Two-type classification system for femoral trochlear dysplasia in recurrent patellar instability based on three-dimensional morphology

IF 3.3 2区医学 Q1 ORTHOPEDICS

Knee Surgery, Sports Traumatology, Arthroscopy Pub Date : 2022-07-30 DOI:10.1007/s00167-022-07077-1

Guangmin Yang, Yike Dai, Conglei Dong, Yingzhen Niu, Huijun Kang, Fei Wang

{"title":"Two-type classification system for femoral trochlear dysplasia in recurrent patellar instability based on three-dimensional morphology","authors":"Guangmin Yang, Yike Dai, Conglei Dong, Yingzhen Niu, Huijun Kang, Fei Wang","doi":"10.1007/s00167-022-07077-1","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n \n <section>\n \n <h3> Purpose</h3>\n <p>Radiographic and two-dimensional (2D) CT/MRI analysis of femoral trochlear dysplasia play a significant role in surgical decision-making for recurrent patellar instability. However, the three-dimensional morphology of dysplastic trochlea is rarely studied due to the limitations of conventional imaging modalities. This study aimed to (1) develop a 3D morphological classification for trochlear dysplasia based on the concavity of the trochlear groove and (2) analyze the interrater reliability of the classification system.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n <p>The 3D trochleae of 132 knees with trochlear dysplasia and recurrent patellar instability were reconstructed using CT scan data and classified using the innovative classification criteria between January 2016 and June 2020. A concave trochlear sulcus with sloped medial and lateral trochlear facets was classified as Type I trochlea. The trochlear groove with no concavity is classified as Type II. Furthermore, in Type II, the trochlea with the elevated trochlear floor at the proximal part was identified as IIa and the trochlea with the hypoplastic trochlear facets as IIb. The intra- and inter-rater reliability was examined using kappa (<i>κ</i>) statistics.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n <p>The 3D classification system showed substantial intra-rater agreement and moderate interrater agreement (0.581 ~ 0.772). The intra- and interrater agreement of Dejour’s four-grade classification was fair-to-moderate (0.332 ~ 0.633). Eighty-one trochleae with concave trochlear sulcus were classified as Type I, and fifty-one without concavity as Type II. Twenty-five non-concave trochleae were classified as type IIa due to the elevated trochlear floor and 26 trochleae into IIb with the hypoplasia of trochlear facets.</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n <p>This study developed a 3D classification system to classify trochlear dysplasia according to trochlear concavity and morphology of the trochlear facets. On CT/MRI scans or 3D reconstructions, the interpretation of features of dysplastic trochleae may vary, especially for the flat and convex trochleae. The novel system provides morphological evidence for when to consider trochleoplasty according to the different types of trochlear sulcus.</p>\n </section>\n </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"31 5","pages":"1790-1797"},"PeriodicalIF":3.3000,"publicationDate":"2022-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"5","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Knee Surgery, Sports Traumatology, Arthroscopy","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1007/s00167-022-07077-1","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ORTHOPEDICS","Score":null,"Total":0}

引用次数: 5

Abstract

Purpose

Radiographic and two-dimensional (2D) CT/MRI analysis of femoral trochlear dysplasia play a significant role in surgical decision-making for recurrent patellar instability. However, the three-dimensional morphology of dysplastic trochlea is rarely studied due to the limitations of conventional imaging modalities. This study aimed to (1) develop a 3D morphological classification for trochlear dysplasia based on the concavity of the trochlear groove and (2) analyze the interrater reliability of the classification system.

Methods

The 3D trochleae of 132 knees with trochlear dysplasia and recurrent patellar instability were reconstructed using CT scan data and classified using the innovative classification criteria between January 2016 and June 2020. A concave trochlear sulcus with sloped medial and lateral trochlear facets was classified as Type I trochlea. The trochlear groove with no concavity is classified as Type II. Furthermore, in Type II, the trochlea with the elevated trochlear floor at the proximal part was identified as IIa and the trochlea with the hypoplastic trochlear facets as IIb. The intra- and inter-rater reliability was examined using kappa (κ) statistics.

Results

The 3D classification system showed substantial intra-rater agreement and moderate interrater agreement (0.581 ~ 0.772). The intra- and interrater agreement of Dejour’s four-grade classification was fair-to-moderate (0.332 ~ 0.633). Eighty-one trochleae with concave trochlear sulcus were classified as Type I, and fifty-one without concavity as Type II. Twenty-five non-concave trochleae were classified as type IIa due to the elevated trochlear floor and 26 trochleae into IIb with the hypoplasia of trochlear facets.

Conclusion

This study developed a 3D classification system to classify trochlear dysplasia according to trochlear concavity and morphology of the trochlear facets. On CT/MRI scans or 3D reconstructions, the interpretation of features of dysplastic trochleae may vary, especially for the flat and convex trochleae. The novel system provides morphological evidence for when to consider trochleoplasty according to the different types of trochlear sulcus.

查看原文本刊更多论文

基于三维形态学的复发性髌骨不稳股骨滑车发育不良的两型分类系统

目的股骨滑车发育不良的x线和二维CT/MRI分析对复发性髌骨不稳的手术决策具有重要意义。然而，由于常规成像方式的限制，对发育不良滑车的三维形态研究很少。本研究旨在(1)基于滑车沟的凹凸度建立滑车发育不良的三维形态学分类;(2)分析该分类系统的相互可靠性。方法对2016年1月至2020年6月期间132例滑车发育不良伴复发性髌骨不稳膝的三维滑车进行CT扫描重建，并采用创新的分类标准进行分类。滑车沟内凹，滑车内外侧小面倾斜，分类为I型滑车。无凹陷的滑车槽为II型。此外，在II型中，滑车近端滑车底升高的滑车被识别为IIa，滑车小面发育不良的滑车被识别为IIb。采用kappa (κ)统计量检验评分内信度和评分间信度。结果三维分类系统评分内一致性较好，评分间一致性中等(0.581 ~ 0.772)。Dejour四级分类的内部一致性和内部一致性为中等到中等(0.332 ~ 0.633)。滑车沟凹的滑车突81个为ⅰ型，无凹的滑车突51个为ⅱ型。25个非凹形滑车因滑车底升高而被归类为IIa型，26个滑车因滑车小面发育不全而被归类为IIb型。结论根据滑车凹度和滑车小关节形态，建立了滑车发育不良的三维分类系统。在CT/MRI扫描或3D重建中，对发育不良滑车特征的解释可能会有所不同，特别是对于扁平和凸滑车。根据滑车沟的不同类型，该系统为何时考虑滑车成形术提供了形态学依据。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Knee Surgery, Sports Traumatology, Arthroscopy 医学-外科

CiteScore

8.10

自引率

18.40%

发文量

418

审稿时长

2 months

期刊介绍： Few other areas of orthopedic surgery and traumatology have undergone such a dramatic evolution in the last 10 years as knee surgery, arthroscopy and sports traumatology. Ranked among the top 33% of journals in both Orthopedics and Sports Sciences, the goal of this European journal is to publish papers about innovative knee surgery, sports trauma surgery and arthroscopy. Each issue features a series of peer-reviewed articles that deal with diagnosis and management and with basic research. Each issue also contains at least one review article about an important clinical problem. Case presentations or short notes about technical innovations are also accepted for publication. The articles cover all aspects of knee surgery and all types of sports trauma; in addition, epidemiology, diagnosis, treatment and prevention, and all types of arthroscopy (not only the knee but also the shoulder, elbow, wrist, hip, ankle, etc.) are addressed. Articles on new diagnostic techniques such as MRI and ultrasound and high-quality articles about the biomechanics of joints, muscles and tendons are included. Although this is largely a clinical journal, it is also open to basic research with clinical relevance. Because the journal is supported by a distinguished European Editorial Board, assisted by an international Advisory Board, you can be assured that the journal maintains the highest standards. Official Clinical Journal of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA).