Decreasing Thickness of Partial Lateral Trochlear Cartilage in Patients with Patellar Instability

Abstract

Objective: To explore morphological characteristics of patellofemoral joint surface of patients with patellar instability by adopting the MRI-based method.

Methods: A retrospective analysis was performed from March 2016 to January 2020 to assess morphological characteristics of the patellofemoral joint surface by Magnetic Resonance Imaging (MRI) scanning knees of 30 patients (24 females, six males) with patellar instability and trochlear dysplasia and knees of 30 subjects from a randomly selected control group (25 females, five males). The control group was matched as per age and sex. All participants had undergone MRI scans in the supine position and keep knees in or near full extension. Six parts were measured in total, including thickness of trochlear cartilage, thickness of patella cartilage, cartilaginous sulcus angle, cartilaginous Wiberg angle, contact range and frequency and distributions of the mean difference measurement of the femoral trochlea, to evaluate the difference of trochlear and patellar morphology between the patient group and the control group. The threshold for statistical significance was set at P < 0.05.

Results: There were significant differences in four values between the two groups (P < 0.05). The cartilage thickness two-third along the lateral condyle in the patient group was significantly lower than that in the control group (LCT2,1.80 ± 0.37 vs 2.06 ± 0.52, 1.92 ± 0.36 vs 2.17 ± 0.50), but there was no significant difference in other sites. There was no significant difference in patella thickness between the patient group and the control group. The cartilaginous sulcus angle in the patient group was larger than that in the control group (157.90 ± 6.64 vs 142.23 ± 3.95, P < 0.001), but there was no significant difference in cartilaginous Wiberg angle. The patient group had a larger initial contact ratio (59.47 ± 6.13 vs 46.50 ± 3.67, P < 0.001), and a smaller contact range (16.55 ± 4.14 vs 27.55 ± 4.09, P < 0.001). The deepest part of the intercondylar suclus appears more often in the lateral of the deepest part of the osseous concavity of the femoral trochlea. Among the patient group, 18 cases (60%) were found with the deepest part of the intercondylar suclus lateral to the deepest point of the osseous concavity of the femoral trochlea while among the control group only 4 cases (13.33%) were found. The distribution of trochlear dysplasia of Dejour grades was type B (n = 22), type C (n = 5), and type D (n = 3).

Conclusion: Thickness of partial lateral trochlear cartilage decreases in patients with patellar instability and the trochlear cartilage develops abnormal morphological characteristics. Moreover, it also suggests that MRI can be used to further present the morphology of cartilage for the convenience of surgical planning.

Keywords: Cartilage thickness; MRI; Patellar dislocation; Patellar instability; Trochlear dysplasia.