Bony asymmetry in patellofemoral morphology and risk factors of instability are mostly clinically negligible.

• Dagneaux Louis
• Bin Abd Razak Hamid Rahmatullah
• Laumonerie Pierre
• Faizhan Ahmad
• Liarno Sally
• Wellings Peter
• Ollivier Matthieu
• Jacquet Christophe

• Asymmetry
• CT-scan
• Femoral trochlea
• Patella/diagnostic imaging
• Side-to-side differences
• Tibia

PURPOSE: Previous investigations suggested that femoral side-to-side differences were located in the upper femur anatomy. However, little is known about the asymmetry between distal femur and patella. The degree of bony asymmetry in the patellofemoral joint was evaluated using pairs of CT-scans with emphasis on morphometric measurements and risk factors relevant to patellofemoral disorders. METHODS: Patellofemoral morphometric parameters and anatomical risk factors were analyzed from 345 pairs of CT scans to evaluate side-to-side differences for each patient. All measurements were automatized using previously published algorithm-calculated bone landmarks. We analyzed asymmetry based on absolute differences (AD) and percentage asymmetry (AS%). Significant asymmetry was defined as AS% \textgreater 10%. RESULTS: Patellar height was found to be highly symmetric (mean AD 0.1 for both Insall-Salvatti and Caton-Deschamps methods, AS% 8% and 9%, respectively). Patellar and femoral morphometric parameters were found highly symmetric, except for the trochlear groove depth. Substantial asymmetry was reported in two patellofemoral risk factors: the lateral trochlear inclination (mean AD 2°, AS% 16%) and the tibial tuberosity-trochlear groove distance (1 mm, 116%). Patellar and femoral morphometric asymmetries were independent of demographics, including age, gender, height, weight and ethnicity. CONCLUSION: Patellar height was found to be highly symmetric and is, therefore, a reasonable index for contralateral templating. While very few patellofemoral morphometric parameters and anatomical risk factors were asymmetric, the mean differences were clinically negligible and independent of demographics. LEVEL OF EVIDENCE: III.