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Evidence of trochlear dysplasia in patellofemoral arthroplasty designs.
[trochlear dysplasia]
The
design
of
the
trochlear
compartment
is
crucial
in
patellofemoral
arthroplasty
(
PFA
)
,
because
78
%
of
patients
with
isolated
patellofemoral
arthritis
present
concomitant
trochlear
dysplasia
with
patellar
maltracking
and
therefore
remain
predisposed
to
post-operative
patellar
subluxation
and
dislocation
.
The
study
investigated
whether
current
PFA
implants
are
designed
with
anatomic
trochlear
parameters
such
as
the
sulcus
angle
,
lateral
facet
height
and
groove
orientation
.
Five
trochlear
components
of
commercially
available
PFA
implants
were
scanned
,
and
the
generated
three
-dimensional
surfaces
were
measured
using
engineering
design
software
.
The
mediolateral
trochlear
profiles
were
plotted
at
various
flexion
angles
(
0
°
,
15
°
,
30
°
and
45
°
)
to
deduce
the
following
variables
:
sulcus
angle
,
height
of
lateral
facet
and
trochlear
groove
orientation
.
Four
specimens
had
sulcus
angle
>
144
°
in
the
45
°
of
flexion
,
and
all
five
specimens
had
sulcus
angle
>
143
°
in
30
°
of
flexion
.
Three
specimens
had
a
facet
<
5
mm
high
through
the
entire
range
of
early
flexion
(
0
°
-
30
°
)
,
and
two
specimens
had
a
facet
<
5
mm
high
beyond
early
flexion
(
30
°
-
45
°
)
.
The
trochlear
groove
was
oriented
laterally
in
all
specimens
(
range
1
.
6
°
-
13
.
5
°
)
.
Current
PFA
trochlear
components
are
not
always
designed
with
anatomic
parameters
,
and
some
models
exhibit
characteristics
of
trochlear
dysplasia
.
Surgeons
are
therefore
advised
to
implant
components
with
a
deep
sulcus
,
particularly
in
patients
with
history
of
patellofemoral
disorders
,
and
to
adapt
the
surgical
technique
and
extensor
mechanism
if
the
component
implanted
has
a
shallow
sulcus
,
to
ensure
normal
patellar
tracking
.
III
.
Diseases
Validation
Diseases presenting
"lateral facet"
symptom
trochlear dysplasia
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