Representative 3D shape of the distal femur, modes of variation and relationship with abnormality of the trochlear region.

The anatomy of the distal femur has a predominant influence on the mechanics of both patello- and tibio-femoral joints. Especially, the morphological degeneration of the trochlear region dramatically affects the overall knee biomechanics and, from a clinical point of view, the staging of such a degeneration is fundamental to tailor the optimal therapeutic solution. The description of morphological variability and pathological inter-subject differences of the trochlea can be achieved by means of statistical shape modeling of a set of three-dimensional surfaces. This representation encodes information, spread into the dataset, in terms of modes of variations that model global, regional and even local morphological features. In view of that, the aim of this study was to develop a statistical shape model of the distal femur to capture the variability of the trochlear region into specific modes of variation and to study the interplay between the variation of the trochlea and the condylar regions. Using CT scans of patients affected by different levels of abnormality of the trochlear region, the distal femur geometries were co-registered to a reference shape using the pair-wise correspondence approach and principal component analysis provided the key modes of variation (MoVs). Apart from the first two MoVs, which described the global magnitude of the femur and the shaft length, the main following ones showed high correlation with sulcus depth (r

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