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Xu Z, Song Y, Deng R, Zhang Z, Wang H, Yu JK. Pathological Thresholds of Segmental Femoral Torsion in Patients With Patellar Dislocation: Influence on Patellofemoral Malalignment. Orthop J Sports Med 2022; 10:23259671221125218. [PMID: 36329949 PMCID: PMC9623427 DOI: 10.1177/23259671221125218] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 07/24/2022] [Indexed: 11/07/2022] Open
Abstract
Background Femoral torsion can be evaluated from different femoral segments. The
pathological thresholds for femoral torsion of different segments and the
influence of segmental femoral torsion on patellofemoral alignment remain
unknown. Purpose To compare femoral torsion between patients with recurrent patellar
dislocation and healthy individuals, to determine the statistical
physiological range and pathological thresholds of femoral torsion in
different segments, and to investigate the influence of femoral torsion on
patellofemoral malalignment. Study Design Cross-sectional study; Level of evidence, 3. Methods We retrospectively reviewed the records of patients with patellar dislocation
who received surgical treatment in our department between 2019 and 2020.
Healthy participants were recruited as the control group. The control
patients were asymptomatic and had no history of lower extremity disorders.
The differences in femoral torsion between the study and control groups were
compared. The diagnostic capacity of femoral torsion in different segments
and their correlation with patellar tilt were investigated. The mean value
and 95% CI of femoral torsion in different segments were established using
data from healthy volunteers. Results A total of 60 patients with patellar dislocation and 100 healthy volunteers
were included in this study. The total, mid, and distal femoral torsion
values differed significantly between the study and control groups
(P < .01). Total femoral torsion had the highest
diagnostic value (area under the receiver operating curve = 0.733). Total
torsion (r = 0.432; P < .001), mid
torsion (r = 0.242; P = .002), and distal
torsion (r = 0.324; P < .001) showed
significant correlations with patellar tilt. The pathological thresholds of
excessive femoral torsion of the total, proximal, mid, and distal femoral
segments were 24.73°, 46.68°, –6.55°, and 14.92°, respectively. Conclusion Patients with patellar dislocation had greater femoral torsion than healthy
individuals in multiple femoral segments. Excessive mid, distal, and total
torsion was associated with more significant patellar tilt.
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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
| | - 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
| | - Ronghui Deng
- Sports Medicine Department, Beijing Key Laboratory of Sports
Injuries, Peking University Third Hospital, Beijing, China.,Institute of Sports Medicine, Peking University, Beijing,
China
| | - Zining Zhang
- 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.,Jia-Kuo Yu, MD, PhD, and Haijun Wang, MD, Sports Medicine
Department, Beijing Key Laboratory of Sports Injuries, Peking University Third
Hospital, Institute of Sports Medicine, Peking University, No. 49 North Garden
Road, Haidian District, Beijing 100191, China (
and ,
respectively)
| | - 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.,Jia-Kuo Yu, MD, PhD, and Haijun Wang, MD, Sports Medicine
Department, Beijing Key Laboratory of Sports Injuries, Peking University Third
Hospital, Institute of Sports Medicine, Peking University, No. 49 North Garden
Road, Haidian District, Beijing 100191, China (
and ,
respectively)
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Tibial Tubercle to Trochlear Groove Distance Measured by Posterior Condylar Reference Line on MRI Can Over-Evaluate Lateralization Deformity of Tibial Tubercle in Patients with Recurrent Patellar Dislocation. J Clin Med 2022; 11:jcm11175072. [PMID: 36079000 PMCID: PMC9457527 DOI: 10.3390/jcm11175072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/24/2022] [Accepted: 08/25/2022] [Indexed: 11/23/2022] Open
Abstract
Background: The tibial tubercle to trochlear groove (TT-TG) distance is currently considered as an indication for tibial tubercle osteotomy. While the influence of femoral condylar morphology on such measurement remains unclear. Methods: A total of 86 patients with patellar dislocation (PD) and 86 healthy individuals were enrolled. Femoral condylar morphology and the TT-TG distance measured by anatomical transepicondylar axis (TT-TGa), by surgical transepicondylar axis (TT-TGs), and by posterior condylar reference line (TT-TGp) were assessed by MRI. Unpaired t-test, Spearman, and Pearson correlation analysis were conducted. We determined the pathological value of the parameters and established a binary regression model. Results: The interclass correlation coefficients of all the TT-TG distances were greater than 0.75 in all types of trochlear dysplasia. The lateral/posterior femoral condyle was shorter and the medial/posterior condyle was longer in the study group (28.5 ± 3.3 and 35.2 ± 2.8, respectively) than in the control group (30.9 ± 2.7 and 33.5 ± 2.3, respectively). In the study group, the TT-TGp distance was greater than TT-TGs and TT-TGa distance (p < 0.001). The pathological value of the TT-TG distance was 13.0 mm. Each TT-TG distance revealed a significant OR with regard to PD. Conclusion: The TT-TGa, TT-TGs, and TT-TGp distance can be reliably measured by MRI even in patients with trochlear dysplasia. While the TT-TGp distance may overestimate the lateralization deformity of the tibial tubercle. Posterior femoral condylar dysplasia may be a reason for such overestimating. These findings have not been correlated to clinical outcomes and further studies are required.
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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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Dong C, Hao K, Zhao C, Wang F. A new factor predicting excessive femoral anteversion in patients with recurrent patellar dislocation. J Orthop Surg Res 2022; 17:366. [PMID: 35902873 PMCID: PMC9330675 DOI: 10.1186/s13018-022-03259-2] [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: 04/20/2022] [Accepted: 07/15/2022] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Determining a new imaging method on full-leg standing lower limb radiographs to predict excessive femoral anteversion in patients with patellar dislocation. METHODS This study included 119 patients with patellar dislocation from January 2014 to January 2021. The femoral anteversion and tibial torsion were measured by CT scanning. The medial condylar angle was measured by the full-leg standing lower limb radiographs. Pearson correlation coefficient was used to evaluate the correlation between rotation parameters and medial condylar angle. RESULTS Included patients were divided into DFO group and control group according to whether they received derotational femoral osteotomy (DFO) operation or not. DFO group had significantly higher femoral anteversion (29.8° ± 7.2° vs 23.1° ± 6.5°, P < 0.05), higher tibial torsion (28.6° ± 6.9° vs 24.7° ± 7.9°, P < 0.05), lower medial condylar angle (154.8° ± 4.7° vs 157.5° ± 6.7°, P < 0.05) than control group. Correlation analysis showed that the values of femoral anteversion were significantly correlated with medial condylar angle (r = -0.719, P < 0.001). CONCLUSION This study showed that medial condylar angle had a negative correlation with excessive femoral anteversion on the full-leg standing lower limb radiographs. The medial condylar angle can be a good predictor of femoral anteversion and can be used to guide the performance of DFO to treat patellar dislocation in clinical practice.
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Affiliation(s)
- Conglei Dong
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Ziqiang Road 139, Shijiazhuang, 050051, Hebei, China
| | - Kuo Hao
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Ziqiang Road 139, Shijiazhuang, 050051, Hebei, China
| | - Chao Zhao
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Ziqiang Road 139, Shijiazhuang, 050051, Hebei, China
| | - Fei Wang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Ziqiang Road 139, Shijiazhuang, 050051, Hebei, China.
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Chen J, Yin B, Yao J, Zhou Y, Zhang H, Zhang J, Zhou A. Femoral anteversion measured by the surgical transepicondylar axis is a reliable parameter for evaluating femoral rotational deformities in patients with patellar dislocation. Knee Surg Sports Traumatol Arthrosc 2022:10.1007/s00167-022-07016-0. [PMID: 35666305 DOI: 10.1007/s00167-022-07016-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 05/15/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE To verify whether femoral anteversion measured by the surgical transepicondylar axis (S-FA) is a reliable parameter for evaluating femoral rotational deformities and to provide an indication for derotational distal femoral osteotomy (DDFO) in patients with patellar dislocation. METHODS Ninety patients with recurrent patellar dislocation and 90 healthy individuals were enrolled. The S-FA, the femoral anteversion measured by posterior condylar reference line (P-FA), the length of posterior femoral condyles, and the posterior condylar angle (PCA) were assessed by CT images. The unpaired t test and Pearson correlation analysis were conducted. Receiver operating characteristic curves and the area under the curve (AUC) were used to evaluate the diagnostic capacity of the parameters. The pathological value of the measurements was determined, and a binary regression model was established. RESULTS The S-FA and P-FA were greater in the study group (14.2 ± 7.7° and 19.7 ± 7.3°, respectively) than in the control group (7.2 ± 8.0° and 12.2 ± 8.2°, respectively) (P < 0.001). The lateral/posterior condyle was shorter in patients with patellar dislocation (21.2 ± 2.5 mm) than in healthy individuals (23.5 ± 2.7 mm) (P = 0.001). The P-FA was correlated with PCA in the study group (P < 0.001). The S-FA and P-FA had AUCs of 0.734 and 0.767 for patellar dislocation, respectively. The pathological values of the S-FA and P-FA were 20.4° and 25.8°, respectively. The S-FA revealed a significant OR of 10.47 (P = 0.014) for patellar dislocation. CONCLUSION The S-FA is a reliable parameter for identifying femoral rotational deformities in patients with patellar dislocation. DDFO is recommended when a pathological S-FA (> 20.4°) is presented. LEVEL OF EVIDENCE Retrospective cohort study (diagnostic), level II.
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Affiliation(s)
- Jiaxing Chen
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.,Orthopedic Laboratory of Chongqing Medical University, Chongqing, 400016, China
| | - Baoshan Yin
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.,Orthopedic Laboratory of Chongqing Medical University, Chongqing, 400016, China
| | - Jinjiang Yao
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.,Orthopedic Laboratory of Chongqing Medical University, Chongqing, 400016, China
| | - Yunlong Zhou
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.,Orthopedic Laboratory of Chongqing Medical University, Chongqing, 400016, China
| | - Hua Zhang
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.,Orthopedic Laboratory of Chongqing Medical University, Chongqing, 400016, China
| | - Jian Zhang
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.,Orthopedic Laboratory of Chongqing Medical University, Chongqing, 400016, China
| | - Aiguo Zhou
- Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China. .,Orthopedic Laboratory of Chongqing Medical University, Chongqing, 400016, China.
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Ahrend MD, Eisenmann T, Herbst M, Gueorguiev B, Keller G, Schmidutz F, Döbele S, Schröter S, Ihle C. Increased tibial tubercle-trochlear groove and patellar height indicate a higher risk of recurrent patellar dislocation following medial reefing. Knee Surg Sports Traumatol Arthrosc 2022; 30:1404-1413. [PMID: 34032867 PMCID: PMC9007812 DOI: 10.1007/s00167-021-06581-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 04/13/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE Identifying anatomical risk factors on recurrent dislocation after medial reefing is important for deciding surgical treatment. The present study aimed to retrospectively analyze the preoperative magnetic resonance imaging (MRI)-based parameters of patients treated with medial reefing and whether these parameters lead to a higher risk of recurrent dislocation. METHODS Fifty-five patients (18.6 ± 6.6 years) who underwent medial reefing after primary traumatic patellar dislocation (84% with medial patellofemoral ligament [MPFL] rupture) were included. Patients were followed up for at least 24 months postoperatively (3.8 ± 1.2 years) to assess the incidence of recurrent patellar dislocation. In patients without recurrent dislocation, the Kujala and subjective IKDC scores were assessed. Moreover, the tibial tubercle-trochlear groove (TT-TG), sulcus angle, patellar tilt, patellar shift, and lateral trochlea index (LTI) were measured. The patellar height was measured using the Caton-Dechamps (CDI), Blackburne-Peel (BPI), and Insall-Salvati index (ISI). The cohort was subclassified into two groups with and without recurrent dislocation. Differences between groups were analyzed with respect to the MRI parameters. RESULTS Forty percent had a pathological sulcus angle of > 145°, 7.2% had an LTI of < 11°, 47.3% had a patellar tilt of > 20°, and 36.4% had a TT-TG of ≥ 16 mm. Increased patellar height was observed in 34.5, 65.5, and 34.5% of the patients as per CDI, BPI, and ISI, respectively. Nineteen (34.5%) patients suffered from recurrent dislocation. Compared with patients without recurrent dislocation, those with recurrent dislocation had a significantly lower LTI (p = 0.0467). All other parameters were not significantly different between the groups. Risk factor analysis showed higher odds ratios (OR > 2), although not statistically significant, for MPFL rupture (OR 2.05 [95% confidence interval 0.38-11.03], LTI (6.6 [0.6-68.1]), TT-TG (2.9 [0.9-9.2]), and patellar height according to ISI (2.3 [0.7-7.5]) and CDI (2.3 [0.7-7.5])). Patients without recurrent dislocation had a Kujala score of 93.7 ± 12.1 (42-100) points and an IKDC score of 90.6 ± 11.7 (55.2-100) points. CONCLUSION Anatomical, MRI-based parameters should be considered before indicating medial reefing. A ruptured MPFL, an LTI < 11°, a TT-TG ≥ 16 mm, a patellar tilt > 20 mm, and an increased patellar height according to ISI and CDI were found to be associated, although not significantly, with a higher risk (OR > 2) of recurrent patellar dislocation after medial reefing. Thorough preoperative analysis is crucial to reduce the risk of recurrent dislocation in young patient cohorts. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Marc-Daniel Ahrend
- grid.10392.390000 0001 2190 1447Department of Traumatology and Reconstructive Surgery, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany ,grid.418048.10000 0004 0618 0495AO Research Institute Davos, Davos, Switzerland
| | - Tobias Eisenmann
- grid.10392.390000 0001 2190 1447Department of Traumatology and Reconstructive Surgery, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Moritz Herbst
- Department of Traumatology and Reconstructive Surgery, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany.
| | - Boyko Gueorguiev
- grid.418048.10000 0004 0618 0495AO Research Institute Davos, Davos, Switzerland
| | - Gabriel Keller
- grid.411544.10000 0001 0196 8249Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Tübingen, Germany
| | - Florian Schmidutz
- grid.10392.390000 0001 2190 1447Department of Traumatology and Reconstructive Surgery, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Stefan Döbele
- grid.10392.390000 0001 2190 1447Department of Traumatology and Reconstructive Surgery, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Steffen Schröter
- grid.491771.dDepartment of Traumatology and Reconstructive Surgery, Diakonie Klinikum GmbH Jung-Stilling-Krankenhaus, Siegen, Germany
| | - Christoph Ihle
- grid.10392.390000 0001 2190 1447Department of Traumatology and Reconstructive Surgery, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
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How to Evaluate and Treat Skeletally Mature Patients With Patellar Dislocation. Arthrosc Tech 2021; 10:e721-e726. [PMID: 33738207 PMCID: PMC7953235 DOI: 10.1016/j.eats.2020.10.064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 10/25/2020] [Indexed: 02/03/2023] Open
Abstract
Although patellar dislocation is a knee disorder prevalent in adolescence and young adults, the evaluation and treatment of patients are complex and even enigmatic. Much of the literature fails to provide a detailed description of patient management. The purpose of this study is to introduce a method for the evaluation and treatment of patellar dislocation. This Technical Note will help guide clinicians in the clinical evaluation of patients and formulation of treatment plans.
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