ReSurg SA, Rue Saint Jean 22, 1260, Nyon, Switzerland.
Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Knee Surg Sports Traumatol Arthrosc. 2020 Dec;28(12):3871-3878. doi: 10.1007/s00167-020-05871-3. Epub 2020 Feb 4.
To determine if trochlear morphology in healthy knees depends on sex and ethnicity, and to compare it to off-the-shelf TKA prostheses.
Three retrospective series of CT angiograms from France (female, 124; male, 135), China (female, 122; male, 137) and South Africa (female, 21; male, 62) were used to digitize osseous landmarks at the level of the femoral epicondyles. Sulcus angle, trochlear rotation, lateral trochlear inclination, trochlear asymmetry ratio, and trochlear depth index were quantified for each knee and for 10 total knee arthroplasty (TKA) models. Univariable regression analyses were performed to determine associations of the five trochlear parameters with sex and ethnicity. Interquartile ranges (IQR) of native trochlear parameters were compared to the trochlear parameters of 10 off-the-shelf TKA prostheses.
Compared to French knees, Chinese knees had greater sulcus angle (β = 6.3°, p < 0.001), trochlear rotation (β = 0.8°, p = 0.004) and trochlear depth index (β = 1.60, p < 0.001). Conversely, South African knees had greater trochlear rotation (β = 1.9°, p < 0.001) and lateral trochlear inclination (β = 3.7°, p < 0.001). Female knees had smaller trochlear asymmetry ratios (β = - 0.03, p = 0.05) but greater trochlear rotation angles (β = 0.7, p = 0.005). Considerable mismatches in trochlear morphology were revealed between native knees and off-the-shelf TKA prostheses.
The findings suggest that thresholds used in the diagnosis of patellofemoral instability should be adapted to patient sex and ethnicity, and that standard off-the-shelf TKA may not restore native trochlear parameters in all patients.
III, retrospective comparative.
确定健康膝关节的滑车形态是否存在性别和种族差异，并与市售全膝关节置换假体进行比较。
本研究回顾性分析了来自法国（女性 124 例，男性 135 例）、中国（女性 122 例，男性 137 例）和南非（女性 21 例，男性 62 例）的三组 CT 血管造影膝关节数据，以数字化股骨髁上的骨性标志。对每个膝关节和 10 个全膝关节置换模型（TKA）进行滑车角、滑车旋转、外侧滑车倾斜度、滑车不对称比和滑车深度指数的定量测量。采用单变量回归分析确定 5 个滑车参数与性别和种族的相关性。比较了正常滑车参数的四分位间距（IQR）与 10 个市售 TKA 假体的滑车参数。
与法国膝关节相比，中国膝关节的滑车角更大（β=6.3°，p<0.001），滑车旋转（β=0.8°，p=0.004）和滑车深度指数（β=1.60，p<0.001）更大。相比之下，南非膝关节的滑车旋转（β=1.9°，p<0.001）和外侧滑车倾斜度（β=3.7°，p<0.001）更大。女性膝关节的滑车不对称比更小（β= - 0.03，p=0.05），但滑车旋转角度更大（β=0.7，p=0.005）。在正常膝关节和市售 TKA 假体之间，滑车形态存在明显的不匹配。
研究结果表明，髌股关节不稳定的诊断阈值应根据患者的性别和种族进行调整，而标准的市售 TKA 假体可能无法在所有患者中恢复正常的滑车参数。
III 级，回顾性比较。
