Fucentese Sandro F, von Roll Andreas, Koch Peter P, Epari Devakara R, Fuchs Bruno, Schottle Philip B
Department of Orthopaedics, University of Zurich, Uniklinik Balgrist, Zurich, Switzerland.
Knee. 2006 Mar;13(2):145-50. doi: 10.1016/j.knee.2005.12.005. Epub 2006 Feb 9.
Trochlear dysplasia is suspected to have a genetic basis and causes recurrent patellar instability due to insufficient anatomical geometry. Numerous studies about trochlear morphology and the optimal surgical treatment have been carried out, but no attention has been paid to the corresponding patellar morphology.
The aim of this study was the evaluation of the patellar morphology in normal and trochlear dysplastic knees.
Biometric analysis.
Twenty two patellae with underlying trochlear dysplasia (study group--SG) were compared with 22 matched knees with normal trochlear shape (control group--CG) on transverse and sagittal MRI slices. We compared transverse diameter, cartilaginous thickness, Wiberg-index and -angle, length and radius of lateral and medial facet, patellar shape and angle, retropatellar length, and type of trochlear dysplasia. For statistical analysis we used the Wilcoxon signed ranks test.
The transverse and sagittal diameter, mean length of medial patellar facet, and mean cartilaginous and subchondral Wiberg-index showed statistical differences between the two groups.
Although the insufficient trochlear depth and decreased lateral trochlear slope are responsible for patellofemoral instability, the patella shows morphological changes in trochlear dysplastic knees. Its overall size and the medial facet are smaller. Although the femoral sulcus angle is larger, the Wiberg-angle and -index are equal to the control group. This may indicate that the patellar morphology may not be a result of missing medial patellofemoral pressure in trochlear dysplastic knees, but a decreased medial patellofemoral traction. This seems to be caused by hypotrophic medial patellofemoral restraints in combination with an increased lateral patellar tilt, both resulting in a decreased tension onto the medial patella facet. Whether there is a genetic component to the patellar morphology remains open.
滑车发育不良被怀疑有遗传基础，并且由于解剖结构几何形状不足导致复发性髌骨不稳定。已经开展了许多关于滑车形态和最佳手术治疗的研究，但尚未关注相应的髌骨形态。
本研究的目的是评估正常和滑车发育不良膝关节中的髌骨形态。
生物测量分析。
在横向和矢状面MRI切片上，将22个伴有滑车发育不良的髌骨（研究组-SG）与22个滑车形状正常的匹配膝关节（对照组-CG）进行比较。我们比较了横径、软骨厚度、维伯格指数和角度、外侧和内侧关节面的长度和半径、髌骨形状和角度、髌后长度以及滑车发育不良的类型。对于统计分析，我们使用了威尔科克森符号秩检验。
两组之间的横径和矢状径、髌骨内侧关节面的平均长度以及平均软骨和软骨下维伯格指数存在统计学差异。
虽然滑车深度不足和外侧滑车斜率降低是髌股关节不稳定的原因，但在滑车发育不良的膝关节中，髌骨显示出形态变化。其整体尺寸和内侧关节面较小。虽然股骨沟角较大，但维伯格角和指数与对照组相等。这可能表明，在滑车发育不良的膝关节中，髌骨形态可能不是髌股内侧压力缺失的结果，而是髌股内侧牵引力降低的结果。这似乎是由内侧髌股约束组织发育不良与髌骨外侧倾斜增加共同导致的，两者均导致内侧髌骨关节面的张力降低。髌骨形态是否存在遗传成分仍未明确。
