Dejour David H, de Sanctis Edoardo Giovanetti, Müller Jacobus H, Deroche Etienne, Pineda Tomas, Guarino Amedeo, Toanen Cécile
Lyon-Ortho-Clinic, Clinique de la Sauvegarde, Ramsay Santé, Lyon, France.
ReSurg SA, Nyon, Switzerland.
Knee Surg Sports Traumatol Arthrosc. 2025 Aug;33(8):2833-2846. doi: 10.1002/ksa.12539. Epub 2024 Nov 18.
To adapt the current D. Dejour trochlear dysplasia classification (v2.0) to only rely on quantitative magnetic resonance imaging (MRI) measurements (v3.0) to maximize objectivity and repeatability.
A consecutive series of adult knee MRIs were divided into objective patellar instability (OPI, n = 127) or controls (n = 103; isolated meniscal tears) and postprocessed with multiplanar reconstruction (MPR) to standardize the sagittal plane and ensure true lateral views. Thresholds for sulcus angle, lateral trochlear inclination (LTI) and central bump were established using regression tree models to distinguish OPI from controls. The sensitivity and specificity of sulcus angle and LTI combinations to diagnose OPI were then evaluated, and the combination yielding the highest sensitivity was selected as basis for trochlear dysplasia classification. Finally, sulcus angle and LTI measurability and presence of a central bump >5 mm were used to grade dysplasia as low, moderate or high.
The regression tree models produced thresholds of ≥157° for sulcus angle and <14° for LTI to distinguish OPI from controls. 'Sulcus angle ≥157° OR LTI < 14°' yielded the highest sensitivity (87%) to diagnose OPI. The quantitative MRI classification was sulcus angle <157° AND LTI ≥ 14° for Type 0 (No dysplasia); (sulcus angle ≥ 157° OR LTI < 14°) AND central bump <5 mm for Type 1 (Low-grade dysplasia); (sulcus angle OR LTI are 'unmeasurable') AND central bump <5 mm for Type 2 (Moderate-grade dysplasia); (sulcus angle ≥ 157° OR 'unmeasurable' OR LTI < 14° OR 'unmeasurable') AND central bump ≥5 mm for Type 3 (High-grade dysplasia).
This MRI classification depends exclusively on quantitative measurements, has excellent interobserver agreement, and yields high sensitivity to diagnose OPI. The MRI imaging protocol with MPR mode and standardized measurements could be quickly adopted and correctly applied by clinicians worldwide in any type of institution to determine the ideal treatment plan.
Level III.
调整当前的D. Dejour滑车发育不良分类（v2.0），使其仅依赖于定量磁共振成像（MRI）测量（v3.0），以最大限度地提高客观性和可重复性。
将一系列连续的成人膝关节MRI分为客观髌骨不稳定（OPI，n = 127）组或对照组（n = 103；单纯半月板撕裂），并采用多平面重建（MPR）进行后处理，以标准化矢状面并确保获得真正的侧视图。使用回归树模型确定沟角、外侧滑车倾斜度（LTI）和中央隆起的阈值，以区分OPI组和对照组。然后评估沟角和LTI组合诊断OPI的敏感性和特异性，并选择敏感性最高的组合作为滑车发育不良分类的基础。最后，根据沟角和LTI的可测量性以及中央隆起>5 mm的情况，将发育不良分为低、中、高等级。
回归树模型得出沟角≥157°和LTI < 14°的阈值，以区分OPI组和对照组。“沟角≥157°或LTI < 14°”对诊断OPI的敏感性最高（87%）。定量MRI分类为：0型（无发育不良）：沟角<157°且LTI≥14°；1型（低度发育不良）：（沟角≥157°或LTI < 14°）且中央隆起<5 mm；2型（中度发育不良）：（沟角或LTI“不可测量”）且中央隆起<5 mm；3型（高度发育不良）：（沟角≥157°或“不可测量”或LTI < 14°或“不可测量”）且中央隆起≥5 mm。
这种MRI分类完全依赖于定量测量，具有极好的观察者间一致性，对诊断OPI具有高敏感性。采用MPR模式和标准化测量的MRI成像方案可被全球任何类型机构的临床医生快速采用并正确应用，以确定理想的治疗方案。
三级。
