scholarly journals Evaluation of the Effect of the Sulcus Angle and Lateral to Medial Facet Ratio of the Patellar Groove on Patella Tracking in Aging Subjects with Stable Knee Joint

2018 ◽  
Vol 2018 ◽  
pp. 1-5
Author(s):  
Jianghui Qin ◽  
Dongyang Chen ◽  
Zhihong Xu ◽  
Dongquan Shi ◽  
Jin Dai ◽  
...  
Keyword(s):  
Lower Limb ◽  
Lateral Displacement ◽  
Three Dimensional ◽  
Trochlear Groove ◽  
Patellar Tilt ◽  
Sulcus Angle ◽  
Lateral Tilt ◽  
Computed Tomography Images ◽  
Three Dimensional Models ◽  
Patella Tracking

Purpose.To determine whether the sulcus angle and the lateral to medial facet ratio correlate with patella lateral displacement and tilt in patients without patella instability.Methods.Computed tomography images of the lower limb of 64 patients without known arthropathy were collected. Three-dimensional models of the lower limb with a unified coordinate system were rebuilt by using Mimics software. The sulcus angle, lateral to medial facet ratio, lateral trochlear inclination of the patellar groove, tibial tuberosity-trochlear groove (TT-TG) distance, bisect offset index, and lateral tilt of the patella were measured. Pearson’s correlation test was used to determine the relationship between the aforementioned parameters.Results.Data from 51 patients were analyzed. The sulcus angle was negatively correlated with lateral tilt inclination (p<0.001,r=0.8406) and positively correlated with the bisect offset index (p=0.003,r=0.634) and patellar tilt (p=0.03,r=0.551); the lateral to medial facet ratio was positively correlated with TT-TG distance (p=0.003,r=0.643) and bisect offset index (p=0.026,r=0.559).Conclusion.The sulcus angle and lateral to medial facet ratio of the patellar groove can influence patella tracking in patients with stable knee joints.

A navigation system for shoulder arthroscopic surgery

2007 ◽  
Vol 221 (7) ◽  
pp. 801-812 ◽  
Author(s):  
K Tyryshkin ◽  
P Mousavi ◽  
M Beek ◽  
R E Ellis ◽  
D R Pichora ◽  
...  
Keyword(s):  
Navigation System ◽  
Shoulder Arthroscopy ◽  
Dimensional Space ◽  
Arthroscopic Surgery ◽  
Three Dimensional ◽  
Surgical Instruments ◽  
Surface Model ◽  
Ultrasound Images ◽  
Computed Tomography Images ◽  
Three Dimensional Models

The general framework and experimental validation of a novel navigation system designed for shoulder arthroscopy are presented. The system was designed to improve the surgeon's perception of the three-dimensional space within the human shoulder. Prior to surgery, a surface model of the shoulder was created from computed tomography images. Intraoperatively optically tracked arthroscopic instruments were calibrated. The surface model was then registered to the patient using tracked freehand ultrasound images taken from predefined landmark regions on the scapula. Three-dimensional models of the surgical instruments were displayed, in real time, relative to the surface model in a user interface. Laboratory experiments revealed only small registration and calibration errors, with minimal time needed to complete the intraoperative tasks.

scholarly journals NUMERICAL ANALYSIS OF SHORT AND LONG INSTRUMENTATION IN THE TREATMENT OF THORACOLUMBAR FRACTURES CONSIDERING THE LIGAMENTOUS PORTION

2019 ◽  
Vol 18 (2) ◽  
pp. 144-150
Author(s):  
André Rafael Hubner ◽  
Danilo Mourão Ribeiro ◽  
Eduardo Dassoler ◽  
Daniel Gasparin ◽  
Charles Leonardo Israel ◽  
...  
Keyword(s):  
Numerical Analysis ◽  
Thoracolumbar Spine ◽  
Three Dimensional ◽  
Maximum Tensile Stress ◽  
Thoracolumbar Fractures ◽  
Level Of Evidence ◽  
Safety Coefficient ◽  
Computed Tomography Images ◽  
Three Dimensional Models ◽  
Anterior Posterior

ABSTRACT Objective: This study aims to numerically evaluate the surgical treatment of thoracolumbar fractures, comparing the strengths between the long and short fixations using the pedicle of the fractured vertebra, taking into account the supraspinous, intertransverse, and anterior longitudinal ligaments. Methods: A numerical analysis of the techniques of long and short fixation of a thoracolumbar spine fracture was performed using computed tomography images that were converted into three-dimensional models and analyzed through the ANSYS program. The two types of treatments were analyzed considering the tensions generated in the immediate postoperative period, when the fracture has not yet been consolidated. The anterior, posterior, supraspinal and intertransverse longitudinal ligaments were added, in addition to considering different vertebral geometries. Results: Taking into account that the maximum tensile stress of the material used in the metal implant, in the case of titanium, was 960 MPa, the highest tension found in the analysis of the short instrumentation was 346.83 MPa, reaching only 36.13% of the load the material supports, being, therefore, within a safety limit. The analysis performed in the spine with long instrumentation showed the highest tension value of 229.22 MPa. Conclusions: Considering the values found and the resistance of the synthesis material used, the short and long fixation can be considered in the treatment of thoracolumbar fractures with similarity and a good safety coefficient. Level of Evidence III; Case-Control.

How Do Axial Scan Orientation Deviations Affect the Measurements of Knee Anatomical Parameters Associated with Patellofemoral Instability? A Simulated Computed Tomography Study

2017 ◽  
Vol 31 (05) ◽  
pp. 425-432 ◽  
Author(s):  
Ran Xiong ◽  
Cheng Chen ◽  
Li Yin ◽  
Xiaoyuan Gong ◽  
Jiangming Luo ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Cruciate Ligament ◽  
Patellofemoral Instability ◽  
Ct Scanning ◽  
Tibial Tubercle ◽  
Trochlear Groove ◽  
Patellar Tilt ◽  
Sulcus Angle ◽  
Scan Data ◽  
Anatomical Parameters

AbstractThe purpose of this study was to detect the correlation between axial scan orientation discrepancy and the knee anatomical parameters associated with patellofemoral instability during computed tomography (CT) scanning. CT scan data of 16 knees from 16 healthy subjects were retrieved. The reslicing processes were performed to simulate different axial scan orientations generated due to leg adduction/abduction during CT scanning. Eight parameters (tibial tubercle to trochlear groove [TT-TG], tibial tubercle to posterior cruciate ligament [TT-PCL], patellar tilt, lateral trochlear inclination, sulcus angle, trochlear depth, trochlear facet asymmetry, and trochlear condyle asymmetry) of five angles (neutral zero, 4/8 degrees of adduction and 4/8 degrees abduction) were quantified. All eight parameters showed varying degrees of deviations to the different axial scan orientations. TT-TG, patellar tilt, lateral trochlear inclination, and trochlear condyle asymmetry were relatively sensitive to axial scan orientation changes, whereas TT-PCL, sulcus angle, trochlear depth, and trochlear facet asymmetry were relatively insensitive. Although the sensitivities are various, surgeons should be aware of this situation and make necessary corrections.

scholarly journals Patellar Kinematics, Part II: The Influence of the Depth of the Trochlear Groove in Subjects With and Without Patellofemoral Pain

2000 ◽  
Vol 80 (10) ◽  
pp. 965-973 ◽  
Author(s):  
Christopher M Powers
Keyword(s):  
Knee Flexion ◽  
Important Determinant ◽  
Knee Extension ◽  
Patellofemoral Pain ◽  
Trochlear Groove ◽  
Resonance Imaging ◽  
Patellar Tilt ◽  
Patellar Kinematics ◽  
Sulcus Angle ◽  
Kinematic Magnetic Resonance Imaging

Abstract Background and Purpose. A shallow intercondylar groove has been implicated as being contributory to abnormal patellar alignment. The purpose of this study was to assess the influence of the depth of the intercondylar groove on patellar kinematics. Subjects. Twenty-three women (mean age=26.8 years, SD=8.5, range=14–46) with a diagnosis of patellofemoral pain and 12 women (mean age=29.1 years, SD=5.0, range=24–38) without patellofemoral pain participated. Only female subjects were studied because of potential biomechanical differences between sexes. Methods. Patellar kinematics were assessed during resisted knee extension using kinematic magnetic resonance imaging. Measurements of medial and lateral patellar displacement and tilt were correlated with the depth of the trochlear groove (sulcus angle) at 45, 36, 27, 18, 9, and 0 degrees of knee flexion using regression analysis. Results. The depth of the trochlear groove was found to be correlated with patellar kinematics, with increased shallowness being predictive of lateral patellar tilt at 27, 18, 9, and 0 degrees of flexion and of lateral patellar displacement at 9 and 0 degrees of flexion (r=.51–.76). Conclusions and Discussion. The results of this study indicate that bony structure is an important determinant of patellar kinematics at end-range knee extension (0°–30°).

scholarly journals Differences between native and prosthetic knees in trochlear groove tracking based on a morphometric measurement of three-dimensional reconstruction models in Chinese people

2020 ◽  
Author(s):  
Shi Chang Chen ◽  
Hua Xu ◽  
Shaohua Gong
Keyword(s):  
Cross Section ◽  
Three Dimensional ◽  
Lateral Position ◽  
Trochlear Groove ◽  
Dimensional Reconstruction ◽  
Total Knee ◽  
Three Dimensional Models ◽  
Prosthetic Knees ◽  
Tissue Tension ◽  
Patellofemoral Kinematics

Abstract Background Prosthetic trochlear design is important to ideal postoperative patellofemoral kinematics and knee function. But there has been little research on the differences of trochlear groove trackings between the native and prosthetic knees. We aimed to investigate the differences between native and prosthetic knees through the entire trochlear length by three-dimensional computerized quantification.Methods Virtual total knee arthroplasty was performed, using three-dimensional models of 42 healthy knees that were matched to the femoral components of five different prosthesis systems. Coaxial planes were created along the trochlear groove in 3° increments, and the deepest points of the trochlear groove were marked in each plane. Taking the lower extremity mechanical axis as reference line, the differences in the mediolateral location of the groove tracking were analyzed between the native and prosthetic knees.Results From the proximal to the distal end, the native tracking started from 0° cross section and extended laterally and then medially with its turning point located in 69° cross section, while the prosthetic knees showed medial orientation throughout the trochlear length. Compared with the proximal portion of the native tracking, the prosthetic trackings extended along a paradoxical orientation and started from a more proximal and lateral position, with maximal discrepancy to, 3.2 mm in the 0° cross section. Distally, the prosthetic trackings were located significantly medial, with maximal discrepancy, to 2.4 mm in the 69° cross section.Conclusion The prosthetic trochlear design varies among different types, and does not conform to that of the native knee in terms of shape, orientation, and location, which may cause soft tissue tension imbalance and abnormal patellofemoral biomechanics during knee flexion. This study may be helpful for prosthetic trochlear design that accords with native anatomy so as to optimize patellofemoral biomechanics and decrease the risk of patellofemoral complications.

scholarly journals Trochlear Development in Children From 1 Month to 10 Years of Age: A Descriptive Study Utilizing Analysis by Magnetic Resonance Imaging

2021 ◽  
Vol 9 (9) ◽  
pp. 232596712110282
Author(s):  
Gherardo Pagliazzi ◽  
Jutta M. Ellermann ◽  
Cathy S. Carlson ◽  
Kevin G. Shea ◽  
Elizabeth A. Arendt
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Age Groups ◽  
Three Dimensional ◽  
Ossification Center ◽  
Trochlear Groove ◽  
Resonance Imaging ◽  
Sulcus Angle ◽  
Biometric Analysis ◽  
Bony Anatomy

Background: Understanding the morphology of cartilage/bony maturation in preadolescents may help explain adult trochlear variation. Purpose: To study trochlear morphology during maturation in children and infants using magnetic resonance imaging (MRI). Study Design: Descriptive laboratory study. Methods: Twenty-four pediatric cadaveric knees (10 male and 14 female knees; age, 1 month to 10 years) were included. High-resolution imaging of the distal femoral secondary ossification center was performed using 7-T or 9.4-T MRI scanners. Three-dimensional MRI scans were produced, and images were reformatted; 3 slices in the axial, sagittal, and coronal planes images were analyzed, with coronal and sagittal imaging used for image orientation. Biometric analysis included lateral and medial trochlear height (TH); cartilaginous sulcus angle (CSA); osseous sulcus angle (OSA); trochlear depth; and trochlear facet (TF) length symmetry. Sex comparisons were considered when ≥1 specimen from both sexes of the same age was available; these included 11 knees spanning 4 age groups (ages 1, 3, 4, and 7 years). Results: The analysis of trochlear morphology showed a lateral TH greater than the medial TH at all ages. The thickest cartilage was found on the lateral TF in the younger specimens. Regarding the development of osseous and cartilaginous trochlear contour, a cartilaginous sulcus was present in the 3-month-old specimen and continued to deepen up to the age of 4 years. The shape of the osseous center evolved from round (1 month) to oval (9 months) to rectangular (2 years); no distinct bony trochlear sulcus was present, although a well-formed cartilaginous sulcus was present. The first evidence of formation of a bony sulcus was at 4 years. By the age of 7 to 8 years, the bony contour of the adult distal femur resembled its cartilaginous contour. Female samples had a shallower CSA and OSA than did the male ones in all samples that had a defined OSA. Conclusion: Female trochlear grooves tended to be shallower (flatter). The lateral trochlea was higher (TH) and wider (TF length) during growth than was the medial trochlea in both sexes; furthermore, the development of the osseous sulcus shape lagged behind the development of the cartilaginous sulcus shape in the authors’ study population. Clinical Relevance: Bony anatomy of the trochlear groove did not match the cartilaginous anatomy in preadolescent children, suggesting that caution should be used when interpreting bony anatomy in this age group.

Association of Patellofemoral Morphology and Alignment With the Radiographic Severity of Patellofemoral Osteoarthritis

2021 ◽  
Author(s):  
Yike Dai ◽  
Heyong Yin ◽  
Chongyang Xu ◽  
Hongrui Zhang ◽  
Ai Guo ◽  
...  
Keyword(s):  
Tibial Tubercle ◽  
Type I ◽  
Trochlear Groove ◽  
Patellofemoral Osteoarthritis ◽  
Patellar Tilt ◽  
Sulcus Angle ◽  
Patella Height ◽  
Radiographic Severity ◽  
Type Iii

Abstract Background: Risk factors for the progression of patellofemoral osteoarthritis (PFOA) are poorly understood. This research aims to evaluate the association between patellofemoral joint (PFJ) morphology and alignment with the radiographic severity of PFOA.Methods: A retrospective analysis of CT scan and lateral radiograph data were acquired in patients with PFOA. The radiographic severity of PFOA and tibiofemoral OA (TFOA), lateral and medial trochlear inclination angle, sulcus angle and the Wiberg classification of patella morphology, the congruence angle, patellar tilt angle, and lateral patellar angles, and tibial tubercle trochlear groove distance (TT-TG), patella height (i.e., Caton-Deschamps index) were assessed using CT scans and sagittal radiographs of the knee. All the PFJ morphology and alignment data were divided into quarters and the relationship between each measure and the severity of PFOA was investigated.Results: By studying 150 patients with PFOA, we found a U-shaped relationship between the Caton-Deschamps index and the severity of PFOA (P <0.001). A lower value of sulcus angle and lateral patellar angle, a higher value of congruence angle, and type III patella were associated with more severity of lateral PFOA. Compared with the highest quarter of each measure, the adjusted odds ratios (OR) of the severity of PFOA in the lowest quarter of sulcus angle, lateral patellar angle, and congruence angle, and type I patella was 8.80 (p=0.043), 16.51 (P <0.001), 0.04(P <0.001), and 0.18 (p=0.048) respectively.Conclusions: Extreme value of patella height, a higher value of lateral patellar displacement and lateral patellar tilt, lower value of sulcus angle, and type III patella were associated with more severity of PFOA.

Computed Tomographic Trochlear Depth Measurement in Normal Dogs

2018 ◽  
Vol 31 (06) ◽  
pp. 431-437 ◽  
Author(s):  
Elena De Giacinto ◽  
Daniele Troiano ◽  
Francesco Denti ◽  
Michela Buiatti ◽  
Massimo Petazzoni
Keyword(s):  
Computed Tomography ◽  
Three Dimensional ◽  
Groove Depth ◽  
Trochlear Groove ◽  
Depth Measurement ◽  
Computed Tomography Images ◽  
Depth Ratio ◽  
Wide Range ◽  
The Mean ◽  
Patellar Thickness

Objectives The main purpose of this study was to describe the relationship between patellar maximal craniocaudal thickness and femoral trochlear groove depth in normal dogs and to valuate the intra-observer or inter-observer variability of maximal trochlear depth and maximal patellar craniocaudal thickness using computed tomography. Methods Trochlear groove depth and patellar maximal craniocaudal thickness of 40 limbs (20 dogs) were measured by three independent veterinarians using three-dimensional multiplanar reconstruction computed tomography images. The patellar maximal craniocaudal thickness/trochlear depth ratio was determined. Results The mean ratio of these stifles was 0.46 (range 0.24–0.70), meaning that the mean maximal depth of the trochlea was 46% of the mean maximal-patellar thickness. Clinical Significance A wide range of maximal–patellar–craniocaudal–thickness/maximal trochlear-depth ratio was found suggesting that breed studies should be performed to determine a breed-specific patellar-thickness/trochlear-depth ratio. To make decisions on when and where to perform a sulcoplasty during patellar luxation surgery, patella/trochlea thickness relationship should be measured for each breed with patellar tracking from stifle hyperflexion to stifle hyperextension.

scholarly journals Increased tibial tubercle-trochlear groove and patellar height indicate a higher risk of recurrent patellar dislocation following medial reefing

2021 ◽  
Author(s):  
Marc-Daniel Ahrend ◽  
Tobias Eisenmann ◽  
Moritz Herbst ◽  
Boyko Gueorguiev ◽  
Gabriel Keller ◽  
...  
Keyword(s):  
Patellar Dislocation ◽  
Recurrent Dislocation ◽  
Patellar Height ◽  
Tibial Tubercle ◽  
Trochlear Groove ◽  
Recurrent Patellar Dislocation ◽  
Patellar Tilt ◽  
Level Of Evidence ◽  
Sulcus Angle ◽  
Patellar Shift

Abstract Purpose Identifying anatomical risk factors on recurrent dislocation after medial reefing is important for deciding surgical treatment. The present study aimed to retrospectively analyze the preoperative magnetic resonance imaging (MRI)-based parameters of patients treated with medial reefing and whether these parameters lead to a higher risk of recurrent dislocation. Methods Fifty-five patients (18.6 ± 6.6 years) who underwent medial reefing after primary traumatic patellar dislocation (84% with medial patellofemoral ligament [MPFL] rupture) were included. Patients were followed up for at least 24 months postoperatively (3.8 ± 1.2 years) to assess the incidence of recurrent patellar dislocation. In patients without recurrent dislocation, the Kujala and subjective IKDC scores were assessed. Moreover, the tibial tubercle-trochlear groove (TT-TG), sulcus angle, patellar tilt, patellar shift, and lateral trochlea index (LTI) were measured. The patellar height was measured using the Caton-Dechamps (CDI), Blackburne-Peel (BPI), and Insall-Salvati index (ISI). The cohort was subclassified into two groups with and without recurrent dislocation. Differences between groups were analyzed with respect to the MRI parameters. Results Forty percent had a pathological sulcus angle of > 145°, 7.2% had an LTI of < 11°, 47.3% had a patellar tilt of > 20°, and 36.4% had a TT-TG of ≥ 16 mm. Increased patellar height was observed in 34.5, 65.5, and 34.5% of the patients as per CDI, BPI, and ISI, respectively. Nineteen (34.5%) patients suffered from recurrent dislocation. Compared with patients without recurrent dislocation, those with recurrent dislocation had a significantly lower LTI (p = 0.0467). All other parameters were not significantly different between the groups. Risk factor analysis showed higher odds ratios (OR > 2), although not statistically significant, for MPFL rupture (OR 2.05 [95% confidence interval 0.38–11.03], LTI (6.6 [0.6–68.1]), TT-TG (2.9 [0.9–9.2]), and patellar height according to ISI (2.3 [0.7–7.5]) and CDI (2.3 [0.7–7.5])). Patients without recurrent dislocation had a Kujala score of 93.7 ± 12.1 (42–100) points and an IKDC score of 90.6 ± 11.7 (55.2–100) points. Conclusion Anatomical, MRI-based parameters should be considered before indicating medial reefing. A ruptured MPFL, an LTI < 11°, a TT-TG ≥ 16 mm, a patellar tilt > 20 mm, and an increased patellar height according to ISI and CDI were found to be associated, although not significantly, with a higher risk (OR > 2) of recurrent patellar dislocation after medial reefing. Thorough preoperative analysis is crucial to reduce the risk of recurrent dislocation in young patient cohorts. Level of evidence Level IV

Anatomic Risk Factors for Focal Cartilage Lesions in the Patella and Trochlea: A Case-Control Study

2019 ◽  
Vol 47 (10) ◽  
pp. 2444-2453 ◽  
Author(s):  
Luiz Felipe Ambra ◽  
Betina B. Hinckel ◽  
Elizabeth A. Arendt ◽  
Jack Farr ◽  
Andreas H. Gomoll
Keyword(s):  
Risk Factors ◽  
Trochlear Dysplasia ◽  
Cartilage Lesion ◽  
Patella Alta ◽  
Lesion Group ◽  
Control Group ◽  
Trochlear Groove ◽  
Patellar Tilt ◽  
Sulcus Angle ◽  
Cartilage Lesions

Background:Focal cartilage lesions in the patellofemoral (PF) joint are common. Several studies correlated PF risk factors with PF instability, anterior knee pain, and PF arthritis; however, there is a lack of evidence correlating those factors to PF focal cartilage lesions.Purpose:To evaluate the influence of the anatomic PF risk factors in patients with isolated focal PF cartilage lesions.Study Design:Cross-sectional study; Level of evidence, 3.Methods:Patients with isolated PF focal cartilage lesions were included in the cartilage lesion group, and patients with other pathologies and normal PF cartilage were included in the control group. Multiple PF risk factors were accessed on magnetic resonance imaging scans: patellar morphology (patellar width, patellar thickness, and patellar angle), trochlear morphology (trochlear sulcus angle, lateral condyle index, and trochlear sulcus depth), patellar height (Insall-Salvati ratio and Caton-Deschamps index), axial patellar positioning (patellar tilt, angle of Fulkerson), and quadriceps vector (tibial tuberosity–trochlear groove distance).Results:A total of 135 patients were included in the cartilage lesion group and 100 in the control group. As compared with the control group, the cartilage lesion group had a higher sulcus angle ( P = .0007), lower trochlear sulcus depth ( P < .0001), lower angle of Fulkerson ( P < .0001), lower patellar width ( P = .0003), and higher Insall-Salvati ratio ( P < .0001). From the patients in the cartilage lesion group, 36% had trochlear dysplasia; 27.6%, patella alta; and 24.7%, abnormal patellar tilt. These parameters were more frequent in the cartilage lesion group ( P < .0001). Trochlear lesions were more frequent in men, presented at an older age, and had fewer associated anatomic risk factors. Patellar lesions, conversely, were more frequent in women, presented at younger age, and were more closely associated with anatomic risk factors.Conclusion:PF anatomic abnormalities are significantly more common in patients with full-thickness PF cartilage lesions. Trochlear dysplasia, patella alta, and excessive lateral patellar tilt are the most common correlated factors, especially in patellar lesions.

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