Trochlear dysplasia
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This document summarizes a lesson plan about trochlear dysplasia presented by Dr. Madhavan. The key points covered include: 1) Anatomy of the trochlear groove and how variations can lead to maltracking. 2) Classification of trochlear dysplasia according to the Dejour system from Type A to D based on radiological findings. 3) Treatment options like MPFL reconstruction and Dejour trochleoplasty to correct the anatomy in severe types of trochlear dysplasia.
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Trochlear dysplasia
- 1. Pedagogy Topic : Trochlear Dysplasia Dr.Madhavan
- 2. LESSON PLAN • Name of the lecturer :Dr. MADHAVAN • Date :25/08/2020 • Class: Orthopaedic Post Graduates, interns • Number of students : 24 • Time :8mins • Subject : Orthopaedics • Topic :Trochlear Dysplasia
- 3. SPECIFIC LEARNING OBJECTIVES • Each Students should be able to 1. Describe the anatomy, radiological findings , Trochlear dysplasia classification. 2. Describe the treatment for Trochlear dysplasia At the end of the class, With out mistakes
- 4. Sl no Content Method and media Time taken Evaluation 1 • Anatomy • Radiology Power point presentation 3 Questions and answers 2. •Classification Power point presentation 2 Questions and answers 3. •Treatment •Summary Power point presentation 3 Questions and answers Assignment :All students should able to describe the Type of Trochlear dysplasia and their radiological findings
- 5. • Trochlear groove consists of a shallow depression 5–6 mm • Bound by the medial and the lateral femoral articular surfaces • Prominent lateral surface of trochlear groove projects anteriorly • Variation in the structural anatomy of the trochlear groove predispose to maltracking INTRODUCTION
- 7. • The normal shape of the trochlear groove is concave • This allows the patella to glide down the central aspect of the distal femur • This is important because the patella serves as a fulcrum to increase the overall strength and efficiency of the quadriceps muscles of the thigh
- 9. • The MPFL acts as the major restraint to lateral patellar translation from full extension through the first 20°–70° of knee flexion • The trochlea serves as the main restraint throughout the flexion • A shallow trochlea is said to be dysplastic if the sulcus angle, taken on an axial radiograph with the knee flexed to 30°, is greater than 145°
- 11. X-RAY VIEWS INFRAPATELLER VIEW/ HUGHSTON Angled 45 degrees cephalad
- 12. AXIAL VIEW The beam is directed caudal and inferior, With 45 degrees knee flexion
- 14. • Trochlear dysplasia is one of the major anatomical cause for recurrent patellar dislocation • It has been reported to be present in 85–96% of patients with a patellar dislocation events
- 15. Dejour identified multiple radiographic parameters that are present in Trochlear dysplasia as a predisposing factors (1)Trochlear depth < 4 mm or < 3 mm on MRI (2) Patellar tilt > 20° (3) Spur height > 5 mm (4) Trochlear angle > 145°
- 17. PATELLAR TILT
- 18. NORMAL TROCHLEA DYSPLASTIC TROCHLEA
- 19. Dejour Classification of Trochlear Dysplasia Type A: Crossing sign / trochlea is shallower than normal/ but still symmetric and concave. Reff: The sulcus deepening trochleoplasty—the Lyon’s procedure, Int Orthop 34:311, 2010.)
- 20. CROSSING SIGN • when the line of the Trochlear groove crosses the anterior border of one of the condyle
- 21. Type B: Crossing sign + trochlear spur/ trochlea is flat or convex in axial images. Reff: The sulcus deepening trochleoplasty—the Lyon’s procedure, Int Orthop 34:311, 2010.)
- 22. Type C: Crossing sign + double-contour sign representing sclerosis of the subchondral bone of the medial hypoplastic facet/ lateral facet is convex Reff: The sulcus deepening trochleoplasty—the Lyon’s procedure, Int Orthop 34:311, 2010.)
- 23. DOUBLE CONTOUR SIGN • A double line at the anterior aspect of condyles that occurs if the medial femoral condyle is hypoplastic
- 24. Type D: Combination of all signs—crossing sign, supratrochlear spur, and double contour Sign+ cliff pattern-in axial view Reff: The sulcus deepening trochleoplasty—the Lyon’s procedure, Int Orthop 34:311, 2010.)
- 25. • Trochlear dysplasia: Crossing sign • Sulcus angle >145 degrees • MPFL reconstruction • Trochleoplasty
- 26. TREATMENT Dejour sulcus-deepening trochleoplasty Type ? SUBCHONDRAL BONE CUT AND MAKING A DEFECT FIXED WITH BONE STAPLES
- 27. Measuring the thickness • below osteochondral edge
- 28. Before After Make a gentle cut with osteotome and remove the sub chondral bone with rongeur
- 29. SUMMARY • Trochlear dysplasia is one of the main cause for recurrent patellar dislocation • TD accounts for around 95% of recurrent patellar dislocation • Normal sulcus angle 137 0 ± 6 0 • Normal congruence angle -6 0 • Normal trochlear depth 1cm • DEJOUR classification for trochlear dysplasia • Type A-crossing sign, B-spur , C-double contour sign, D-ciff • Treatment –Dejour trochleoplasty + immediate passive mobilization
- 30. Crossing sign Supratrochlear spur Double contour sign Medial condyle hypoplasia Cliff and convex lateral condyle
- 31. • Thank you