Alteration of patellar tendon morphology in patellofemoral instability (trochlear dysplasia).

ABSTRACT

INTRODUCTION: Trochlear Dysplasia (TD) is a condition that is characterized by the presence of an abnormally shaped trochlear groove, which hinders the patellofemoral joint (PFJ) stability. PFJ stability is determined by static and dynamic structures around the knee joint. We analysed whether the patellar tendon morphology is altered in patients with patellofemoral instability in Trochlear Dysplasia (TD). MATERIAL AND METHODS: Magnetic Resonance Imaging (MRI) studies for 50 consecutive knees with TD and 50 consecutive knees with normal PFJ morphology were obtained for evaluation. For each MRI study, the cross-sectional area (CSA) of the medial and lateral components of the patellar tendon was measured and used to calculate the cross-sectional area ratio (CSAR) by two readers. RESULTS: There was a statistically significant difference in the CSAR of the lateral-to-medial components of the patellar tendon between knees with normal PFJ morphology and knees with TD (one way ANOVA, F (4,95) = 7.743, p < 0.001). Pairwise comparisons amongst the Dejour subtypes of TD, revealed a statistically significance difference (p < 0.05) in the CSAR ratio between patients with normal PFJ morphology, and patients with type A (p = 0.007) and type C, TD. There was moderate correlation between the readers on Intraclass Correlation Coefficient (ICC) analysis (ICC- 0.7). CONCLUSION: Our findings reveals hypertrophy of the medial part of the patellar tendon in patients with PFJ instability and TD. These differences could reflect the dynamic compensatory changes occurring at the PFJ to counteract the laterally directed instability vectors found in this condition.