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Trochlear Development in Children From 1 Month to 10 Years of Age: A Descriptive Study Utilizing Analysis by Magnetic
Gherardo Pagliazzi1,2, Jutta M Ellermann3, Cathy S Carlson3
1Rizzoli Orthopaedic Institute, Bologna, Italy.
Insights
Pediatric trochlear morphology shows the lateral trochlea is higher and wider than the medial. Bony sulcus development lags behind cartilage, with female grooves being shallower.
Area of Science:
- Pediatric Orthopedics
- Skeletal Development
- Imaging Science
Background:
- Understanding pediatric cartilage and bony maturation is crucial for explaining adult trochlear variations.
- Early identification of morphological differences can inform clinical assessments.
Purpose of the Study:
- To investigate trochlear morphology during pediatric maturation using magnetic resonance imaging (MRI).
- To analyze the development of the trochlear groove from infancy to preadolescence.
Main Methods:
- Descriptive laboratory study of 24 pediatric cadaveric knees (1 month to 10 years).
- High-resolution 7-T or 9.4-T MRI of the distal femur, generating 3D scans.
- Biometric analysis included trochlear height, cartilaginous and osseous sulcus angles, trochlear depth, and facet length symmetry.
Main Results:
- Lateral trochlear height consistently exceeded medial trochlear height across all ages.
- A cartilaginous sulcus was present early, deepening by age 4, while the osseous sulcus developed later.
- By 7-8 years, bony and cartilaginous contours began to align; females exhibited shallower sulcus angles than males.
Conclusions:
- Significant differences exist in pediatric trochlear morphology, with lateral prominence and delayed bony sulcus formation.
- Female trochlear grooves tend to be shallower, and bony anatomy does not fully mirror cartilaginous anatomy in preadolescents.
- Caution is advised when interpreting bony trochlear anatomy in children due to developmental lags.
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.
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