The shape and orientation of the trochlea run more parallel to the posterior condylar line than generally believed.

Abstract

This study was set up to identify the native trochlear geometry and define its relationship with the rotational landmarks of the distal femur. The rotational landmarks of the distal femur were analysed on CT-scans of 281 patients with end-stage knee osteoarthritis. The anterior trochlear line (ATL) was on average 4.3° (SD 3.3°) internally rotated relative to the surgical transepicondylar axis (sTEA). The ATL was on average 2.1° (SD 3.0°) internally rotated relative to the posterior condylar line (PCL). The relationship between the ATL and the sTEA was statistically different in the different coronal alignment groups (p=0.004): 3.9° (SD 3.0°) in varus knees, 4.0° (SD 2.9°) in neutral knees and 5.4° (SD 3.8°) in valgus knees. The lateralisation of the trochlea, represented by the distance between the perpendicular to PCL and the perpendicular to the posterior parallel line to the sTEA, was on average 2.2mm (SD 1.8mm). The ATL was on average 4.3° (SD 3.3°) internally rotated relative to the sTEA and 2.1° (SD 3.0°) internally rotated relative to the PCL. The ATL is more externally orientated in varus knees and more internally rotated in valgus knees. The trochlear groove is lateralised by only 2.2mm when the femoral component is externally rotated. III.