Trochlear Dysplasia means that the groove (trochlea) for the kneecap (patella) is too flat or even dome-shaped. This knee condition is the single most important factor for having a loose kneecap.
Definition Trochlear Dysplasia
Trochlear dysplasia basically means that the groove for the kneecap have not become deep enough, since there is too much bone volume in the top of the groove or more seldom is the out part of the trochlea too low. The definition for trochlear dysplasia is an abnormal shallow, flat or even dome shaped groove. If you have trochlear dysplasia this can lead to both patella dislocation, anterior knee pain and cartilage breakdown. Your tendency to cartilage breakdown is based on too much load in this special part of the knee. Cartilage breakdown predispose to osteoarthritis.
Why did you get trochlear dysplasia?
Basically we do not have the answer for this yet. We do not know for sure if it is innate. However there is likely some heredity involved. But breech position during foetal life may also play a role. In some patients only one knee is involved. Once I was told by a patient having trochlear dysplasia and loose kneecaps, that in her family, loose kneecaps could be traced seven generations back. Sheila Strover can explain so it is more easy to understand - Click here.
Why is it of importance with this shallow groove?
Since humans are walking upright we have developed from other animals, and the result is that the thigh muscle constantly is pulling the kneecap outwards. To compensate for this high force, humans have developed this groove to provide the kneecap stability and containment. If the groove is missing the kneecap tends to go to the outer site - called a kneecap dislocation.
Lateral Trochlea Inclination angle - LTI
The lateral trochlea inclination angle is regarded as the most important measurement for evaluation of Trochlear dysplasia. This angle says something about the osseous support for the kneecap. This is the angle of the outer part of the groove (Trochlea), compared to line in the back of the knee between the two femur condyles. In other words the more steep the outer edge of groove, the more stability it provides for the kneecap. A high angle prevents the kneecap for coming out of the joint. Further if the angle is below 9 degrees it means trochlear dysplasia (shallow groove). Please notice the examples below - left is normal - right demonstrates trochlear dysplasia. Read more here.
This picture demonstrate how to measure in practical daily life. You place a 'postit' on the screen at the axial slice, where the femoral condyles are most prominent. The you scroll until you reach the most proximal slice where you notice cartilage, and measure the angle of the lateral trochlear and the postit. At the presented example, you are not able to measure the trochlear angle since the lateral trochlea has a convex configuration. When it is like that, it´s the same as severe trochlear dysplasia.
'Difficult to balance a tennis ball on a football'
Trochlear depth and trochlear asymmetry
If the trochlear depth is less than 3 mm or if the trochear asymmetry is less than 40% the trochlea is dysplastic. A trochlear bump may also involved in some cases.
Dejour is a very experienced and skilled orthopedic surgeon. He has made a classification based upon x-rays, having four subgroups. It contains Dejour type A,B,C and D. Today we mainly uses MRI or CT scans instead of x-rays. And also since the classification is not reliable, it is slowly out-faded. Instead the lateral trochlea inclination angle have been more accepted. Also some other measurements can be used.
Oswestry-Bristol Classification for trochlear dysplasia
This is a newer and more simple classification, however it a subjective classification like the Dejour Classification. When ether or not the subgroups reflects what´s of importance for stability or not, is not solved by this.
According to biomechanical studies, this have importance in respect to pressure in the patellofemoral joint. The pressure can be elevated and this might lead to cartilage breakdown and/or patellofemoral pain.
When your kneecap tilts, it is sometime because the outer kneecap ligament is to tight, but actually quite rare. Importantly your tilt is most often caused by trochlear dysplasia. When you have too much bone in the trochlea, consequently this causes your kneecap only to articulate on the outer part, as you might see below. Moreover this typically gives anterior knee pain or hyperpressure syndrome, based on to much pressure in the patellofemoral joint. In these cases trochleoplasty could be the right solution for you, since it reduces the pressure by unloading your joint. I some more rare cases is the patella tilt caused by increased femoral torsion - also called increased femoral anteversion.
Patella tilt - Trochlear dysplasia
Another Patella tilt - Trochlear dysplasia
This means Tuberositas Tibia - Trochlear Groove distance. The measure is done by CT or MRI scans. It explain how much offset the groove has in relation to where the patella tendon attaches to the tibia (Tuberositas Tibia). TT-TG distance is normally about 9 mm and if it´s more than 14 mm on MRI scans or 15-20 mm on CT scans, it´s too high. Increased TT-TG distance can also be caused by a rotational abnormality of the tibia (increased tibial external torsion).
This is a MRI picture that demonstrates a slice of a normal knee, demonstrating the kneecap and the trochlear groove
Severe increased TT-TG distance on a CT scan in a knee having a degree of trochlear dysplasia
A drawing of how you measure the TT-TG distance. Two axial slices from the MRI or CT scan are overlapping or superimposed and thereby you can measure the distance.
Just a drawing of the same picture at left, demonstrating a TT-TG distance above 40 mm which is extreme. Dejour type D.