Abstract：
The likelihood of healing of osteochondritis dissecans decreases with skeletal maturity and there are theories that abnormal biomechanical forces contribute to the development and progression of these lesions.
To characterize, according to regional skeletal maturity, the morphology and alignment indices of the patellofemoral joint on MRI in patients with patellar osteochondritis dissecans.
MRI examinations of patients with patellar osteochondritis dissecans obtained between January 2008 and May 2023 were retrospectively reviewed to determine regional skeletal maturity, osteochondritis dissecans lesion size and location, patellar and trochlear morphology (Wiberg/Dejour classifications), and to calculate trochlear sulcus angles, trochlear depth index, lateral trochlear inclination, Insall-Salvati index, Caton-Deschamps index, patellar tendon-lateral trochlear ridge, and tibial tubercle-trochlear groove distances. Values were compared between skeletally immature and mature groups.
Sixty-eight children (22 girls, 46 boys, age: 14.0 ± 1.7 years) yielded 74 knees with patellar osteochondritis dissecans lesions, 14 (19%) of which were skeletally mature. The most common anatomic location was over the central patella [median ridge (34/74 - 46%) on the axial images and over the middle third (45/74 - 61%) on the sagittal images]. Overall, mean trochlear sulcus angle (high, 151 ± 11°), trochlear depth index (low, 2.8 ± 1.4 mm), and Insall-Salvati index (borderline, 1.3 ± 0.1) were abnormal for the entire sample. Skeletally mature knees were significantly more likely to have higher (more dysplastic) Dejour types when compared to skeletally immature knees (p < 0.01). Knees in the mature group, compared to immature, had significantly more abnormal mean lateral trochlear inclination (15 ± 8° vs. 19 ± 6°, p = 0.03) and patellar tendon-lateral trochlear ridge distance (5.55 ± 4.31 mm vs. 2.89 ± 4.69 mm, p = 0.04). Half of the knees had ≥ 4 abnormal features that predispose to patellofemoral maltracking; mature knees were significantly (p = 0.02) more likely to have a higher number of abnormal features (> 6 features, 7/14, 50.0%) versus immature knees (0-3 features, 33/60, 55.0%).
In children with patellar osteochondritis dissecans, abnormal patellofemoral morphology and alignment indices were common in all patients and more severe in mature knees.
To characterize, according to regional skeletal maturity, the morphology and alignment indices of the patellofemoral joint on MRI in patients with patellar osteochondritis dissecans.
MRI examinations of patients with patellar osteochondritis dissecans obtained between January 2008 and May 2023 were retrospectively reviewed to determine regional skeletal maturity, osteochondritis dissecans lesion size and location, patellar and trochlear morphology (Wiberg/Dejour classifications), and to calculate trochlear sulcus angles, trochlear depth index, lateral trochlear inclination, Insall-Salvati index, Caton-Deschamps index, patellar tendon-lateral trochlear ridge, and tibial tubercle-trochlear groove distances. Values were compared between skeletally immature and mature groups.
Sixty-eight children (22 girls, 46 boys, age: 14.0 ± 1.7 years) yielded 74 knees with patellar osteochondritis dissecans lesions, 14 (19%) of which were skeletally mature. The most common anatomic location was over the central patella [median ridge (34/74 - 46%) on the axial images and over the middle third (45/74 - 61%) on the sagittal images]. Overall, mean trochlear sulcus angle (high, 151 ± 11°), trochlear depth index (low, 2.8 ± 1.4 mm), and Insall-Salvati index (borderline, 1.3 ± 0.1) were abnormal for the entire sample. Skeletally mature knees were significantly more likely to have higher (more dysplastic) Dejour types when compared to skeletally immature knees (p < 0.01). Knees in the mature group, compared to immature, had significantly more abnormal mean lateral trochlear inclination (15 ± 8° vs. 19 ± 6°, p = 0.03) and patellar tendon-lateral trochlear ridge distance (5.55 ± 4.31 mm vs. 2.89 ± 4.69 mm, p = 0.04). Half of the knees had ≥ 4 abnormal features that predispose to patellofemoral maltracking; mature knees were significantly (p = 0.02) more likely to have a higher number of abnormal features (> 6 features, 7/14, 50.0%) versus immature knees (0-3 features, 33/60, 55.0%).
In children with patellar osteochondritis dissecans, abnormal patellofemoral morphology and alignment indices were common in all patients and more severe in mature knees.
摘要：
背景：剥脱性骨软骨炎愈合的可能性随着骨骼成熟而降低，并且有理论认为异常的生物力学力有助于这些病变的发展和进展。
目的：表征，根据区域骨骼成熟度，髌骨剥脱性骨软骨炎患者MRI上髌股关节的形态和对齐指标。
方法：回顾性回顾了2008年1月至2023年5月之间获得的髌骨剥脱性骨软骨炎患者的MRI检查，以确定区域骨骼成熟度。剥脱性骨软骨炎病变的大小和位置，髌骨和滑车形态（Wiberg/Dejour分类），并计算滑车沟角度，滑车深度指数，外侧滑车倾斜,Insall-Salvati指数,卡顿-德尚指数,髌腱-外侧滑车脊，和胫骨结节-滑车沟距离。比较骨骼未成熟组和成熟组之间的值。
结果：68名儿童（22名女孩，46个男孩，年龄：14.0±1.7岁）产生了74个膝盖的髌骨剥脱性骨软骨炎病变，其中14例（19%）骨骼成熟。最常见的解剖位置是中央髌骨[轴向图像上的正中脊（34/74-46％）和矢状图像上的中间三分之一（45/74-61％）]。总的来说,平均滑车沟角(高，151±11°),滑车深度指数(低，2.8±1.4mm),和Insall-Salvati指数(边界线，1.3±0.1）对于整个样品是异常的。与骨骼未成熟的膝盖相比，骨骼成熟的膝盖显着更可能具有更高（更多发育不良）的Dejour类型（p<0.01）。成熟群体中的膝盖，与不成熟相比，平均外侧滑车倾角异常显著(15±8°与19±6°,p=0.03）和髌腱-外侧滑车脊距离（5.55±4.31mmvs.2.89±4.69mm,p=0.04)。一半的膝盖有≥4个异常特征，易导致髌股走线不良；成熟的膝盖明显（p=0.02）更可能有更多的异常特征（>6个特征，7/14，50.0％）与未成熟的膝盖（0-3特征，33/60，55.0%）。
结论：在髌骨剥脱性骨软骨炎患儿中，所有患者的髌股形态和对齐指数异常均常见，成熟膝关节更为严重。
目的：表征，根据区域骨骼成熟度，髌骨剥脱性骨软骨炎患者MRI上髌股关节的形态和对齐指标。
方法：回顾性回顾了2008年1月至2023年5月之间获得的髌骨剥脱性骨软骨炎患者的MRI检查，以确定区域骨骼成熟度。剥脱性骨软骨炎病变的大小和位置，髌骨和滑车形态（Wiberg/Dejour分类），并计算滑车沟角度，滑车深度指数，外侧滑车倾斜,Insall-Salvati指数,卡顿-德尚指数,髌腱-外侧滑车脊，和胫骨结节-滑车沟距离。比较骨骼未成熟组和成熟组之间的值。
结果：68名儿童（22名女孩，46个男孩，年龄：14.0±1.7岁）产生了74个膝盖的髌骨剥脱性骨软骨炎病变，其中14例（19%）骨骼成熟。最常见的解剖位置是中央髌骨[轴向图像上的正中脊（34/74-46％）和矢状图像上的中间三分之一（45/74-61％）]。总的来说,平均滑车沟角(高，151±11°),滑车深度指数(低，2.8±1.4mm),和Insall-Salvati指数(边界线，1.3±0.1）对于整个样品是异常的。与骨骼未成熟的膝盖相比，骨骼成熟的膝盖显着更可能具有更高（更多发育不良）的Dejour类型（p<0.01）。成熟群体中的膝盖，与不成熟相比，平均外侧滑车倾角异常显著(15±8°与19±6°,p=0.03）和髌腱-外侧滑车脊距离（5.55±4.31mmvs.2.89±4.69mm,p=0.04)。一半的膝盖有≥4个异常特征，易导致髌股走线不良；成熟的膝盖明显（p=0.02）更可能有更多的异常特征（>6个特征，7/14，50.0％）与未成熟的膝盖（0-3特征，33/60，55.0%）。
结论：在髌骨剥脱性骨软骨炎患儿中，所有患者的髌股形态和对齐指数异常均常见，成熟膝关节更为严重。
