Ackermann Jakob, Bergheim Niklas, Hartmann Martin, Vlachopoulos Lazaros, Fucentese Sandro F
Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
Arthroscopy. 2025 Apr;41(4):1002-1008. doi: 10.1016/j.arthro.2024.05.023. Epub 2024 Jun 4.
To compare the sagittal position of the tibial tubercle in relation the trochlea groove in patients with and without trochlear dysplasia (TD). Patients with high-grade TD show a significantly increased sagittal position of the tibial tubercle in relation to the trochlear groove (sTTTG) compared with patients without TD. This may affect patellofemoral loading and contribute to the increased prevalence of cartilage lesions seen in the patellofemoral joint of patients with dysplasia of the trochlear groove.
All patients between January 2017 and December 2020 with high-grade TD (Dejour type B, C, and D) who underwent patellar-stabilizing surgery for patellar instability at a single institution were included in the current study. Patients without preoperative magnetic resonance imaging (MRI), any previous osteotomy on the affected lower extremity, or cruciate ligament insufficiency were excluded. Patients who underwent knee arthroscopy for meniscal repair/debridement without any signs of TD or any of the aforementioned criteria served as the control group. Preoperative MRI was retrospectively assessed to compare common patellofemoral anatomic parameters including patellar angle, patellar tilt, patella morphology according to Wiberg, Caton-Deschamps index, PF index, trochlear sulcus angle, sulcus depth, lateral inclination angle of the trochlea, tibiofemoral rotation, TTTG, and sTTTG distance between both groups. The sTTTG is measured as the distance between the nadir point of the cartilaginous trochlear groove and the most anterior point of the tibial tubercle on an axial MRI. Independent predictors for the sTTTG were assessed for patients with TD.
Patients with high-grade TD (n = 82) showed an increased patellar tilt, Caton-Deschamps index, trochlear sulcus angle, lateral tibiofemoral rotation angle, TTTG, and sTTTG (9.16 ± 4.47 mm vs 2.66 ± 4.21 mm) compared with the control group (n = 83) (P < .001). Patellar angle, PF index, sulcus depth, and lateral inclination angle of the trochlear were significantly decreased in the TD group (P < .001). The sTTTG was similar in all TD groups (n.s.). Among patients with TD, both tibiofemoral rotation and patellar height were independent predictors of the sTTTG (P < .05).
Patients with high-grade TD show not only abnormal values in common patellofemoral instability risk factors but also a significantly increased sTTTG compared with patients without TD.
Level III, retrospective case comparative study.
比较有和没有滑车发育不良（TD）的患者中胫骨结节相对于滑车沟的矢状位。与没有TD的患者相比，重度TD患者的胫骨结节相对于滑车沟（sTTTG）的矢状位显著增加。这可能会影响髌股关节负荷，并导致滑车沟发育不良患者髌股关节软骨损伤患病率增加。
纳入2017年1月至2020年12月间在单一机构因髌骨不稳接受髌骨稳定手术的重度TD（Dejour B型、C型和D型）患者。排除术前未进行磁共振成像（MRI）、患侧下肢既往有任何截骨术或交叉韧带功能不全的患者。因半月板修复/清创接受膝关节镜检查且无TD体征或上述任何标准的患者作为对照组。回顾性评估术前MRI，比较两组常见的髌股解剖参数，包括髌骨角、髌骨倾斜度、根据Wiberg分型的髌骨形态、Caton-Deschamps指数、PF指数、滑车沟角、沟深度、滑车外侧倾斜角、胫股旋转、TTTG和sTTTG。sTTTG测量为轴位MRI上软骨滑车沟最低点与胫骨结节最前点之间的距离。评估TD患者sTTTG的独立预测因素。
与对照组（n = 83）相比，重度TD患者（n = 82）的髌骨倾斜度、Caton-Deschamps指数、滑车沟角、胫股外侧旋转角、TTTG和sTTTG增加（9.16±4.47 mm对2.66±4.21 mm）（P <.001）。TD组的髌骨角、PF指数、沟深度和滑车外侧倾斜角显著降低（P <.）。所有TD组的sTTTG相似（无显著性差异）。在TD患者中，胫股旋转和髌骨高度均为sTTTG的独立预测因素（P <.05）。
与没有TD的患者相比，重度TD患者不仅常见髌股不稳危险因素的值异常，而且sTTTG显著增加。
III级，回顾性病例对照研究。
