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Zhou Z, Hua Q, Wen C, Qian W, Su J, Yang M, Lei M. Effect of Patellar Morphology on the Risk of Osteochondral Fracture after Patellar Dislocation: A Cross-sectional Study. Orthop Surg 2024; 16:1089-1100. [PMID: 38561949 PMCID: PMC11062850 DOI: 10.1111/os.14036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 02/07/2024] [Accepted: 02/25/2024] [Indexed: 04/04/2024] Open
Abstract
OBJECTIVE The risk of osteochondral fracture (OCF) after patellar dislocation has been shown to be related to patellofemoral anatomy, but its relationship to patellar morphology remains unknown. The aim of this study was to investigate the associations between patellar morphology and the risk of OCF after patellar dislocation. METHODS A total of 140 patients with patellar dislocation between January 2018 and June 2023 were enrolled in this study and divided into two groups. Sixty-five patellar dislocation patients with OCF were included in the OCF group, while 75 patellar dislocation patients without OCF were included in the non-OCF group. Computed tomography was used to compare measurements of patellar morphology including Wiberg classification, patellar width and thickness, Wiberg angle, Wiberg index, facet ratio, lateral patellar facet angle, and patellar tilt angle. A logistic regression model was performed to evaluate the correlations between patellar morphology and the risk of OCF after patellar dislocation. Receiver operating characteristic curves were used to calculate the area under the curve (AUC) and determine the diagnostic values of patellar morphology for OCF after patellar dislocation. Subgroup analyses for gender and age were conducted to compare the differences in patellar morphology of PD patients. RESULTS Wiberg angle was significantly lower in the OCF group (p = 0.017), while Wiberg index (p = 0.002) and facet ratio (p = 0.023) were significantly higher in the OCF group. According to the results of logistic regression analysis, Wiberg angle (odds ratio [OR] = 0.96, p = 0.022) and Wiberg index (OR = 1.105, p = 0.032) were the final relevant factors for the occurrence of OCF after patellar dislocation. The AUC was 0.622 (95% confidence interval [CI]: 0.529-0.714) for Wiberg angle, 0.65 (95% CI: 0.558-0.742) for Wiberg index, and 0.702 (95% CI: 0.615-0.788) for the combination of Wiberg angle plus Wiberg index. CONCLUSION Wiberg angle and Wiberg index were independent risk factors for the occurrence of osteochondral fracture after patellar dislocation. Moreover, Wiberg angle, Wiberg index, and the combination of Wiberg angle plus Wiberg index had good predictive diagnostic value for the occurrence of OCF after patellar dislocation.
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Affiliation(s)
- Zirui Zhou
- College of Sports Medicine and HealthChengdu Sport UniversityChengduChina
| | - Qiang Hua
- Department of Sports Injury, Affiliated Sports Hospital of Chengdu Sport UniversityChengdu Sport UniversityChengduChina
| | - Chenghong Wen
- Department of Sports Injury, Affiliated Sports Hospital of Chengdu Sport UniversityChengdu Sport UniversityChengduChina
| | - Wenduo Qian
- Department of Sports Injury, Affiliated Sports Hospital of Chengdu Sport UniversityChengdu Sport UniversityChengduChina
| | - Jide Su
- Department of Sports Injury, Affiliated Sports Hospital of Chengdu Sport UniversityChengdu Sport UniversityChengduChina
| | - Min Yang
- Department of Sports Injury, Affiliated Sports Hospital of Chengdu Sport UniversityChengdu Sport UniversityChengduChina
| | - Mingming Lei
- Department of Sports Injury, Affiliated Sports Hospital of Chengdu Sport UniversityChengdu Sport UniversityChengduChina
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Sheehan FT, Shah P, Boden BP. The Importance of Medial Patellar Shape as a Risk Factor for Recurrent Patellar Dislocation in Adults. Am J Sports Med 2024; 52:1282-1291. [PMID: 38557261 DOI: 10.1177/03635465241233732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
BACKGROUND Research on the cause of lateral patellar dislocation (LPD) has focused on trochlear morphologic parameters, joint alignment, and patellofemoral soft tissue forces. A paucity of information is available regarding how patellar morphologic parameters influence the risk for LPD. PURPOSE/HYPOTHESIS The purpose was to assess whether patellar morphology is a risk factor for recurrent LPD. It was hypothesized that (1) patients with recurrent LPD would have decreased patellar width and volume and (2) patellar morphologic parameters would accurately discriminate patients with recurrent LPD from controls. STUDY DESIGN Cohort study (diagnosis); Level of evidence, 3. METHODS A total of 21 adults with recurrent LPD (age, 29.7 ± 11.1 years; height, 170.8 ± 9.9 cm; weight, 76.1 ± 17.5 kg; 57% female) were compared with 21 sex- and height-matched controls (age, 27.2 ± 6.7 years; height, 172.0 ± 10.6 cm; weight, 71.1 ± 12.8 kg; 57% female). Three-dimensional axial fat-saturated magnetic resonance imaging scans were used to measure patellar medial, lateral, and total width; patellar volume; patellar medial and lateral facet length; the Wiberg index; and previously validated knee joint alignment and femoral shape measurements (eg, tibial tuberosity to trochlear groove distance, trochlear dysplasia). RESULTS The LPD group demonstrated reduced medial patellar width (Δ = -3.6 mm; P < .001) and medial facet length (Δ = -3.7 mm; P < .001) but no change in lateral width or facet length. This resulted in decreased total patellar width (Δ = -3.2 mm; P = .009), decreased patellar volume (Δ = -0.3 cm3; P = .025), and an increased Wiberg index (Δ = 0.05; P < .001). No significant differences were found for all other patellar shape measures between cohorts. Medial patellar width was the strongest single discriminator (83.3% accuracy) for recurrent LPD. Combining medial patellar width, patellofemoral tilt, and trochlear groove length increased the discrimination to 92.9%. CONCLUSION The medial patellar width was significantly smaller in patients with recurrent LPD and was the single most accurate discriminator for recurrent LPD, even compared with traditional trochlear shape and joint alignment measures (eg, trochlear dysplasia, patella alta). Therefore, medial patellar morphology should be assessed in patients with LPD as a risk factor for recurrence and a potential means to improve treatment.
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Affiliation(s)
- Frances T Sheehan
- Department of Rehabilitation Medicine, National Institutes of Health, Bethesda, Maryland, USA
| | - Paras Shah
- Department of Rehabilitation Medicine, National Institutes of Health, Bethesda, Maryland, USA
| | - Barry P Boden
- The Orthopaedic Center, a Division of CAO, Rockville, Maryland, USA
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Kader DF, Jones S, Haddad FS. Towards a better understanding of patellofemoral instability. Bone Joint J 2023; 105-B:1235-1238. [PMID: 38035592 DOI: 10.1302/0301-620x.105b12.bjj-2023-1026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Affiliation(s)
- Deiary F Kader
- South West London Elective Orthopaedic Centre, Epsom, UK
- University of Kurdistan Hewlêr, Erbil, Iraq
| | - Samantha Jones
- South West London Elective Orthopaedic Centre, Epsom, UK
- Institute of Medical and Biomedical Education, St George's, University of London, London, UK
| | - Fares S Haddad
- University College London Hospitals, London, UK
- The Princess Grace Hospital, London, UK
- The NIHR Biomedical Research Centre, London, UK
- The Bone & Joint Journal , London, UK
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Assessment of the reliability and validity of imaging measurements for patellofemoral instability: an updated systematic review. Skeletal Radiol 2022; 51:2245-2256. [PMID: 35794393 DOI: 10.1007/s00256-022-04110-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/28/2022] [Accepted: 06/28/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To provide an update on the reliability and validity of all radiological measures used to assess patients presenting with patellofemoral instability. METHODS A search of the CINHAL, EMBASE, MEDLINE, and SCOPUS databases and the Cochrane library was conducted. All studies assessing the validity, reliability, sensitivity, and specificity of radiological measures of the patellofemoral joints of patients with patellofemoral instability from 2010 onwards were considered for inclusion. Discrimination validity, inter- and intra-observer reliability, and the sensitivity and specificity of specific imaging measures were evaluated. RESULTS Seventy-three studies met the selection criteria and were included for analysis. We identified eight radiological measures in four categories with good reliability and validity: the tibial tubercle to trochlear groove distance, specific measures of patellar height (Blackburne-Peel index, Caton-Deschamps index and Insall-Salvati ratios), three measures of trochlear dysplasia (sulcus angle, trochlear depth, and lateral trochlear inclination), and the tibial tubercle to posterior cruciate ligament distance. No included studies examined the reliability and validity of patellofemoral instability ultrasound measures. CONCLUSION Our updated review demonstrated good inter- and intra-observer reliability and discrimination validity for the tibial tubercle-trochlear groove distance, specific patellar height, and trochlear dysplasia measures on MRI. The tibial tubercle to posterior cruciate ligament distance, an indirect measure of rotational asymmetry, was a valid and reliable measure on MRI. Due to a lack of assessments across more than one study, there are a variety of proposed measures with insufficient evidence to determine their validity, reliability, sensitivity, and specificity.
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Xu Z, Zhao P, Song Y, Wang H, Zhou A, Yu JK. Reliability of the Tibial Tubercle-Roman Arch Distance for Evaluating Tibial Tubercle Malposition and Predicting Patellar Dislocation via Magnetic Resonance Imaging. Orthop J Sports Med 2022; 10:23259671221118561. [PMID: 36051972 PMCID: PMC9425913 DOI: 10.1177/23259671221118561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 05/17/2022] [Indexed: 12/02/2022] Open
Abstract
Background: The tibial tubercle (TT)–trochlear groove (TT-TG) distance has low reproducibility in patients with a dysplastic trochlea, whereas the clinical value of the TT–posterior cruciate ligament (TT-PCL) distance remains controversial. Purposes: To establish a method to assess the position of the TT on magnetic resonance imaging (MRI) scans using the TT–Roman arch (TT-RA) distance, compare this method with the TT-TG and TT-PCL distance, and provide the pathological threshold value of the TT-RA distance in patients with patellar dislocation. Study Design: Cross-sectional study; Level of evidence, 3. Methods: The TT-RA distance, TT-TG distance, and TT-PCL distance were measured on MRI scans in 70 patients with a history of patellar dislocation and 70 healthy individuals. Inter- and intraobserver reliability of each measurement parameter were evaluated. The discriminatory capacity and the interrelationship of the 3 measurement parameters were investigated using Pearson correlation and the receiver operating characteristic curve. The pathological threshold values of these measurements were calculated according to the data of healthy individuals. Finally, logistic regression analysis was performed using these values. Results: Patients with patellar dislocation had a greater TT-RA distance compared with healthy individuals (18.05 ± 4.16 vs 13.86 ± 2.90 mm; P < .001). The TT-RA distance had a stronger diagnostic capacity, with an area under the curve of 0.802 compared with 0.625 for TT-PCL distance. Excellent reproducibility was seen for TT-RA distance measurement at any degree of trochlear dysplasia (all intraclass correlation coefficients [ICCs] >0.90). The inter- and intraobserver ICCs of the TT-TG distance measurements were extremely low for Dejour type D dysplasia (ICC, 0.509 and 0.616, respectively). The pathological TT-RA distance threshold was calculated as 19.5 mm. Logistic regression showed that patients with a TT-RA distance >19.5 mm were 11.7 times more likely to sustain patellar dislocation than were those with TT-RA distance less than this value. Conclusion: The TT-RA distance was a more reliable parameter with which to evaluate TT position than was TT-TG distance in patients with trochlear dysplasia. The TT-PCL distance was the least reliable among the 3 parameters studied.
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Affiliation(s)
- Zijie Xu
- Sports Medicine Department, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China.,Institute of Sports Medicine, Peking University, Beijing, China
| | - Pei Zhao
- Department of Orthopedics, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yifan Song
- Sports Medicine Department, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China.,Institute of Sports Medicine, Peking University, Beijing, China
| | - Haijun Wang
- Sports Medicine Department, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China.,Institute of Sports Medicine, Peking University, Beijing, China
| | - Aiguo Zhou
- Department of Orthopedics, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jia-Kuo Yu
- Sports Medicine Department, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China.,Institute of Sports Medicine, Peking University, Beijing, China
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Ormeci T, Sen S, Turkten I, Gulabi D, Avcı CC, Sakul BU. The relationship between patellar volume and trochlear volume in patients with patellofemoral instability. Clin Radiol 2022; 77:e329-e336. [PMID: 35144768 DOI: 10.1016/j.crad.2022.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 01/06/2022] [Indexed: 11/19/2022]
Abstract
AIM To investigate a possible relationship between both the volume and morphology of the patella and the volume of the trochlea in trochlear dysplasia (TD). MATERIALS AND METHODS Eighteen patients with TD and 18 controls were evaluated retrospectively in two groups using computed tomography (CT). Patellar morphology was evaluated with the standard measurement methods described in the literature. Additionally trochlear sulcus volume (TV) and patellar volume (PV) were measured quantitatively using the three-dimensional volume-rendering method. The relationship between patella dimensions and volume and trochlea volume was evaluated. RESULTS The length of the medial patellar facet (lMP), patellar width (PW), TV and PV were significantly lower in the patient group. When compared according to Dejour types, PW was statistically significantly lower than the control group in those with high-grade and those with low-grade dysplasia. A positive correlation was found between the TV and PV in both groups (patient group: r=0.583 p=0.011; control group: r=0.485 p=0.042). CONCLUSİONS: PV and the TV are related. Therefore, PV can be used as a determining parameter in the evaluation of TD. This technique can also be used for prosthesis construction and more accurate surgical planning.
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Affiliation(s)
- T Ormeci
- Department of Radiology, School of Medicine, Istanbul Medipol University, Istanbul, Turkey.
| | - S Sen
- Department of Anatomy, School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - I Turkten
- Department of Anatomy, School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - D Gulabi
- Orthopedics and Traumatology Department, Sağlık Bilimleri University Istanbul Kanuni Sultan Süleyman Training and Research Hospital, Istanbul, Turkey
| | - C C Avcı
- Orthopedics and Traumatology Department, School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - B U Sakul
- Department of Anatomy, School of Medicine, Istanbul Medipol University, Istanbul, Turkey
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Qiu L, Li J, Sheng B, Yang H, Xiao Z, Lv F, Lv F. Patellar shape is associated with femoral trochlear morphology in individuals with mature skeletal development. BMC Musculoskelet Disord 2022; 23:56. [PMID: 35039027 PMCID: PMC8764759 DOI: 10.1186/s12891-022-05000-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 01/03/2022] [Indexed: 11/11/2022] Open
Abstract
Background As several studies have detected correlations between patellar and femoral trochlear development, this raises the question of whether patellar shape is associated with trochlear developmental outcomes. Methods Patellar shape and femoral trochlear morphology were retrospectively analyzed in 183 subjects, of whom 61 each were classified as having Wiberg type I, II, and III patellae (groups A, B, and C, respectively). The sulcus angle (SA), lateral trochlea inclination angle (LTA), medial trochlear inclination angle (MTA), lateral facet length (LFL), medial facet length (MFL), lateral trochlear height (LTH), medial trochlear height (MTH), trochlea sulcus height (TH), and lateral-medial trochlear facet distance (TD) were analyzed as a means of evaluating trochlear morphology. Trochlear depth, trochlear condyle asymmetry, and trochlear facet asymmetry were additionally calculated, and differences in trochlear morphology and correlations between trochlear morphology and patellar shape were evaluated. Results The femoral trochlear parameters of patients in group A differed significantly from those of patients in groups B and C. No significant differences between groups B and C were evident. Patellar shape was positively correlated with LTA, MTA, MFL, trochlear condyle asymmetry, and trochlear facet asymmetry, and was negatively correlated with SA. Conclusions These data indicated that patellar shape and trochlear morphology are related to one another,which suggest normalized patella morphology surgery and trochlear surgery are better choices for patients with patella instability. Trial registration Retrospectively registered.
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Affiliation(s)
- Lanyu Qiu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, 1 youyi road, yuzhong district, Chongqing, 400016, P.R. China
| | - Jia Li
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, 1 youyi road, yuzhong district, Chongqing, 400016, P.R. China
| | - Bo Sheng
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, 1 youyi road, yuzhong district, Chongqing, 400016, P.R. China
| | - Haitao Yang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, 1 youyi road, yuzhong district, Chongqing, 400016, P.R. China
| | - Zhibo Xiao
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, 1 youyi road, yuzhong district, Chongqing, 400016, P.R. China
| | - Fajin Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, 1 youyi road, yuzhong district, Chongqing, 400016, P.R. China
| | - Furong Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, 1 youyi road, yuzhong district, Chongqing, 400016, P.R. China.
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Changes in patellar morphology following surgical correction of recurrent patellar dislocation in children. J Orthop Surg Res 2021; 16:607. [PMID: 34656140 PMCID: PMC8520291 DOI: 10.1186/s13018-021-02779-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 10/06/2021] [Indexed: 11/24/2022] Open
Abstract
Background The aim of this study was to evaluate patellar morphological changes following surgical correction of recurrent patellar dislocation in children. Methods A total of 35 immature children aged 5 to 10 years who suffered from bilateral recurrent patellar dislocation associated with abnormal patella morphology were enrolled in this study. The knees with the most frequent dislocations (treated with medial patellar retinacular plasty) were selected as the study group (SG), and those undergoing conservative treatment for the contralateral knee were selected as the control group (CG). Computed tomography (CT) scans were performed on all children preoperatively and at the last follow-up to evaluate morphological characteristics of the patella. Results All the radiological parameters of the patella showed no significant difference between the two groups preoperatively. At the last follow-up for CT scans, no significant differences were found for the relative patellar width (SG, 54.61%; CG, 52.87%; P = 0.086) and the relative patellar thickness (SG, 26.07%; CG, 25.02%; P = 0.243). The radiological parameters including Wiberg angle (SG, 136.25°; CG, 122.65°; P < 0.001), modified Wiberg index (SG, 1.23; CG, 2.65; P < 0.001), and lateral patellar facet angle (SG, 23.35°; CG, 15.26°; P < 0.001) showed statistical differences between the two groups. Conclusions The patellar morphology can be improved by early surgical correction in children with recurrent patellar dislocation. Therefore, early intervention is of great importance for children diagnosed with recurrent patellar dislocation.
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Cao L, Sun K, Yang H, Wang H, Zeng R, Fan H. Influence of Patellar Morphology Classified by Wiberg Classification on Knee Joint Function and Patellofemoral Tracking After Total Knee Arthroplasty Without Patellar Resurfacing. J Arthroplasty 2021; 36:3148-3153. [PMID: 33962823 DOI: 10.1016/j.arth.2021.04.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 03/06/2021] [Accepted: 04/13/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND To evaluate the influence of patellar morphology on knee joint function and patellofemoral tracking in patients with primary osteoarthritis after total knee arthroplasty (TKA) without patellar resurfacing. METHODS We performed a retrospective study of 156 patients with primary osteoarthritis who underwent TKA without patellar resurfacing from April 2018 to July 2019. As per Wiberg classification, patients were divided into Wiberg type I (group A, n = 38), II (group B, n = 88), and III (group C, n = 30) groups. The clinical data, postoperative follow-up data, and radiological data between three groups were compared. RESULTS There was no statistically significant difference in the HSS score and Feller score between the three groups before surgery and at each follow-up point after surgery (P > .05). At the last follow-up, there were no significant differences in the height and relative thickness of the patella between the three groups (P > .05). However, the incidence of anterior knee pain was significantly higher in group C than in the group B (P < .05). The patellar tilt angle was significantly larger in group C than in the groups A and B (both P < .05). The patellar facet angle was significantly larger in group A than in group B and C, which was also significantly larger in group B than in group C (both P < .05). CONCLUSION Patients with three different morphologic types of the patella both exhibited improved knee joint function after TKA, however, patients with Wiberg type Ⅲ patella were more prone to have poor patellofemoral tracking and anterior knee pain after surgery.
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Affiliation(s)
- Le Cao
- Department of Orthopaedics, Fuyang Hospital of Anhui Medical University, Fuyang, Anhui Province, China
| | - Kai Sun
- Department of Orthopaedics, Fuyang Hospital of Anhui Medical University, Fuyang, Anhui Province, China
| | - Haitao Yang
- Department of Orthopaedics, Fuyang Hospital of Anhui Medical University, Fuyang, Anhui Province, China
| | - Hanbang Wang
- Department of Orthopaedics, Fuyang Hospital of Anhui Medical University, Fuyang, Anhui Province, China
| | - Ran Zeng
- Department of Intensive Care Unit, Fuyang Hospital of Anhui Medical University, Fuyang, Anhui Province, China
| | - Haitao Fan
- Department of Orthopaedics, Fuyang Hospital of Anhui Medical University, Fuyang, Anhui Province, China
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Abstract
Optimal treatment of patients with patellofemoral trochlear dysplasia and recurrent patellar instability requires in-depth understanding of this complex structural anomaly. An extensive review of the literature suggests that dysplasia occurs as a result of aberrant forces applied to the patellofemoral joint in the majority of cases. Evidence supports surgical stabilization that reconstructs the medial patellofemoral and/or medial quadriceps tendon-femoral ligament without added trochleoplasty in the majority of patients with trochlear dysplasia and recurrent patellar instability. Adding tibial tubercle transfer distally, medially, or anteromedially in those who need it to treat specific deficits in alignment or articular cartilage can be beneficial in selected patients with trochlear dysplasia and recurrent patellar instability. Trochleoplasty may be appropriate in those few cases in which permanent stable patellofemoral tracking cannot be restored otherwise, but the indications are not yet clear, particularly as trochleoplasty adds risk to the articular cartilage. Improved understanding of imaging techniques and 3-dimensional reproductions of dysplastic patellofemoral joints are useful in surgical planning for patients with recurrent patellar instability and trochlear dysplasia.
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Affiliation(s)
- Benjamin J Levy
- School of Medicine, University of Connecticut, Farmington, Connecticut, USA.,Department of Orthopaedic Surgery, UConn Health, Farmington, Connecticut, USA
| | - Miho J Tanaka
- Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - John P Fulkerson
- School of Medicine, University of Connecticut, Farmington, Connecticut, USA.,Department of Orthopaedic Surgery, Yale University, New Haven, Connecticut, USA
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Jimenez AE, Levy BJ, Grimm NL, Andelman SM, Cheng C, Hedgecock JP, Cohen A, Pace JL. Relationship Between Patellar Morphology and Known Anatomic Risk Factors for Patellofemoral Instability. Orthop J Sports Med 2021; 9:2325967120988690. [PMID: 33748306 PMCID: PMC7940750 DOI: 10.1177/2325967120988690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 10/16/2020] [Indexed: 11/27/2022] Open
Abstract
Background: Patellar instability (PI) is a common problem among pediatric, adolescent, and young adult patients. Recent literature has shown a correlation between pathoanatomy and PI. Purpose/Hypothesis: The purpose of this study was to determine if there is any difference in patellar shape in patients with and without PI and if there is any association between the shape of the patella and the shape of the trochlea. Our hypothesis was that there would be no association between the shape of the patella and the likelinhood of having PI and that the shape of the trochlea would not be associated with patellar morphology. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Magnetic resonance imaging (MRI) scans were analyzed for 97 study patients with PI and 100 control patients with anterior cruciate ligament tears. Radiologic measurements of trochlear morphology were collected via MRI; 15 measurements of patellar morphology were then measured using axial MRI scans. Comparisons between the control and PI groups were performed using a 2-tailed t test. Regression analysis was performed to determine if associations existed between the 15 patellar morphology measurements and the trochlear dysplasia measurements. Results: There were no statistically significant differences between the PI and control groups for the majority of patellar morphology measurements. With regression analysis, there were no statistically significant associations between the majority of patellar morphology measurements and the trochlear dysplasia measurements. Conclusion: Patellar morphology is highly variable in knees with and without PI. There was a minimal association between measurements of patellar morphology and trochlear dysplasia.
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Affiliation(s)
- Andrew E Jimenez
- University of Connecticut Health and School of Medicine, Farmington, Connecticut, USA
| | - Benjamin J Levy
- University of Connecticut Health and School of Medicine, Farmington, Connecticut, USA.,Department of Orthopaedics and Sports Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USA
| | | | | | - Chris Cheng
- Case Western Reserve Hospitals, Cleveland, Ohio, USA
| | - Jon P Hedgecock
- Orthopedic Health of Kansas City, Kansas City, Missouri, USA
| | - Andrew Cohen
- Elite Sports Medicine at Connecticut Children's Medical Center, Farmington, Connecticut, USA
| | - J Lee Pace
- University of Connecticut Health and School of Medicine, Farmington, Connecticut, USA.,Elite Sports Medicine at Connecticut Children's Medical Center, Farmington, Connecticut, USA
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