Morphological development of the femoral trochlea: A literature review

This literature review aimed to synthesize the current evidence on the developmental processes of the femoral trochlea, both non-dysplastic and dysplastic. A comprehensive literature review was conducted in three databases (PubMed, Google Scholar, and Sofia) for studies published up to June 2025 using predefined keywords related to trochlear morphology and development. Studies addressing the development of both dysplastic and non-dysplastic trochleae were included after a stepwise screening of titles, abstracts, and full texts. Eleven studies were included, three were prenatal and eight were postnatal. Most studies relied only on the sulcus angle to characterize trochlear dysplasia. In non-dysplastic trochlea, trochlear morphology starts in utero, with a relatively flat osseous groove at birth that is functionally compensated by a well-formed cartilaginous trochlea, followed by progressive osseous deepening and integration with the cartilaginous morphology until skeletal maturity. In dysplastic trochlea, while a genetic predisposition appears involved, altered patellar tracking and insufficient patellar engagement during growth may also contribute a developmental component of dysplasia. Future studies should combine longitudinal follow-up with comprehensive three-dimensional assessment of trochlear morphology to improve our understanding of femoral trochlear development and the pathogenesis of trochlear dysplasia.