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Trochlear Morphological Changes in Skeletally Immature Patients Across Consecutive MRI Studies
Kevin J Orellana1, Julianna Lee1, Daniel Yang1
1Department of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
The American Journal of Sports Medicine
|January 24, 2025
Summary
Recurrent patellofemoral instability (PFI) worsens trochlear dysplasia in children over time. In contrast, children without PFI show improved trochlear anatomy as they grow, indicating natural normalization.
Area of Science:
- Orthopedics
- Pediatric imaging
- Biomedical engineering
Background:
- Trochlear dysplasia is a known risk factor for recurrent patellofemoral instability (PFI).
- The developmental trajectory of trochlear anatomy in skeletally immature patients with and without PFI is not well understood.
Purpose of the Study:
- To evaluate serial MRI studies in skeletally immature patients.
- To characterize longitudinal changes in trochlear anatomy in patients with and without PFI.
Main Methods:
- Retrospective case-control study of pediatric patients (<18 years) with and without PFI.
- Analysis of serial knee MRIs (minimum 6 months apart) focusing on trochlear morphology using established classifications and measurements.
- Comparison of morphological changes between PFI and non-PFI groups.
Main Results:
- In the PFI group, moderate to severe trochlear dysplasia increased significantly (67% to 89%), with worsening sulcus angle and lateral trochlear inclination (LTI).
- In the non-PFI group, normal trochlear morphology increased (53% to 87%), with improvements in trochlear depth index, LTI, and sulcus angle.
- Trochlear metrics shifted towards more dysplasia in the PFI cohort and towards normalization in the non-PFI group.
Conclusions:
- Untreated PFI in skeletally immature patients is associated with progressive worsening of trochlear dysplasia.
- Conversely, children without PFI exhibit trochlear characteristics that tend to normalize during skeletal maturation.
