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The Trochlear Cleft: Initial Experience in Elite Athletes

Wissman, Robert D. MD*; England, Eric MD*; Mehta, Kaushal MD*; d’Heurle, Albert MD; Langenderfer, Eric BS*; Mangine, Robert MS; Kenter, Keith MD

Journal of Computer Assisted Tomography: July/August 2014 - Volume 38 - Issue 4 - p 499–502
doi: 10.1097/RCT.0000000000000075
Musculoskeletal Imaging

Objective The trochlear cleft is a recently described vertically oriented, low-signal cartilage lesion centered in the trough of the trochlear cartilage. The purpose of our study was to determine the incidence of clefts in an at-risk group of athletes and correlate these findings with clinical and physical examination results.

Materials and Methods Sixteen female collegiate volleyball players consented to bilateral knee evaluations, which consisted of history, physical examination, and magnetic resonance (MR) imaging. Two fellowship-trained musculoskeletal radiologists reviewed each MR study by consensus. The trochlear cartilage was considered to be either normal, at risk of developing a cleft, or meeting the previously described criteria for clefts. The Fisher exact test was used for categorical variables, and the Mann-Whitney U test was used for nonparametric continuous variable.

Results A total of 16 athletes (32 knees; 16 women; age range, 18–22 years; mean, 19.9 years) were enrolled in the study. Four knees (13%) in 3 athletes were diagnosed with a trochlear cleft; 6 knees (19%) in 4 athletes had clefts or were at risk of developing clefts. Among those players with unilateral cartilage lesions, 67% had contralateral abnormalities (P = 0.0783). Functional outcomes and physical examination findings were within normal limits for all athletes, with no difference noted between those with and without clefts.

Conclusions Elite athletes have a much higher incidence of trochlear clefts than the general population and are at risk of bilateral disease. Clefts are likely to be an incidental finding at MR imaging for unrelated symptoms.

From the Departments of *Radiology and †Orthopaedic Surgery, University of Cincinnati Medical Center, Cincinnati, OH.

Received for publication December 12, 2013; accepted January 17, 2014.

Reprints: Robert D. Wissman, MD, Department of Radiology, University of Cincinnati Medical Center, 234 Goodman St, Cincinnati, OH 45267-0761 (e-mail:

Funding for this research project came through the University of Cincinnati Orthopaedic Research and Education Foundation.

The authors report no conflicts of interest.

© 2014 by Lippincott Williams & Wilkins