PRESENTED BY-- SHAROL RASHID

3RD BAMS
GOVT AYURVEDA COLLEGE
TRIVANDRUM
TROCHLEAR DYSPLASIA
Introduction
 is a geometric abnormality of the trochlear
groove, mainly at its cranial part.
 Trochlear dysplasia (TD) is poorly recognised,
generally considered uncommon and to present
purely as persistent patella dislocation
 Only 66% had suffered a dislocation
 Extensor mechanism affected
 Lateral Trochlea Inclination angle <11 degree
ETIOLOGY
 As trochlear dysplasia is frequently bilateral, it is said
to be a developmental anomaly
 most cases are felt to be genetic
 Sustained patella disclocation causing deformity to
trochlear groove.
 breech position during foetal life.
CLINICAL ANATOMY
 The patella lies in an area known as the trochlear
groove.
 The sides of the patella and the walls of the groove
should be almost parallel.
 The normal shape of the trochlea groove is concave.
MECHANISM OF INJURY
 pathologic alteration in the shape of the femoral
trochlea.(flat,convex or dome shaped)
 higher risk of having the patella dislocate or
partially dislocate (sublaxation) to the outside.
 The trochlea is not shaped normally, and the patella
does not have the normal bony constraints to provide
stability.
 Thus, one needs to rely on the medial patellofemoral
ligament and their quadriceps mechanism to hold the
patella in place.
CLINICAL PRESENTATIONS
 Anterior knee pain and knee aching
 patellar dislocations and instability
 Increased medial and lateral patellar translation near
full extension and at 45 degrees of knee flexion
 Lack of trust, wobbling, stair problems,
DIAGNOSIS X-Ray
 lateral radiographs
 crossing sign
Indicate that the trochlea groove is both flat and
shallow.
 supratrochlear spur
 double contour which represents the hypoplastic
medial trochlear facet.
 45 degree Skyline view-the trochlear sulcus angle will
be increased, flattened groove
MRI
 correlating the x-ray findings to the MRI findings
 effect the shape of the articular cartilage
 TT-TG distance (Tuberositas Tibia - Trochlear
Groove)
Normal 9 mm
Abnormal < 14mm
CARDINAL SIGNS IN LATERAL XRAY
1. CROSSING SIGN
2. DOUBLE COUNTOUR
3. SUPRATROCHLEAR SPUR
CLASSIFICATION
Dejour’s classification for the trochlear dysplasia:
 Type A with an isolated crossing sign
 Type B with a crossing sign and a supratrochlear spur
(flat or convex trochlea)
 Type C with a crossing sign and a double contour
(asymmetry of trochlear facets with a hypoplastic
medial condyle)
 Type D with a crossing sign, a supratrochlear spur and
a double contour
CLINICAL EXAMINATION
 Patella apprehension test
 Patella tracking assessment
 Patellar hypermobility
COMPLICATIONS
 patellofemoral instability
 Recurrent patellar dislocations leading to articular
cartilage injuries, osteochondral fractures, pain
 lateral patello-femoral osteoarthritis
 valgus knee.
TREATMENT OPTIONS
 reconstruction of the medial patellofemoral ligament
 a tibial tubercle osteotomy
 a trochleoplasty, ( sulcus deepening trochleoplasty,
the ‘Bereiter’ trochleoplasty and the recession
trochleoplasty.)where the distal aspect of the femur is
cut and reshaped
 a distal femoral osteotomy
 and other associated treatments.
DIFFERENTIAL DIAGNOSIS
 Patella alta
 Excessive lateral patellar tilt
 Lateral femoral condyle hypoplasia
RESEARCH CITINGS
 Patellar dislocation in a 16-year-old athlete with femoral
trochlear dysplasia.
 BY Cho JC1, Haun DW, Morrell AP, Kettner NW.
 Conservative stabilization and strengthening protocols
 patient underwent a chiropractic treatment protocol
consisting of stabilization with patellar tracking orthosis,
customized orthotic support, and various muscular
stabilization and strengthening exercises. After 6 weeks of
treatment, the swelling and ecchymosis resolved.
 The knee ranges of motion were full without pain. Although the
hypermobility of the patella demonstrated no interval change,
the patient reported improved strength and stability of the right
knee.
 Morphological changes in patella overall size and
the medial facet are smaller.
 https://www.sciencedirect.com/science/article/abs/pii
/S0968016005001870
 anterior acetabular coverage increased in TD
cases
https://www.sciencedirect.com/science/article/pii/S0
976566219302966
 children born in the breech position had an
approximately 15-fold higher risk of dysplasia
 child’s birth presentation Knees in the extended
position had a 45-fold higher risk of dysplasia than
knees that were free to flex
 increased prevalence of trochlear dysplasia and patella
alta in patients with ACL injury
 a laterally-positioned trochlear groove was more
important than its concave shape for preventing
patellar dislocation.
 lateral trochlea inclination- BEST ASSESEMENT
 Study Finds Ligament Reconstruction is an Effective
Treatment for Kneecap Instability in Patients with
Trochlear Dysplasia