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Blaney TCR, Ronsky JL, Macri EM, Jaremko JL, Kuntze G, Pakdel A, Whittaker JL, Emery CA. Concurrent validity and reliability of a semi-automated approach to measuring the magnetic resonance imaging morphology of the knee joint in active youth. Proc Inst Mech Eng H 2022; 236:1023-1035. [DOI: 10.1177/09544119221095337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Post-traumatic knee osteoarthritis is attributed to alterations in joint morphology, alignment, and biomechanics triggered by injury. While magnetic resonance (MR) imaging-based measures of joint morphology and alignment are relevant to understanding osteoarthritis risk, time consuming manual data extraction and measurement limit the number of outcomes that can be considered and deter widespread use. This paper describes the development and evaluation of a semi-automated software for measuring tibiofemoral and patellofemoral joint architecture using MR images from youth with and without a previous sport-related knee injury. After prompting users to identify and select key anatomical landmarks, the software can calculate 37 (14 tibiofemoral, 23 patellofemoral) relevant geometric features (morphology and alignment) based on established methods. To assess validity and reliability, 11 common geometric features were calculated from the knee MR images (proton density and proton density fat saturation sequences; 1.5 T) of 76 individuals with a 3–10-year history of youth sport-related knee injury and 76 uninjured controls. Spearman’s or Pearson’s correlation coefficients (95% CI) and Bland-Altman plots were used to assess the concurrent validity of the semi-automated software (novice rater) versus expert manual measurements, while intra-class correlation coefficients (ICC2,1; 95%CI), standard error of measurement (95%CI), 95% minimal detectable change, and Bland-Altman plots were used to assess the inter-rater reliability of the semi-automated software (novice vs resident radiologist rater). Correlation coefficients ranged between 0.89 (0.84, 0.92; Lateral Trochlear Inclination) and 0.97 (0.96, 0.98; Patellar Tilt Angle). ICC estimates ranged between 0.79 (0.63, 0.88; Lateral Patellar Tilt Angle) and 0.98 (0.95, 0.99; Bisect Offset). Bland-Altman plots did not reveal systematic bias. These measurement properties estimates are equal, if not better than previously reported methods suggesting that this novel semi-automated software is an accurate, reliable, and efficient alternative method for measuring large numbers of geometric features of the tibiofemoral and patellofemoral joints from MR studies.
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Affiliation(s)
- Traven CR Blaney
- McCaig Institute of Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Faculty of Engineering, McGill University, Montreal, Canada
| | - Janet L Ronsky
- McCaig Institute of Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Schulich School of Engineering, University of Calgary, Calgary, AB, Canada
| | - Erin M Macri
- Department of General Practice, Department of Orthopedics and Sports Medicine, Erasmus MC, Rotterdam, Amsterdam, The Netherlands
| | - Jacob L Jaremko
- Department of Radiology & Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Gregor Kuntze
- McCaig Institute of Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Schulich School of Engineering, University of Calgary, Calgary, AB, Canada
| | - Amir Pakdel
- Department of Radiology & Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Jackie L Whittaker
- McCaig Institute of Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Deparment of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
- Arthritis Research Canada, Vancouver, BC, Canada
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Carolyn A Emery
- McCaig Institute of Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- The Alberta Children’s Hospital Research Institute for Child and Maternal Health, Faculty of Medicine, University of Calgary, Calgary, AB, Canada
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The Tibial Tubercle-Trochlear Groove Distance/Trochlear Dysplasia Index Quotient Is the Most Accurate Indicator for Determining Patellofemoral Instability Risk. Arthroscopy 2022; 38:1608-1614. [PMID: 34450216 DOI: 10.1016/j.arthro.2021.08.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 08/02/2021] [Accepted: 08/10/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The primary aim of our study was to evaluate diagnostic accuracy of the tibial tubercle-trochlear groove (TT-TG) distance relative to associated quotients produced from trochlear width (TT-TG distance/TW) and trochlear dysplasia index (TT-TG distance/TDI) for detecting patellofemoral instability. Secondary aims included identifying thresholds for risk and comparing differences between cases and controls. METHODS Consecutive sampling of electronic medical records produced 48 (21 males, 27 females) patellofemoral instability cases (19 ± 7 years old) and 79 (61 males, 18 females) controls (23 ± 4 years old) who had a history of isolated meniscal lesion, as evaluated by magnetic resonance imaging. Standardized methods were employed with measurements executed in a blinded and randomized manner. A receiver operating characteristic curve assessed accuracy by area under the curve (AUC). The index of union (IU) was employed to identify a threshold for risk. Two-sample t-tests examined group differences. P < .05 denoted statistical significance. RESULTS The AUC values were .69 (.60, .79) for TT-TG distance, .81 (.73, .88) for TT-TG distance/TW, and .85 (.78, .91) for TT-TG distance/TDI. Thresholds were 14.7 mm for TT-TG distance, .36 for TT-TG distance/TW, and 1.88 for TT-TG distance/TDI. Cases demonstrated statistically significant (P < .001) greater values for each measure compared with controls: TT-TG distance (15.8 ± 4.2 mm vs 12.9 ± 3.6 mm, [1.4, 4.3]); TT-TG distance/TW (.51 ± .24 vs .31 ± .09, [.13, .27]); TT-TG distance/TDI (3.07 ± 1.55 vs 1.7 ± .7, [.9, 1.84]). CONCLUSION The TT-TG distance, TT-TG distance/TW, and TT-TG distance/TDI measures were 69%, 81%, and 85%, respectively, accurate for determining patellofemoral instability risk. Thresholds for risk were 14.7 mm for TT-TG distance, .36 for TT-TG distance/TW, and 1.88 for TT-TG distance/TDI. The thresholds reported in this study may help in advancing clinical decision-making. LEVEL OF EVIDENCE Level III, diagnostic retrospective comparative observatory trial.
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Li Z, Li M, Du Y, Zhang M, Jiang H, Zhang R, Ma Y, Zheng Q. Femur-tibia angle and patella-tibia angle: new indicators for diagnosing anterior cruciate ligament tears in magnetic resonance imaging. BMC Sports Sci Med Rehabil 2022; 14:66. [PMID: 35418093 PMCID: PMC9009057 DOI: 10.1186/s13102-022-00462-w] [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: 02/07/2022] [Accepted: 04/05/2022] [Indexed: 11/17/2022]
Abstract
Background Femur-tibia angle (FTA) and patella-tibia angle (PTA) are two MRI measurements that reflect the rotation of the knee joint. The purposes of this study were to assess whether FTA and PTA are associated with ACL tear and to explore their roles in ACL tear diagnosis. Methods FTA, PTA, ACL angle and anterior tibial subluxation were compared between the two matched groups: ACL tear group and control group (each n = 20). Diagnostic performance was evaluated in a consecutive 120-patient cohort who underwent MR imaging of the knee and subsequently had arthroscopy. Different measurements were assessed by area under the curve (AUC) of receiver operating characteristic (ROC) curve. Results FTA and PTA increased significantly in ACL tears group when compared to the control group (4.79 and 7.36 degrees, respectively, p < 0.05). In distinguishing complete ACL tear, ACL angle had the highest AUC of 0.906 while AUC of PTA and FTA were 0.849 and 0.809. The cutoff of FTA was 80 degrees with a sensitivity of 82% and specificity of 68%, while the cutoff of PTA was 91 degrees with a sensitivity of 82% and specificity of 74%. In distinguishing partial ACL tear, FTA and PTA had the highest AUCs of 0.847 and 0.813, respectively. The calculated cutoff of FTA was 84 degrees with a sensitivity of 90% and specificity of 81%, while the cutoff of PTA was 92 degrees with a sensitivity of 80% and specificity of 77%. Conclusion FTA and PTA increased when ACL tears and they might be valuable in diagnosing ACL tears, especially in distinguishing partial ACL tear from intact ACL.
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Affiliation(s)
- Zeng Li
- Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Mengyuan Li
- Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Yan Du
- Clinical Research Unit, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, 200011, China
| | - Mo Zhang
- Clinical Research Unit, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, 200011, China
| | - Hai Jiang
- Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Ruiying Zhang
- Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Yuanchen Ma
- Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China.
| | - Qiujian Zheng
- Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China.
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Duran S, Gunaydin E. Investigation of the relationship between trochlear morphology and medial patellar cartilage defect using magnetic resonance imaging. Acta Orthop Belg 2021. [DOI: 10.52628/87.2.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The aim of this study was to evaluate trochlear morphology in patients with medial patellar cartilage defects via magnetic resonance imaging (MRI).
Three hundred patients who were diagnosed with grade 2, 3 and 4 medial patellar cartilage defect using MRI according to the International Cartilage Repair Society Classification System and 100 control subjects were evaluated. Trochlear morphology was evaluated based on lateral trochlear inclination (LTI), medial trochlear inclination (MTI), sulcus angle( SA), femoral lateral and medial condyle symmetry, trochlear facet asymmetry, and trochlear width on the axial MR images.
The mean SA was significantly higher in the medial patellar cartilage defect group compared to the control group (p<.05). The LTI and MTI of the cartilage defect group were significantly lower than those of the control group (p<.05). With the decreasing LTI and MTI, there was an increase in medial patellar cartilage loss. LTI (r=-0.46) and MTI (r=-0.53) were moderately correlated with SA. There was no significant differences in femoral lateral and medial condyle symmetry, trochlear facet asymmetry, and trochlear width between groups with and without medial patellar cartilge defect (p > .05).
A flattened medial trochlea is a risk factor for cartilage structural damage of the medial patellofemoral joint, and it plays a role in the development of a defect in the medial patellar cartilage. The medial patellar cartilage defect is associated with the flattened lateral trochlea.
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Bajada S, Mandalia V. Patella Height as Defined by Patella-Trochlear Articulation on MRI Scan-A Systemic Review of Current Evidence. J Knee Surg 2020; 33:1206-1212. [PMID: 31357219 DOI: 10.1055/s-0039-1692997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The objective of this study is to investigate what are the normal values, cutoff values, and optimal method of magnetic resonance imaging (MRI) scan for patella height focusing on patella-trochlear index (PTI). Electronic searches of MEDLINE (PubMed), Cumulative Index to Nursing and Allied Health Literature, Cochrane, Embase, ScienceDirect, and National Institute for Health and Care Excellence evidence up to April 2018 were completed. Eligibility criteria for selected studies included case-controlled studies, prospective cohort studies, cross-sectional and randomized controlled trials reporting on the use of MRI to evaluate direct patella height. Exclusions included animal or biomechanical/computational studies; interventional surgery such as knee arthroplasty, bracing, or realignment; and hereditary/congenital disease. A quality assessment of included studies was completed using the Methodological Index for Non-Randomized Studies (MINORS) Criteria. Sixty-four articles were identified which met the inclusion criteria. Following exclusions, 11 full-text studies were reviewed which reported direct measure of patella height. Nine studies reported the use of PTI. Two low power studies described PTI in normal healthy asymptomatic knee. Similarly, one study evaluated the effect of flexion and weight bearing on PTI values. The cutoff values varied between studies from <0.125 to <0.28 for patella alta and >0.50 to >0.80 for patella baja. This review found that currently, there are a very few studies on the assessment of PTI on MRI scan, with only two low powered studies on a true normal population. In view of this, there is a need for adequately powered studies to investigate patella height and PTI in asymptomatic healthy knees.
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Affiliation(s)
- Stefan Bajada
- Exeter Knee Reconstruction Unit, Royal Devon and Exeter Hospital, Wonford, Exeter, United Kingdom
| | - Vipul Mandalia
- Exeter Knee Reconstruction Unit, Royal Devon and Exeter Hospital, Wonford, Exeter, United Kingdom
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Healthy knees have a highly variable patellofemoral alignment: a systematic review. Knee Surg Sports Traumatol Arthrosc 2020; 28:398-406. [PMID: 31256215 DOI: 10.1007/s00167-019-05587-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 06/18/2019] [Indexed: 12/22/2022]
Abstract
PURPOSE There is still lack of knowledge regarding the variability of patellofemoral alignment in healthy, non-osteoarthritic knees, without patellofemoral instability. Therefore, a systematic review of the existing literature was performed to evaluate the variability of patellofemoral alignment. METHODS Patellofemoral alignment of the knee was defined by the following parameters: sulcus angle (SA), femoral trochlear depth (FTD), patellar tilt angle (PTA), lateral patellofemoral angle (LPFA), lateral femoral trochlear inclination (LFTI) and tibial tubercle-trochlear groove distance (TT-TG). The electronic databases MEDLINE and EMBASE were searched from database inception to search date (January 11, 2019) and screened for relevant studies. The PRISMA guidelines were followed. Articles reporting PF alignment measurements of healthy knees in patients between 15 years and 47 years were included. RESULTS A total of 15 studies met the inclusion criteria. The studies reported mean values and standard deviations for the SA between 118.7° ± 7 and 168°; for the FTD between 3.4 mm ± 1.1 and 7.1 mm ± 1.8; for the PTA between 0.7° ± 4.99 and 17.05° ± 4.3; for the LPFA between 6.26° ± 4.1 and 11.1° ± 4.0; for the LFTI between 16.3° ± 2.8 and 22.1° ± 1.9; and for the TT-TG between 9.8 mm ± 4.6 and 17.3 mm ± 5.3. CONCLUSION Patellofemoral alignment in the healthy knee is extremely variable. A more precise knowledge of the complex relationship between the patella and the trochlea may help to better diagnose PF disorders and eventually help in selecting the correct therapy. Furthermore, standardised imaging protocols and measurement techniques for patellofemoral parameters are needed. LEVEL OF EVIDENCE III.
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