A validated cadaveric model of trochlear dysplasia

Purpose: Despite the high prevalence of trochlear dysplasia among patients with patellar instability, it is not well studied and is infrequently addressed surgically. The lack of a validated cadaveric model of trochlear dysplasia may be a contributing factor. The goal of this study was to develop a simple, reproducible, and realistic cadaveric model of trochlear dysplasia by surgically modifying cadaveric femora with normal anatomy and then to validate this model through the use of mechanical and fluoroscopic measurements.

Methods: The floor of the trochlear groove was surgically elevated using an inflatable bone tamp in eight cadaveric femora. The trochlear depth (TD) was measured with a custom-designed measuring device, and radiographic markers of dysplasia (sulcus angle, crossing sign, and prominence) were assessed before and after surgical modification.

Results: The average TD was 3.6 ± 1.4, 4.6 ± 1.1, and 5.1 ± 1.0 mm prior to reverse trochleoplasty (RT) and 1.0 ± 1.8, 2.3 ± 1.3, and 3.3 ± 2.5 mm following RT at 0°, 20°, and 40° of flexion, respectively. These direct measurements of TD were confirmed with fluoroscopy. The sulcus angle averaged 141° prior to RT and 157° after RT. The average prominence across all specimens was 3.3 ± 0.7 mm before RT, and 5.5 ± 1.5 mm after RT. Finally, the crossing sign was found to be absent in all knees prior to RT and present in 7 of the 8 after RT.

Conclusions: The results of this study show that elevation of the trochlear floor with an inflatable bone tamp can reproducibly create a simulated dysplastic trochlea. This model may be useful in biomechanical studies of treatments for patellofemoral instability.