Osseous and Cartilaginous Trochlear Development in the Pediatric Knee: A Cadaveric Computed Tomography Study

Salvador G Ayala; Nicholas Thomas; Matthew Rohde; Anshal Gupta; Mark Sanchez; Marc Tompkins; Shital N Parikh; Henry B Ellis; Daniel W Green; Yi-Meng Yen; Peter D Fabricant; Phil Wilson; Kevin G Shea

doi:10.1177/23259671241249132

Osseous and Cartilaginous Trochlear Development in the Pediatric Knee: A Cadaveric Computed Tomography Study

Orthop J Sports Med. 2024 May 14;12(5):23259671241249132. doi: 10.1177/23259671241249132. eCollection 2024 May.

Authors

Affiliations

¹ University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA.
² Florida State University College of Medicine, Pensacola, Florida, USA.
³ Stanford School of Medicine, Stanford, California, USA.
⁴ University of Minnesota, Minneapolis, Minnesota, USA.
⁵ Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
⁶ Texas Scottish Rite Hospital for Children, Dallas, Texas, USA.
⁷ Hospital for Special Surgery, New York, New York, USA.
⁸ Boston Children's Hospital, Boston, Massachusetts, USA.

Abstract

Background: The anatomy of the trochlea plays a significant role in patellar stability. The developmental anatomy of the trochlea and its relationship to patellar stability remains poorly understood.

Purpose: To describe the developmental changes of the osseous and cartilaginous trochlear morphology in skeletally immature specimens.

Study design: Descriptive laboratory study.

Methods: A total of 65 skeletally immature cadaveric knees between the ages of 2 months and 11 years were evaluated using computed tomography scans. The measurements in the axial plane of both cartilage and bone include medial, central, and lateral trochlear height; sulcus height; medial and later trochlear facet length; trochlear sulcus angle; patellar sulcus angle; condylar height asymmetry; and trochlear facet asymmetry. Additional measurements included trochlear depth and lateral trochlear inclination angle. In the sagittal plane, measurements included curvilinear trochlear length, direct trochlear length, condylar height, and patellar sulcus angle.

Results: Analysis of trochlear morphology using condylar height, condylar height asymmetry, and trochlear depth all increased with increasing age. The osseous and cartilaginous sulcus angles became deeper with age until age 8 and then plateaued. This corresponded with an increase in trochlear depth that also plateaued around age 8. Osseous condylar asymmetry increased with age but flipped from a larger medial condyle to a larger lateral condyle around age 8. The continued growth of the trochlea with age was further demonstrated in all measures in the sagittal view.

Conclusion: This cadaveric analysis demonstrated that there is an increase in condylar height as age increased by all measurements analyzed. These changes in condylar height continued to be seen through age 11, suggesting a still-developing trochlea past this age. By age 8, a plateau in sulcus angle, and sulcus depth suggests more proportionate growth after this point. Similar changes in trochlear and patellar shape with age suggests that the 2 structures may affect each other during development.

Clinical relevance: This information can help design, develop, and determine timing of procedures that may alter the anatomy and stabilize the trochlear and patellofemoral joint.

Keywords: anatomy; imaging, computed tomography; knee, general; knee, patella; pediatric sports medicine.