalization, no significant difference was found in the condylar height between the genders. However, the female subjects had a significantly larger value of approximately 7.9% for the normalized trochlear width. CONCLUSION Male subjects had greater condylar heights and widths than the female subjects. Although the trajectory of the trochlear groove varied greatly among the subjects, the trochlear groove appeared to be wider and shallower in the female subjects than in the male subjects. These results provide important information for the design of femoral trochlea to fit Asian female patients. LEVEL OF EVIDENCE III.
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Yao J, Dong B, Sun J, Liu JT, Liu F, Li XW, Yuan PW, Zhang JB. Accuracy and Reliability of Computer-aided Anatomical Measurements for Vertebral Body and Disc Based on Computed Tomography Scans. Orthop Surg 2020; 12:1182-1189. [PMID: 32618427 PMCID: PMC7454159 DOI: 10.1111/os.12729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 05/08/2020] [Accepted: 05/17/2020] [Indexed: 12/02/2022] Open
Abstract
Objective To assess whether the computed tomography (CT)‐based method of three‐dimensional (3D) analysis (Mimics) was accurate and reliable for spine surgical anatomical measurements. Methods A total of 40 lumbar segments and 32 inter‐vertebral discs from eigth adult male cadavers without fractures or deformities fixed with the classical formaldehyde method were included in this research on 5 June 2017. CT scans including seven dimensions: anterior height of the vertebral body (VBHa), middle height of the vertebral body (VBHm), posterior height of the vertebral body (VBHp), width of the upper endplate (EPWu), depth of the upper endplate (EPDu), anterior height of the inter‐vertebral disc in the median sagittal plane (IDHa), and posterior height of the inter‐vertebral disc in the median sagittal plane (IDHp). They were performed based on uniform conditions (slice thickness: 0.625 mm) using a CT scanner on 8 June 2017. Afterwards, the surgical anatomical measurements were conducted with a Vernier caliper on 12 June 2017. The computer‐aided anatomical measurements were conducted by three investigators using Mimics 16.0 to perform 3D reconstructions of CT bone on 16 June 2017. Finally, the length and angle were measured with associated measurement tools, yielding a verified accuracy of 0.01 mm and 0.01°, respectively. Each measurement was repeated three times, and all anatomical data was analyzed using the statistical software and P‐value < 0.05 was considered statistically significant. Results The results showed no statistically significant difference was observed between the surgical anatomical and computer‐aided anatomical measurements (P > 0.05) for lumbar vertebra measurements, and the absolute difference between surgical and computer‐aided data were all less than 1.0 mm (for the VBHa, VBHm, VBHp, EPWu, and EPDu were 0.12, 0.03, 0.03, 0.31, and 0.03 mm, respectively). Moreover, although the absolute differences of discs was larger than those of lumbar vertebras, no significant differences were detected between the computer‐aided and surgical anatomical measurements for the IDHa, as well as IDHp in the vast majority of measurements (P = 0.543, 0.079 or 0.052 for IDHa, and P = 0.212, 0.133 or 0.042 for IDHp). In addition, excellent reliability correlation was observed between the measurements of each investigator, and the reliability coefficients in the intra‐groups were all greater than 0.9 except for IDHp (reliability coefficient = 0.892). Additionally, the reliability coefficients were greater than 0.9 for the all between‐group correlations, and a significant correlation was also observed. Furthermore, no statistically significant difference for three anatomical values was found in the computer‐assisted measurements of the lumbar bone structure (P > 0.05). Similarly, we did not observe a statistical difference in the anatomical data of the lumbar discs from the three measures (P > 0.05). Conclusions Computer‐aided anatomical measurement for spine based on CT scans presents the high accuracy and reliability for improving spinal surgical procedures.
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Affiliation(s)
- Jie Yao
- The Key Laboratory of Biomedical Information Engineering, Ministry of Education, School of Life Science and Technology, Xi'an Jiao Tong University, Xi'an, China.,Department of Nursing, Shaanxi University of Chinese Medicine, Xianyang, China
| | - Bo Dong
- The Key Laboratory of Biomedical Information Engineering, Ministry of Education, School of Life Science and Technology, Xi'an Jiao Tong University, Xi'an, China.,Department of Orthopaedic, Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, China
| | - Ju Sun
- Department of Orthopaedic, Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, China
| | - Jian-Tao Liu
- Spinal Cord Surgery, People's Hospital of Henan Province, Jinshui District, Zhengzhou, China
| | - Fang Liu
- Department of Nursing, Shaanxi University of Chinese Medicine, Xianyang, China
| | - Xiao-Wei Li
- Department of Nursing, Shaanxi University of Chinese Medicine, Xianyang, China
| | - Pu-Wei Yuan
- Department of Nursing, Shaanxi University of Chinese Medicine, Xianyang, China
| | - Jian-Bao Zhang
- The Key Laboratory of Biomedical Information Engineering, Ministry of Education, School of Life Science and Technology, Xi'an Jiao Tong University, Xi'an, China
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Cerveri P, Belfatto A, Manzotti A. Representative 3D shape of the distal femur, modes of variation and relationship with abnormality of the trochlear region. J Biomech 2019; 94:67-74. [DOI: 10.1016/j.jbiomech.2019.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 03/13/2019] [Accepted: 07/09/2019] [Indexed: 01/17/2023]
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Differences between native and prosthetic knees in terms of cross-sectional morphology of the femoral trochlea: a study based on three-dimensional models and virtual total knee arthroplasty. BMC Musculoskelet Disord 2017; 18:166. [PMID: 28427385 PMCID: PMC5397712 DOI: 10.1186/s12891-017-1529-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 04/10/2017] [Indexed: 12/01/2022] Open
Abstract
Background The cross-sectional morphology of the prosthetic knee is crucial to understanding patellar motion and quadriceps strength after total knee arthroplasty. However, few comparative evaluations of the cross-sectional morphology of the femoral trochlea have been performed in the native knee and currently available femoral implants, and the relationship between the trochlear anatomy of prosthetic components and post-operative patellofemoral complications remains unclear. We aimed to investigate the differences in cross-sectional morphology of the femoral trochlea between native knees and prosthetic femoral components. Methods Virtual total knee arthroplasty was performed, whereby four different femoral components (medial-pivot, Triathlon, NRG and NexGen) were virtually superimposed onto three-dimensional models of 42 healthy femurs. The following morphological parameters were measured in three cross-sections (0, 45 and 90°) of the femoral trochlea: sulcus height, lateral tilt angle, medial tilt angle and sulcus angle. Only statistically significant differences are described further (p < 0.05). Results In the 0° cross-section, sulcus height was smaller in the native knee than in the Triathlon, NRG and NexGen components; all prosthetic components had smaller lateral tilt angles and larger medial tilt angles. In the 45° cross-section, sulcus height was larger in the native knee than in the medial-pivot, Triathlon and NexGen components; both lateral and medial tilt angles were smaller in the prosthetic components. In the 90° cross-section, sulcus height was smaller in the native knee than in the medial-pivot component; all prosthetic components had a larger lateral tilt angle and smaller medial tilt angle. In all cross-sections, the sulcus angle was smaller in the native knee. Conclusions The discrepancy between native and prosthetic trochlear geometries suggests altered knee mechanics after total knee arthroplasty, but further cadaveric, computational or fluoroscopic investigations are necessary to clarify the implications of this observation. Our findings can be used to optimize biomechanical guidelines for total knee arthroplasty (patellar resurfacing or non-resurfacing) in Chinese individuals so as to decrease the risk of patellar lateral dislocation, to maintain stability and to optimize extensor kinematics.
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Du Z, Chen S, Yan M, Yue B, Zeng Y, Wang Y. Do size, shape, and alignment parameters of the femoral condyle affect the trochlear groove tracking? A morphometric study based on 3D- computed tomography models in Chinese people. BMC Musculoskelet Disord 2017; 18:4. [PMID: 28061849 PMCID: PMC5217221 DOI: 10.1186/s12891-016-1374-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 12/19/2016] [Indexed: 01/25/2023] Open
Abstract
Background Our study aimed to investigate whether geometrical features (size, shape, or alignment parameters) of the femoral condyle affect the morphology of the trochlear groove. Methods Computed tomography models of 195 femurs (97 and 98 knees from male and female subjects, respectively) were reconstructed into three-dimensional models and categorised into four types of trochlear groove morphology based on the position of the turning point in relation to the mechanical axis (types 45°, 60°, 75°, and 90°). Only subjects with healthy knees were included, whereas individuals with previous knee trauma or knee pain, soft tissue injury, osteoarthritis, or other chronic diseases of the musculoskeletal system were excluded. The size parameters were: radius of the best-fit cylinder, anteroposterior dimension of the lateral condyles (AP), and distal mediolateral dimension (ML). The shape parameters were: aspect ratio (AP/ML), arc angle, and proximal- and distal- end angles. The alignment parameters were: knee valgus physiologic angle (KVPA), mechanical medial distal femoral angle (mMDFA), and hip-knee-ankle angle (HKA). All variables were measured in the femoral condyle models, and the means for each groove type were compared using one-way analysis of variance. Results No significant difference among groove types was observed regarding size parameters. There were significant differences when comparing type 45° with types 60°, 75°, and 90° regarding aspect ratio and distal-end angle (p < 0.05), but not regarding proximal-end angle. There were significant differences when comparing type 90° with types 45°, 60°, and 75° regarding KVPA, mMDFA, and HKA (p < 0.05). Conclusion Among size, shape, and alignment parameters, the latter two exhibited partial influence on the morphology of the trochlear groove. Shape parameters affected the trochlear groove for trochlear type 45°, for which the femoral condyle was relatively flat, whereas alignment parameters affected the trochlear groove for trochlear type 90°, showing that knees in type 90° tend to be valgus. The morphometric analysis based on trochlear groove classification may be helpful for the future design of individualized prostheses.
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Affiliation(s)
- Zhe Du
- Department of Orthopaedic Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, 145 Shandong Middle Road, Shanghai, 200001, China
| | - Shichang Chen
- Department of Orthopaedic Surgery, Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Mengning Yan
- Department of Orthopaedic Surgery, Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Bing Yue
- Department of Orthopaedic Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, 145 Shandong Middle Road, Shanghai, 200001, China
| | - Yiming Zeng
- Department of Orthopaedic Surgery, Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - You Wang
- Department of Orthopaedic Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, 145 Shandong Middle Road, Shanghai, 200001, China.
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