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Lateral patellar maltracking due to trochlear dysplasia: A computational study.

S Cyrus Rezvanifar¹, Brett L Flesher², Kerwyn C Jones³

¹Department of Biomedical Engineering, The University of Akron, Akron, OH, USA.

|December 2, 2019

Summary

Shallow trochlear grooves worsen patellar maltracking and instability. Lateral tibial tuberosity combined with trochlear dysplasia significantly increases lateral patellar tracking and instability risk.

Keywords:

Computational simulation Patellar instability Patellar tracking Trochlear dysplasia

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Area of Science:

Orthopedic biomechanics
Knee joint kinematics

Background:

Trochlear dysplasia is a key factor in patellar instability.
Understanding its impact on patellar tracking is crucial for treatment.

Purpose of the Study:

To investigate the biomechanical effects of varying trochlear depth on patellar tracking.
To correlate trochlear dysplasia severity with patellar instability risk factors.

Main Methods:

Simulated knee extension and squatting in seven models with altered lateral trochlear inclination (LTI).
Measured patellar lateral shift (bisect offset index) across LTI values (6°, 12°, 24°).
Correlated bisect offset with patella alta (Caton-Deschamps index) and tibial tuberosity position.

Main Results:

Significant differences in patellar lateral shift observed across LTI values during simulated movements (p < 0.05).
Average bisect offset decreased with increasing LTI (e.g., 1.02 at 6° LTI vs. 0.86 at 24° LTI at 0° flexion).
Strongest correlation between peak bisect offset and tibial tuberosity position at 6° LTI during squatting (r²=0.81, p=0.006).

Conclusions:

Shallow trochlear grooves (lower LTI) lead to increased lateral patellar maltracking.
Combined trochlear dysplasia and lateral tibial tuberosity significantly elevate patellar instability risk.
Patella alta has minimal impact on patellar tracking when trochlear dysplasia is present due to limited trochlear constraint.