CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2019; 54(02): 171-177
DOI: 10.1016/j.rbo.2017.11.003
Original Article | Artigo Original
Sociedade Brasileira de Ortopedia e Traumatologia. Published by Thieme Revnter Publicações Ltda Rio de Janeiro, Brazil

Evaluation of the Reproducibility of the Dejour Classification for Femoropatellar Instability[*]

Article in several languages: português | English
Rodrigo de Souza Mendes Santiago Mousinho
1   Instituto de Traumatologia e Ortopedia Romeu Krause (Itork), Recife, PE, Brasil
,
José Neias Araújo Ribeiro
2   Universidade Federal do Ceará, Departamento de Ortopedia e Traumatologia, Fortaleza, CE, Brasil
,
Francisco Kartney Sarmento Pedrosa
1   Instituto de Traumatologia e Ortopedia Romeu Krause (Itork), Recife, PE, Brasil
,
Diego Ariel de Lima
1   Instituto de Traumatologia e Ortopedia Romeu Krause (Itork), Recife, PE, Brasil
2   Universidade Federal do Ceará, Departamento de Ortopedia e Traumatologia, Fortaleza, CE, Brasil
3   Centro Universitário Christus (Unichristus), Fortaleza, CE, Brasil
4   Universidade Federal Rural do Semiárido, Mossoró, RN, Brasil
,
Romeu Krause Gonçalves
1   Instituto de Traumatologia e Ortopedia Romeu Krause (Itork), Recife, PE, Brasil
,
José Alberto Dias Leite
2   Universidade Federal do Ceará, Departamento de Ortopedia e Traumatologia, Fortaleza, CE, Brasil
3   Centro Universitário Christus (Unichristus), Fortaleza, CE, Brasil
› Author Affiliations
Further Information

Publication History

14 September 2017

21 November 2017

Publication Date:
10 May 2019 (online)

Abstract

Objective To evaluate the classification proposed by David Dejour to describe trochlear dysplasia of the knee through inter- and intraobserver reproducibility measurements.

Methods Ten patients with trochlear dysplasia were studied. Three physicians, members of the Sociedade Brasileira de Cirurgia do Joelho (Brazilian Society of Knee Surgery), were invited to evaluate the images. Intra- and interobserver analyses were performed at one-week intervals. Reproducibility was evaluated in four scenarios: using only radiography; using radiography and tomography; using radiography and consulting the classification; and using radiography and tomography, consulting the classification.

Results The intraobserver evaluation presented discordant results. In the interobserver analysis, the degree of agreement was low for the analyses that used only radiography and excellent for those in which both radiography and tomography were used.

Conclusion The Dejour classification presented a low intra- and interobserver reproducibility when only the profile radiography was used. It was demonstrated that the use of the radiography alone for classification may generate lack of uniformity even among experienced observers. However, when radiography and tomography were combined, reproducibility improved.

* Work developed at the Department of Orthopedics and Traumatology of Centro Universitário Christus (Unichristus), Fortaleza, CE, Brazil.


 
  • References

  • 1 Ribeiro MM, Nogueira F, Sardinha J, Jones JH. Critérios imagiológicos da instabilidade femoro-patelar por ressonância magnética. Rev Port Ortop Traumatol 2012; 20 (04) 425-435
  • 2 Ferrari D, Kuriki HU, Silva CR, Alves N, Mícolis de Azevedo F. Diagnostic accuracy of the electromyography parameters associated with anterior knee pain in the diagnosis of patellofemoral pain syndrome. Arch Phys Med Rehabil 2014; 95 (08) 1521-1526
  • 3 Rebouças Moreira TA, Demange MK, Gobbi RG, Mustacchi Z, Pécora JR, Passarelli Tírico LE. , et al. Trochlear dysplasia and patellar instability in patients with Down syndrome. Rev Bras Ortop 2015; 50 (02) 159-163
  • 4 Fithian DC, Paxton EW, Stone ML, Silva P, Davis DK, Elias DA. , et al. Epidemiology and natural history of acute patellar dislocation. Am J Sports Med 2004; 32 (05) 1114-1121
  • 5 Bollier M, Fulkerson JP. The role of trochlear dysplasia in patellofemoral instability. J Am Acad Orthop Surg 2011; 19 (01) 8-16
  • 6 Dejour H, Walch G, Nove-Josserand L, Guier C. Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc 1994; 2 (01) 19-26
  • 7 Steiner TM, Torga-Spak R, Teitge RA. Medial patellofemoral ligament reconstruction in patients with lateral patellar instability and trochlear dysplasia. Am J Sports Med 2006; 34 (08) 1254-1261
  • 8 White BJ, Sherman OH. Patellofemoral instability. Bull NYU Hosp Jt Dis 2009; 67 (01) 22-29
  • 9 Fulkerson JP. Diagnosis and treatment of patients with patellofemoral pain. Am J Sports Med 2002; 30 (03) 447-456
  • 10 Schöttle PB, Schmeling A, Rosenstiel N, Weiler A. Radiographic landmarks for femoral tunnel placement in medial patellofemoral ligament reconstruction. Am J Sports Med 2007; 35 (05) 801-804
  • 11 Gigante A, Pasquinelli FM, Paladini P, Ulisse S, Greco F. The effects of patellar taping on patellofemoral incongruence. A computed tomography study. Am J Sports Med 2001; 29 (01) 88-92
  • 12 Carrillon Y, Abidi H, Dejour D, Fantino O, Moyen B, Tran-Minh VA. Patellar instability: assessment on MR images by measuring the lateral trochlear inclination-initial experience. Radiology 2000; 216 (02) 582-585
  • 13 Dejour H, Walch G. La pathologie femoro-patellaire. In: 6 émes Journees Lyonnaises de Chirurgie du Genou. Lyon, decembre. 1987
  • 14 Dejour D, Reynaud P, Lecoultre B. Douleurs et instabilité rotulienne, Essai de classification. Med Hyg (Geneve) 1998; 56 (2217): 1466-1471
  • 15 Burmann RC, Locks R, Pozzi JF, Konkewicz ER, Souza MP. Avaliac¸ão dos fatores predisponentes nas instabilidades femoropatelares. Acta Ortop Bras 2011; 19 (01) 37-40
  • 16 Albuquerque RP, Giordano V, Sturm L, Azevedo Júnior V, Leão A, Amaral NP. Análise da reprodutibilidade de três classificações para a osteoartrose do joelho. Rev Bras Ortop 2008; 43 (08) 329-335
  • 17 Gonc¸ alves FB, Rocha FA, Albuquerque RP, Mozella AP, Crespo B, Cobra H. Avaliac¸ão da reprodutibilidade das diferentes descric¸ ões da classificac¸ão de Kellgren e Lawrence para osteoartrite do joelho. Rev Bras Ortop 2016; 51 (06) 687-689
  • 18 Scott WN. Insall & Scott surgery of the knee. Philadelphia: Churchill Livingstone; 2011
  • 19 Azar FM, Canale ST, Beaty JH. Campbell's operative orthopaedics. Philadelphia: Elsevier Health Sciences; 2013
  • 20 Scott WN. Insall & Scott Surgery of the Knee. Philadelphia: Elsevier Health Sciences; 2017
  • 21 Lippacher S, Dejour D, Elsharkawi M, Dornacher D, Ring C, Dreyhaupt J. , et al. Observer agreement on the Dejour trochlear dysplasia classification: a comparison of true lateral radiographs and axial magnetic resonance images. Am J Sports Med 2012; 40 (04) 837-843
  • 22 Rémy F, Chantelot C, Fontaine C, Demondion X, Migaud H, Gougeon F. Inter- and intraobserver reproducibility in radiographic diagnosis and classification of femoral trochlear dysplasia. Surg Radiol Anat 1998; 20 (04) 285-289
  • 23 Nelitz M, Lippacher S, Reichel H, Dornacher D. Evaluation of trochlear dysplasia using MRI: correlation between the classification system of Dejour and objective parameters of trochlear dysplasia. Knee Surg Sports Traumatol Arthrosc 2014; 22 (01) 120-127