Tracey Olivia C, Lijesen Emilie, Bram Joshua T, Oji Nnaoma M, Chipman Danielle E, Fabricant Peter D, Green Daniel W
Hospital for Special Surgery, New York, New York, USA.
Downstate Health Sciences University College of Medicine, Brooklyn, New York, USA.
Orthop J Sports Med. 2024 Nov 25;12(11):23259671241291919. doi: 10.1177/23259671241291919. eCollection 2024 Nov.
Although osteochondritis dissecans (OCD) lesions are well-described in the femoral condyles and have been associated with varus limb alignment, there is limited data on OCD lesions in the trochlea.
To compare the baseline imaging characteristics in pediatric patients with trochlear OCD with those with medial femoral condyle (MFC) OCD to understand whether measures of coronal plane alignment predispose to OCD development by anatomic location.
Cross-sectional study; Level of evidence, 3.
This study retrospectively reviewed all pediatric patients (age ≤18 years) diagnosed with isolated trochlear OCD at a tertiary-care medical center from January 2016 to May 2023; all included patients had weight-bearing hip-to-ankle alignment radiographs. Hip-knee-ankle angle (HKA), mechanical lateral distal femoral angle (mLDFA), medial proximal tibial angle (MPTA), mechanical axis deviation (MAD), Caton-Deschamps Index (CDI), patellar tilt, and sulcus angle were measured on initial/preoperative anteroposterior and lateral knee radiographs. Tibial tubercle-trochlear groove (TT-TG) distance and OCD lesion size were measured on initial/preoperative magnetic resonance imaging sequences. Patients were 1 to 2 matched based on age (±2 years) and sex to a cohort with isolated MFC OCD.
A total of 18 extremities in 16 patients were included in the trochlear OCD cohort and matched to 36 extremities in the MFC OCD cohort. The mean age at the first clinical visit for all patients was 14.8 ± 1.5 years and did not differ significantly between the two groups ( = .40). The extremities with trochlear OCD had significantly less varus HKA (1°± 2° vs -1°± 2°; = .004) and MAD (4 ± 8 vs -3 ± 8 mm; = .004) compared with the MFC cohort as well as lower mLDFA (86°± 2° vs 88°± 2°; = .004). There were no differences in MPTA, CDI, patellar tilt, sulcus angle, TT-TG distance, or OCD lesion size between groups.
Pediatric patients with trochlear OCD had statistically less varus coronal plane alignment compared with age- and sex-matched patients with MFC OCD, with the latter exhibiting more significant varus based on the HKA and MAD.
虽然剥脱性骨软骨炎（OCD）病变在股骨髁中已有详尽描述，且与下肢内翻对线有关，但关于滑车部OCD病变的数据有限。
比较小儿滑车部OCD患者与股骨内侧髁（MFC）OCD患者的基线影像学特征，以了解冠状面排列测量指标是否因解剖位置而易于引发OCD。
横断面研究；证据等级，3级。
本研究回顾性分析了2016年1月至2023年5月在一家三级医疗中心诊断为孤立性滑车部OCD的所有小儿患者（年龄≤18岁）；所有纳入患者均有负重位髋至踝关节对线X线片。在初始/术前膝关节正侧位X线片上测量髋膝踝角（HKA）、机械性股骨远端外侧角（mLDFA）、胫骨近端内侧角（MPTA）、机械轴偏移（MAD）、卡顿-德尚指数（CDI）、髌骨倾斜度和沟角。在初始/术前磁共振成像序列上测量胫骨结节-滑车沟（TT-TG）距离和OCD病变大小。根据年龄（±2岁）和性别将患者1:2匹配至孤立性MFC OCD队列。
滑车部OCD队列共纳入16例患者的18个肢体，并与MFC OCD队列的36个肢体匹配。所有患者首次临床就诊时的平均年龄为14.8±1.5岁，两组间无显著差异（P = 0.40）。与MFC队列相比，滑车部OCD的肢体HKA内翻角度明显更小（1°±2°对-1°±2°；P = 0.004），MAD也更小（4±8对-3±8 mm；P = 0.004），且mLDFA更低（86°±2°对88°±2°；P = 0.004）。两组间MPTA、CDI、髌骨倾斜度、沟角、TT-TG距离或OCD病变大小无差异。
与年龄和性别匹配的MFC OCD患者相比，小儿滑车部OCD患者在统计学上冠状面内翻对线更少，后者基于HKA和MAD表现出更明显的内翻。
