title: Evaluation of trochlear dysplasia using MRI: correlation between the classification system of Dejour and objective parameters of trochlear dysplasia.
abstract: OBJECTIVE
  Trochlear dysplasia is considered to be one of the major factors causing patellofemoral instability (PFI). Dejour's classification is widely used to assess the severity of trochlear dysplasia. Additionally, in current literature, different quantitative parameters are recommended to distinguish between a normal trochlea and a dysplastic trochlea. In order to achieve a more objective evaluation of the trochlea, the aim of this study was to evaluate whether specific measurements of the femoral trochlea can be assigned to the qualitative classification system of Dejour.
  
  
  METHODS
  Transverse MRI T2-weighted scans of 80 knees with symptomatic PFI and varying severity of trochlear dysplasia were classified according to Dejour (type A to D). For all MRI scans, quantitative measurements with parameters as described in the literature were applied. The values were then allocated to Dejour's classification. In addition to the four-grade analysis, two-grade analysis was also performed (Dejour type A against type BCD). Dependent on the cut-off values, specificity, sensitivity and Youden index for each parameter was defined.
  
  
  RESULTS
  The allocation resulted in the following distribution: type A trochlear dysplasia n = 25, type B n = 23, type C n = 18 and type D n = 14. In descriptive statistics, none of the measurements proposed in the literature could be assigned to the four-grade classification system of Dejour. For the two-grade analysis at the cut-off, sensitivity ranged from 75 to 86 % and specificity from 76 to 84 % for lateral trochlear inclination, trochlear facet asymmetry and depth of trochlear groove. All other measurements showed a poor sensitivity ranging from 49 to 67 % and specificity from 40 to 72 %. Interobserver and intraobserver repeatability for the measured parameters was fair to moderate (ICC values 0.34-0.58) in high-grade dysplasia (type BCD) and substantial to almost perfect (ICC values 0.71-0.88) in low-grade trochlear dysplasia (type A).
  
  
  CONCLUSIONS
  Quantitative measurements of the femoral trochlea have shown to be of limited value for the assessment of trochlear dysplasia. None of the quantitative measurements of the trochlea on transverse images could be assigned to the four-grade descriptive classification of trochlear dysplasia of Dejour. Additionally, measurements could not be reliably performed in high-grade trochlear dysplasia. However, trochlear inclination, trochlear facet asymmetry and depth of trochlear groove may help to distinguish between low-grade and high-grade dysplasia.
authors.affiliation: Department of Orthopaedic Surgery, University of Ulm, Ulm, Germany, manfred.nelitz@kliniken-oa.de.
authors.forename: M
authors.initials: M
authors.lastname: Nelitz
authors.forename: S
authors.initials: S
authors.lastname: Lippacher
authors.forename: H
authors.initials: H
authors.lastname: Reichel
authors.forename: D
authors.initials: D
authors.lastname: Dornacher
mesh_terms: D005260:Female; D005269:Femur / Q000000981:diagnostic imaging / Q000473:pathology*; D006801:Humans; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D057071:Patellofemoral Joint; D011859:Radiography; D012680:Sensitivity and Specificity