Generating 3D pseudo-healthy knee MR images to support trochleoplasty planning

Purpose: Trochlear dysplasia (TD) is a common malformation in adolescents, leading to anterior knee pain and instability. Surgical interventions such as trochleoplasty require precise planning to correct the trochlear groove. However, no standardized preoperative plan exists to guide surgeons in reshaping the femur. This study aims to generate patient-specific, pseudo-healthy MR images of the trochlear region that should theoretically align with the respective patient's patella, potentially supporting the preoperative planning of trochleoplasty. Methods: We employ a wavelet diffusion model (WDM) to generate personalized pseudo-healthy, anatomically plausible MR scans of the trochlear region. We train our model using knee MR scans of healthy subjects. During inference, we mask out pathological regions around the patella in scans of patients affected by TD and replace them with their pseudo-healthy counterpart. An orthopedic surgeon measured the sulcus angle (SA), trochlear groove depth (TGD) and D & eacute;jour classification in MR scans before and after inpainting. The code is available at https://github.com/wehrlimi/Generate-Pseudo-Healthy-Knee-MRI. Results: The inpainting by our model significantly improves the SA, TGD and Dejour classification in a study with 49 knee MR scans. Conclusion: This study demonstrates the potential of WDMs in providing surgeons with patient-specific guidance. By offering anatomically plausible MR scans, the method could potentially enhance the precision and preoperative planning of trochleoplasty and pave the way to more minimally invasive surgeries.