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Journal of Bone and Joint Surgery - British Volume, Vol 88-B, Issue 5, 688-691.
doi: 10.1302/0301-620X.88B5.16866  
Copyright © 2006 by British Editorial Society of Bone and Joint Surgery
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Cartilage-bone mismatch in the dysplastic trochlea

AN MRI STUDY

A. L. van Huyssteen, FRCS(Eng), FC Orth(SA), Orthopaedic Surgeon1; M. R. G. Hendrix, MMed(Orth), Consultant Orthopaedic Surgeon2; A. J. Barnett, MRCSEd, Specialist Registrar in Trauma and Orthopaedics3; C. J. Wakeley, FRCS, FRCSEd, FRCR, Consultant Radiologist4; and J. D. J. Eldridge, FRCS (Trauma & Orth), Consultant Orthopaedic Surgeon5

1 Department of Orthopaedic Surgery, Claremont Hospital, Main Road, Claremont, 7708, South Africa.
2 Department of Orthopaedic Surgery, Stirling Royal Infirmary, Livilands, Stirling FK8 2AU, UK.
3 Royal United Hospital, Combe Park, Bath BA1 3NG, UK.
4 Department of Radiology
5 Trauma and Orthopaedic Department, Bristol Royal Infirmary, Bristol BS2 8HW, UK.

Correspondence should be sent to Dr A. L. van Huyssteen at 26 Dreyer Road, Kommetjie 7975, South Africa; e-mail: adriaanandjo{at}tiscali.co.za

Trochlear dysplasia is an important anatomical abnormality in symptomatic patellar instability. Our study assessed the mismatch between the bony and cartilaginous morphology in patients with a dysplastic trochlea compared with a control group.

MRI scans of 25 knees in 23 patients with trochlear dysplasia and in 11 patients in a randomly selected control group were reviewed retrospectively in order to assess the morphology of the cartilaginous and bony trochlea. Inter- and intra-observer error was assessed.

In the dysplastic group there were 15 women and eight men with a mean age of 20.4 years (14 to 30). The mean bony sulcus angle was 167.9° (141° to 203°), whereas the mean cartilaginous sulcus angle was 186.5° (152° to 214°; p < 0.001). In 74 of 75 axial images (98.7%) the cartilaginous contour was different from the osseous contour on subjective assessment, the cartilage exacerbated the abnormality.

Our study shows that the morphology of the cartilaginous trochlea differs markedly from that of the underlying bony trochlea in patients with trochlear dysplasia. MRI is necessary in order to demonstrate the pathology and to facilitate surgical planning.




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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General