The distal femur morphometry during the fetal period

Year 2011, Volume: 18 Issue: 2, 48 - 53, 30.06.2011

Esra Koyuncu , Osman Sulak , Gülnur Özgüner Neslihan Cankara Soner Albay , Mehmet Malas

Abstract

Purpose: It was aimed to investigate the development and morphometric changes of the distal femur during the fetal period. Materials and method: 105 human fetuses (55 males and 50 females) aged between 9-40 weeks were used in this study. Fetuses were divided into four groups between gestational weeks; 1st trimester (9-12 weeks), 2nd trimester (13-25 weeks), 3rd trimester (26-37 weeks) and full term (38-40 weeks). Patella and patellar tendon were dissected in all fetal materials and the knee of each fetus was shown. The dimensions; length and width of intercondylar notch, length and width of medial and lateral condyles, total width of the distal femur and the angle of trochlear groove were measured by Verniers caliper and square. Finding: The length and width of intercondylar notch were found significantly different between trimesters and were rising with gestational age (p<0.05). The length and width of medial and lateral condyles were increased with gestational age. The length and width of lateral condyles were higher than the medial one. The angle of trochlear groove was not changing with gestational age and was found 129.90 . It was also found in our study that notch shape index (NSI) was 0,91 and notch width index (NWI) was 0.26 during the fetal period. Result: We consider that the data acquired in our study may contribute to the evaluation the development of distal femur in intrauterine cases. 

Keywords

distal femur, intecondylar notch, human fetus, morphometry

FETAL DÖNEMDE FEMUR DİSTALİNİN MORFOMETRİK GELİŞİMİ

Abstract

Amaç. Çalýþmamýzda fetal dönem boyunca femurun distalinde yer alan oluþumlarýn morfometrik deðiþimi ve geliþiminin araþtýrýlmasý amaçlandý. Gereç ve Yöntem: Yaþlarý 9-40 hafta arasýnda deðiþen eksternal anomalisi ve patolojisi olmayan 105 (55erkek, 50 kýz) adet insan fetusunda çalýþýldý. Fetuslar I.grup; 9-12 hafta, II. grup; 13-25 hafta, III. grup; 26-37 hafta ve IV. grup; miadýnda, 38-40 hafta olmak üzere 4 gruba ayrýldý. Bütün fetal materyallerde diz eklemi diseke edilerek patella ve patellar ligament yerinden kaldýrýldý ve femur distaline ait fossa intercondylaris yüksekliði, geniþliði, condylus medialis yüksekliði ve geniþliði, condylus lateralis yüksekliði ve geniþliði, femur distalinin geniþliði, trochlear oluk açýsý ölçümleri dijital kumpas ve gönye yardýmý ile alýndý. Bulgular: Fossa intercondylaris yüksekliði ve geniþliði gestasyonel yaþ boyunca artýyordu ve trimesterlar arasýnda anlamlý fark vardý (p<0.05). Femur distalindeki condylus medialis ve condylus lateralis yükseklik ve geniþliklerinin gestasyonel yaþ boyunca arttýðý görüldü (p<0.05). Condylus lateralis yüksekliðinin ve geniþliðinin, condylus medialis yükseklik ve geniþliðinden daha büyük olduðu tespit edildi (p<0.05). Trochlear oluk açýsý ise gestasyonel yaþ boyunca deðiþmiyordu ve ortalama 129. 9° idi. Ayrýca çalýþmamýzda fetal dönemde fossa intercondylaris þekil indeksi (notch shape index) (NSI) 0,91, fossa intecondylaris geniþlik indeksi (notch width index) (NWI) 0.26 olarak tespit edildi. Sonuç: Çalýþmamýzda elde edilen verilerin intrauterin olgularda femur geliþiminin deðerlendirilmesine katkýda bulunacaðýný düþünmekteyiz.

Keywords

femur distali, fossa intercondylaris, fetus, morfometri

References

• Urabe K, Mahoney OM, Mabuchi K, Itoman M. Morphologic differences of the distal femur between Caucasian and Japanese women. J Orthop Surg 2008; 16(3): 312-5.
• Balcarek P, Walde TA, Frosch S, Schüttrumpf JP, Wachowski MM, Stürmer KM et al. Patellar dislocations in children, adolescents and adults: A comparative MRI study of medial patellofemoral ligament injury patterns and trochlear groove anatomy. Eur J Radiol. 2010; (15) [Epub ahead of print]
• Murshed KA, Çiçekcibaþý AE, Karabacakoðlu A, Seker M, Ziylan T. Distal femur morphometry: a gender and bilateral comparative study using magnetic resonance imaging. Surg Radiol Anat. 2005; 27(2): 108-12.
• Shelbourne KD, Gray T, Benner RW. Intercondylar notch width measurement differences between African American and white men and women with intact anterior cruciate ligament knees. Am J Sports Med. 2007; 35(8): 1304-7.
• Tillman MD, Smith KR, Bauer JA, Cauraugh JH, Falsetti AB, Pattishall JL Differences in three intercondylar notch geometry indices between males and females: a cadaver study. Knee 2002; 9(1): 41-6.
• Shelbourne KD, Facibene WA, Hunt JJ. Radiographic and intraoperative intercondylar notch width measurements in men and women with unilateral and bilateral anterior cruciate ligament tears. Knee Surg Sports Traumatol Arthrosc. 1997; 5(4): 229-33.
• Ireland ML., Ballantyne BT., Little K, McClay IS. A radiographic analysis of the relationship between the size and shape of the intercondylar notch and anterior cruciate ligament injury. Knee Surg, Sports Traumatol, Arthrosc 2001; 9(4): 200–5.
• Liu RW, Farrow LD, Messerschmitt PJ, Gilmore A, Goodfellow DB, Cooperman DR. An anatomical study of the pediatric intercondylar notch. J Pediatr Orthop. 2008; 28(2): 177-83.
• Biedert RM, Bachmann M. Anterior-posterior trochlear measurements of normal and dysplastic trochlea by axial magnetic resonance imaging. Knee Surg Sports Traumatol Arthrosc. 2009; 17(10): 1225-30.
• Lonner JH, Jasko JG, Thomas BS. Anthropomorphic differences between the distal femora of men and women. Clin Orthop Relat Res. 2008; 466(11): 2724- 9.
• Nietosvaara AY. The femoral sulcus in children: an ultrasonographic study. J Bone Joint Surg Br 1994; 76(5): 807–9.
• Tardieu C, Glard Y, Garron E, Boulay C, Jouve JL, Dutour O et al. Relationship between formation of the femoral bicondylar angle and trochlear shape: independence of diaphyseal and epiphyseal growth. Am J Phys Anthropol. 2006; 130(4): 491-500.
• Teichtahl AJ, Parkins K, Hanna F, Wluka AE, Urquhart DM, English DR et all. The relationship between the angle of the trochlear groove and patella cartilage and bone morphology--a cross-sectional study of healthy adults. Osteoarthritis Cartilage. 2007; 15(10): 1158- 62.
• Mizobuchi RR, Galbiatti JA, Quirici Neto F, Milani C, Fujiki EN, de Oliveira HC, Bensahel H, Navarro RD. Ultrasonographic study of the femoropatellar joint and its attachments in normal infants from birth to 24 months of age: part I. J Pediatr Orthop B. 2007; 16(4): 262-5.
• Moore KL, Persaud TVN. 2003. The Developing Human (Clinically Oriented Embryology), 7th edn. WB Saunders Company, Philadephia, pp 255–286.
• Souryal TO, Freeman TR. Intercondylar notch size and anterior cruciate ligament injuries in athletes. A prospective study. Am J Sports Med. 1993; 21(4): 535- 9.
• Teitz CC, Lind BK, Sacks BM. Symmetry of the femoral notch width index. Am J Sports Med 1997; 25(5): 687-90.
• Anderson AF, Lipscomb AB, Liudahl KJ, Addlestone RB. Analysis of the intercondylar notch by computed tomography. Am J Sports Med 1987; 15(6): 547-52.
• Muneta T, Takakuda K, Yamamoto H. Intercondylar notch width and its relation to the configuration and crosssectional area of the anterior cruciate ligament. A cadaveric knee study. Am J Sports Med 1997; 25(1): 69-72.
• Dargel J, Michael JW, Feiser J, Ivo R, Koebke J. Human Knee Joint Anatomy Revisited: Morphometry in the Light of Sex-Specific Total Knee Arthroplasty. J Arthroplasty. 2010; (3) [Epub ahead of print]
• Wanner JA. Variations in the anterior patellar groove of the human femur. Am J Phys Anthropol 1977; 47(1): 99–102.
• Glard Y, Jouve JL, Garron E, Adalian P, Tardieu C, Bollini G. Anatomic study of femoral patellar groove in fetus. J pediatr orthop 2005; 14(2): 105-10.
• Garron E, Jouve JL, Tardieu C, Panuel M, Dutour O, Bollini G. Anatomic study of the anterior patellar groove in the fetal period. Rev Chir Orthop Reparatrice Appar Mot. 2003; 89(5): 407-12.