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Vasiliadis AV, Troupis T, Chrysikos D, Chytas D, Noussios G. Trochlea Dysplasia as the Major Anatomic Risk Factors for Patellofemoral Joint Instability: An Infographic as a Visual Learning Tool. Pril (Makedon Akad Nauk Umet Odd Med Nauki) 2024; 45:67-70. [PMID: 39008645 DOI: 10.2478/prilozi-2024-0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/17/2024]
Abstract
Patellofemoral instability (PFI) is a common condition in children and adolescents, ranging from mild discomfort and mal-tracking to lateral patellar dislocation [1]. A number of anatomical risk factors have been described in the literature, such as trochlear dysplasia, patella alta, excessive tibial tuberosity to trochlear groove (TT-TG) distance, patellar tilt and soft tissue alterations [2]. Among them, TD has been identified as the main anatomical risk factor with the strongest association with PFI [1, 2]. In the study by Dejour et al. [2] radiographically observed TD was identified in 96% of patients with a history of patellofemoral dislocation [1, 2]. Patients with Dejour Type D dysplasia are characterized by a prominent and convex lateral facet with a vertical connection to a hypoplastic medial facet (Figure 1), which provides inadequate tracking of the patella in the trochlea during flexion leading to patella subluxation [2]. Non-operative treatment of lateral patellar dislocation presents a rate of re-dislocation up to 70% within 24 months of the first episode [3]. Sulcus deepening trochleoplasty is indicated for Type B and D dysplasia, in order to improve patella tracking, reduce the rate of re-dislocation and achieve good functional outcomes [2, 4]. Trochlea dysplasia is defined as a shallow or flattened groove with decreased resistance to lateral patellar translation. TD can be assessed on computed tomography (CT) and magnetic resonance imaging (MRI) with the use of overlapping axial images and are able to show perfectly the global shape of the femoral trochlea [2]. The thresholds for identifying trochlear dysplasia are established based on the sulcus angle ≥ 145°, medial/lateral trochlea facet asymmetry < 40%, trochlear depth < 3 mm and lateral trochlear inclination ≤ 11° and therefore it can be used in young adolescents [4, 5]. A deep knowledge of anatomic variations and abnormalities of the patellofemoral joint, which may predispose to PFI, is crucial in order to choose the appropriate treatment for each patient.
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Affiliation(s)
- Angelo V Vasiliadis
- 1Department of Orthopaedic Surgery, Sports Trauma Unit, St. Luke's Hospital, Panorama-Thessaloniki, Greece
- 2Department of Physical Education and Sports Sciences at Serres, Aristotle University of Thessaloniki, Greece
- 3Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, Greece
| | - Theodore Troupis
- 3Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, Greece
| | - Dimosthenis Chrysikos
- 3Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, Greece
| | - Dimitrios Chytas
- 4Department of Physiotherapy, University of Peloponnese, Sparta, Greece
| | - George Noussios
- 2Department of Physical Education and Sports Sciences at Serres, Aristotle University of Thessaloniki, Greece
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Eikani C, Knapik DM, Vadhera AS, Singh H, Polce E, Gursoy S, Yanke AB, Chahla J. No significant difference in thick versus thin osteochondral flap trochleoplasty in the treatment of trochlear dysplasia: A systematic review. Knee Surg Sports Traumatol Arthrosc 2024; 32:1168-1178. [PMID: 38494738 DOI: 10.1002/ksa.12108] [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: 01/10/2024] [Revised: 02/06/2024] [Accepted: 02/12/2024] [Indexed: 03/19/2024]
Abstract
PURPOSE Trochleoplasty has become increasingly utilised to address patellar instability in the setting of severe trochlear dysplasia. There remains a paucity of literature on the outcomes of 'thick'- versus 'thin'-osteochondral flap trochleoplasty. The purpose of this study is to compare clinical and radiographic outcomes between patients with patellar instability with symptomatic trochlear dysplasia treated using a 'thick' versus 'thin' osteochondral flap trochleoplasty. METHODS A systematic review and meta-analysis were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using a PRISMA checklist. Quality assessment of final articles was conducted by two blinded reviewers. Articles were separated based on the use of a 'thick' versus 'thin' flap trochleoplasty. Data collection consisted of recording the following variables: patient demographics, indications for trochleoplasty, mean follow-up time, additional procedures performed during trochleoplasty, patient-reported outcome measures (PROMs), radiographic outcomes (tibial tubercle-trochlear groove [TT-TG] distance, Caton-Deschamps Index [CDI] and sulcus angle [SA]) and the incidence of any postoperative complications and patellar redislocation rates. RESULTS A total of 24 studies, consisting of 927 patients, were identified as meeting inclusion criteria. A total of five papers described a 'thick' flap technique, while 19 papers described the use of a 'thin' flap technique. No significant difference in the mean improvement of Kujala scores was appreciated when comparing 'thick' versus 'thin' techniques (p > 0.05). Improvements in mean radiographic outcomes based on TT-TG, CDI and SA were observed in both 'thick' and 'thin' flap trochleoplasty groups. The overall redislocation rate was 0.35%. CONCLUSION No significant difference in Kujala scores was observed in patients undergoing trochleoplasty utilising 'thick' versus 'thin' technique, while improvements in mean TT-TG, CDI and SA were noted in both technique groups, with an overall redislocation rate of 0.35%. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Carlo Eikani
- Department of Orthopedic Surgery, Division of Sports Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Derrick M Knapik
- Department of Orthopedic Surgery, Division of Sports Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Amar S Vadhera
- Department of Orthopedic Surgery, Division of Sports Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Harsh Singh
- Department of Orthopedic Surgery, Division of Sports Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Evan Polce
- Department of Orthopedic Surgery, Division of Sports Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Safa Gursoy
- Department of Orthopedic Surgery, Division of Sports Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Adam B Yanke
- Department of Orthopedic Surgery, Division of Sports Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Jorge Chahla
- Department of Orthopedic Surgery, Division of Sports Medicine, Rush University Medical Center, Chicago, Illinois, USA
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Nguyen JC, Patel V, Kiani SN, Guzek R, Williams BA, Ganley TJ. Patellar osteochondritis dissecans: maturation-dependent patellofemoral joint characteristics. Pediatr Radiol 2024; 54:977-987. [PMID: 38573353 DOI: 10.1007/s00247-024-05914-8] [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] [Received: 11/26/2023] [Revised: 03/18/2024] [Accepted: 03/19/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND The likelihood of healing of osteochondritis dissecans decreases with skeletal maturity and there are theories that abnormal biomechanical forces contribute to the development and progression of these lesions. OBJECTIVE To characterize, according to regional skeletal maturity, the morphology and alignment indices of the patellofemoral joint on MRI in patients with patellar osteochondritis dissecans. MATERIALS AND METHODS MRI examinations of patients with patellar osteochondritis dissecans obtained between January 2008 and May 2023 were retrospectively reviewed to determine regional skeletal maturity, osteochondritis dissecans lesion size and location, patellar and trochlear morphology (Wiberg/Dejour classifications), and to calculate trochlear sulcus angles, trochlear depth index, lateral trochlear inclination, Insall-Salvati index, Caton-Deschamps index, patellar tendon-lateral trochlear ridge, and tibial tubercle-trochlear groove distances. Values were compared between skeletally immature and mature groups. RESULTS Sixty-eight children (22 girls, 46 boys, age: 14.0 ± 1.7 years) yielded 74 knees with patellar osteochondritis dissecans lesions, 14 (19%) of which were skeletally mature. The most common anatomic location was over the central patella [median ridge (34/74 - 46%) on the axial images and over the middle third (45/74 - 61%) on the sagittal images]. Overall, mean trochlear sulcus angle (high, 151 ± 11°), trochlear depth index (low, 2.8 ± 1.4 mm), and Insall-Salvati index (borderline, 1.3 ± 0.1) were abnormal for the entire sample. Skeletally mature knees were significantly more likely to have higher (more dysplastic) Dejour types when compared to skeletally immature knees (p < 0.01). Knees in the mature group, compared to immature, had significantly more abnormal mean lateral trochlear inclination (15 ± 8° vs. 19 ± 6°, p = 0.03) and patellar tendon-lateral trochlear ridge distance (5.55 ± 4.31 mm vs. 2.89 ± 4.69 mm, p = 0.04). Half of the knees had ≥ 4 abnormal features that predispose to patellofemoral maltracking; mature knees were significantly (p = 0.02) more likely to have a higher number of abnormal features (> 6 features, 7/14, 50.0%) versus immature knees (0-3 features, 33/60, 55.0%). CONCLUSION In children with patellar osteochondritis dissecans, abnormal patellofemoral morphology and alignment indices were common in all patients and more severe in mature knees.
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Affiliation(s)
- Jie C Nguyen
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
| | - Vandan Patel
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
- Department of Orthopedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Drexel University College of Medicine, Philadelphia, PA, USA
| | - Sara N Kiani
- Department of Orthopedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Ryan Guzek
- Department of Orthopedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Brendan A Williams
- Department of Orthopedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Theodore J Ganley
- Department of Orthopedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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Ayala SG, Thomas N, Rohde M, Gupta A, Sanchez M, Tompkins M, Parikh SN, Ellis HB, Green DW, Yen YM, Fabricant PD, Wilson P, Shea KG. Osseous and Cartilaginous Trochlear Development in the Pediatric Knee: A Cadaveric Computed Tomography Study. Orthop J Sports Med 2024; 12:23259671241249132. [PMID: 38751851 PMCID: PMC11095196 DOI: 10.1177/23259671241249132] [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: 10/28/2023] [Accepted: 11/13/2023] [Indexed: 05/18/2024] Open
Abstract
Background The anatomy of the trochlea plays a significant role in patellar stability. The developmental anatomy of the trochlea and its relationship to patellar stability remains poorly understood. Purpose To describe the developmental changes of the osseous and cartilaginous trochlear morphology in skeletally immature specimens. Study Design Descriptive laboratory study. Methods A total of 65 skeletally immature cadaveric knees between the ages of 2 months and 11 years were evaluated using computed tomography scans. The measurements in the axial plane of both cartilage and bone include medial, central, and lateral trochlear height; sulcus height; medial and later trochlear facet length; trochlear sulcus angle; patellar sulcus angle; condylar height asymmetry; and trochlear facet asymmetry. Additional measurements included trochlear depth and lateral trochlear inclination angle. In the sagittal plane, measurements included curvilinear trochlear length, direct trochlear length, condylar height, and patellar sulcus angle. Results Analysis of trochlear morphology using condylar height, condylar height asymmetry, and trochlear depth all increased with increasing age. The osseous and cartilaginous sulcus angles became deeper with age until age 8 and then plateaued. This corresponded with an increase in trochlear depth that also plateaued around age 8. Osseous condylar asymmetry increased with age but flipped from a larger medial condyle to a larger lateral condyle around age 8. The continued growth of the trochlea with age was further demonstrated in all measures in the sagittal view. Conclusion This cadaveric analysis demonstrated that there is an increase in condylar height as age increased by all measurements analyzed. These changes in condylar height continued to be seen through age 11, suggesting a still-developing trochlea past this age. By age 8, a plateau in sulcus angle, and sulcus depth suggests more proportionate growth after this point. Similar changes in trochlear and patellar shape with age suggests that the 2 structures may affect each other during development. Clinical Relevance This information can help design, develop, and determine timing of procedures that may alter the anatomy and stabilize the trochlear and patellofemoral joint.
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Affiliation(s)
- Salvador G. Ayala
- University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA
| | - Nicholas Thomas
- Florida State University College of Medicine, Pensacola, Florida, USA
| | - Matthew Rohde
- Stanford School of Medicine, Stanford, California, USA
| | - Anshal Gupta
- Stanford School of Medicine, Stanford, California, USA
| | - Mark Sanchez
- Stanford School of Medicine, Stanford, California, USA
| | - Marc Tompkins
- University of Minnesota, Minneapolis, Minnesota, USA
| | - Shital N. Parikh
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Henry B. Ellis
- Texas Scottish Rite Hospital for Children, Dallas, Texas, USA
| | | | - Yi-Meng Yen
- Boston Children’s Hospital, Boston, Massachusetts, USA
| | | | - Phil Wilson
- Texas Scottish Rite Hospital for Children, Dallas, Texas, USA
| | - Kevin G. Shea
- Stanford School of Medicine, Stanford, California, USA
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Ozawa J, Ikeda A, Kanehara M, Moriyama H, Kaneguchi A. Development of patellofemoral osteoarthritis with knee joint malalignment and lateral patellar dislocation after hindlimb suspension in growing rats. J Orthop Res 2024. [PMID: 38368533 DOI: 10.1002/jor.25812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 11/29/2023] [Accepted: 02/03/2024] [Indexed: 02/19/2024]
Abstract
Knee malalignment is a risk factor for patellar instability and patellofemoral osteoarthritis (PFOA), but etiologies remain unknown. We investigated the potential effects of decreased weight loading during growth on knee alignments and patellofemoral (PF) joint pathology. Hindlimb suspension (HS) was performed in 4-week-old female rats for 2, 4, and 8 weeks (HS groups). Age-matched rats were used as controls. Three-dimensional reconstructed images of the knee were obtained using X-ray computed tomography. Tibial tubercle-trochlear groove (TT-TG) distance, patellar tilt angle, and bisect offset were measured as indices of knee alignment. Histological analysis was also performed to evaluate the changes in cartilage and synovium in the PF joints. At Week 8, TT-TG distance, patella tilt angle, and bisect offset were significantly larger in the HS group than in the control group, respectively, indicating tibial external rotation, outward patellar tilt, and external displacement of the patella. Lateral patellar dislocation was frequently found in the HS group at Week 8 (five of eight knee joints, p < 0.05). Degenerative changes in the cartilage of the trochlear groove were observed at Week 8, and synovial changes such as hypertrophy and synovitis were observed at Weeks 4 and 8. Correlation analyses revealed significant relationships between the Mankin score and bisect offset, and between the OARSI synovitis score and all knee alignments indices. These results suggest that decreased weight loading on the lower extremities in growing rats resulted in knee malalignments characterized by external rotation of tibia and high incidence of lateral patellar dislocation with concomitant PFOA.
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Affiliation(s)
- Junya Ozawa
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Hiroshima, Japan
| | - Airi Ikeda
- Graduate School of Medical Technology and Health welfare Sciences, Hiroshima International University, Hiroshima, Japan
- Department of Judo therapy, Takarazuka University of Medical and Health Care, Takarazuka, Hyogo, Japan
| | - Marina Kanehara
- Graduate School of Medical Technology and Health welfare Sciences, Hiroshima International University, Hiroshima, Japan
| | - Hideki Moriyama
- Life and Medical Sciences Area, Health Sciences Discipline, Kobe University, Kobe, Hyogo, Japan
| | - Akinori Kaneguchi
- Department of Rehabilitation, Faculty of Rehabilitation, Hiroshima International University, Hiroshima, Japan
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Chen J, Li X, Feng Y, Li Q, Xu Z, Wang L, Zhang J, Quan Z, Zhou A. Lateral trochlear inclination measured by the transepicondylar axis holds potential for evaluating trochlear dysplasia in patients with lateral patellar dislocation. Knee Surg Sports Traumatol Arthrosc 2023; 31:5611-5620. [PMID: 37851025 DOI: 10.1007/s00167-023-07614-6] [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] [Received: 01/10/2023] [Accepted: 09/29/2023] [Indexed: 10/19/2023]
Abstract
PURPOSE To verify that lateral trochlear inclination (LTI) measured by the transepicondylar axis can reliably be used to evaluate trochlear dysplasia (TD) on MRI and can serve as an objective indication of trochleoplasty for patients with lateral patellar dislocation (LPD). METHODS Eighty patients with recurrent LPD and eighty healthy subjects were included. TD, posterior condylar angle (PCA), and LTI measured by the posterior condylar reference line (LTIp), surgical transepicondylar axis (LTIs), and anatomical transepicondylar axis (LTIa) were assessed on MRI. The intraclass correlation coefficient (ICC) and Bland-Altman analysis were performed, the correlations and differences amongst the parameters were identified, and a binary logistic regression model was established. RESULTS Each measurement had excellent inter- and intra-observer agreement. The LTIp, LTIs and LTIa were smaller in the study group than in the control group, with mean differences of 9.0°, 7.2° and 7.0°, respectively (P < 0.001). The PCA was larger in patients with LPD than in the control group (P < 0.001). LTIp was associated with PCA in the study group (r = - 0.41, P < 0.001). The pathological values of LTIp, LTIs and LTIa were 11.7°, 15.3° and 17.4°, respectively. LTIs and LTIa were independent risk factors for LPD, with ORs of 7.33 (95% CI [1.06-52.90], P = 0.048) and 10.29 (95% CI [1.38-76.96], P = 0.023), respectively. CONCLUSION The LTI can be reliably measured by MRI, but LTIp could potentially decrease the recorded value from the actual inclination angle. LTIs and LTIa are more appropriate to serve as trochleoplasty indications for patients with LPD, which could help orthopedists with surgical decision-making. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Jiaxing Chen
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
- Orthopedic Laboratory of Chongqing Medical University, Chongqing, 400016, China
| | - Xinyi Li
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Yi Feng
- Medical Education Department, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Qiaochu Li
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
- Orthopedic Laboratory of Chongqing Medical University, Chongqing, 400016, China
| | - Zijie Xu
- Department of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, 100191, China
| | - Linbang Wang
- Department of Orthopedics, Peking University Third Hospital, Beijing, 100191, China
| | - Jian Zhang
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
- Orthopedic Laboratory of Chongqing Medical University, Chongqing, 400016, China
| | - Zhengxue Quan
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
- Orthopedic Laboratory of Chongqing Medical University, Chongqing, 400016, China.
| | - Aiguo Zhou
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
- Orthopedic Laboratory of Chongqing Medical University, Chongqing, 400016, China.
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Pace JL, Drummond M, Brimacombe M, Cheng C, Chiu D, Luczak SB, Shroff JB, Zeng F, Kanski GM, Kakazu R, Cohen A. Unpacking the Tibial Tubercle-Trochlear Groove Distance: Evaluation of Rotational Factors, Trochlear Groove and Tibial Tubercle Position, and Role of Trochlear Dysplasia. Am J Sports Med 2023; 51:16-24. [PMID: 36300815 DOI: 10.1177/03635465221125780] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The tibial tubercle to trochlear groove (TT-TG) distance is often utilized for determining the surgical treatment for patients with patellar instability (PI). It is thought to directly represent the position of the TT on the tibia. Recent work has shown that the measurement of the TT-TG distance is multifactorial. PURPOSE To investigate the relationship between relative tibial external rotation (rTER) and trochlear dysplasia (TD), as well as the location of the TG and TT in patients with and without PI, and to correlate these and other anatomic measurements with the TT-TG distance. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS A total of 89 patients with PI who underwent magnetic resonance imaging were identified with 92 matched control patients. A standardized measurement protocol on axial magnetic resonance imaging determined rTER, the proximal and distal TG lateralization (pTGL and dTGL, respectively) ratios, and the TT lateralization (TTL) ratio. Other measures of interest included the lateral trochlear inclination angle, sulcus angle, and lateral patellar inclination angle. Univariate regression was used to determine the associations of TD (lateral trochlear inclination angle, sulcus angle) with rTER and the TG position, and multivariate regression was used to model associations among all the variables with the proximal and distal TT-TG distances. RESULTS rTER was significantly higher in the study group (P < .001), and univariate regression showed a significant association between dysplasia measures and rTER (P < .001). The pTGL ratio was lower in the study group (P = .025), but there was no difference in the dTGL ratio (P = .090) or the TTL ratio (P = .098) between the groups. There were no associations between dysplasia measures and the pTGL and dTGL ratios (P > .05). Multivariate regression showed that the proximal TT-TG distance is predicted by the sulcus angle, pTGL ratio, rTER, and TTL ratio (P < .05) and that the distal TT-TG distance is predicted by the lateral patellar inclination angle, dTGL ratio, sulcus angle, rTER, and TTL ratio (P < .05). CONCLUSION rTER had a significant association with TD. The position of the proximal TG was more medial in patients with PI. There was no significant difference in the TTL ratio between patients with and without PI. The TT-TG distance was associated with multiple anatomic measures and was not solely predicated on the position of the TT.
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Affiliation(s)
- J Lee Pace
- Children's Health Andrews Institute for Orthopaedics & Sports Medicine, Plano, Texas, USA
| | | | | | - Chris Cheng
- Department of Orthopedics, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - David Chiu
- University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - S Brandon Luczak
- Department of Orthopedics, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Jeffrey B Shroff
- Department of Orthopedics, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Francine Zeng
- University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Greg M Kanski
- Department of Orthopedics, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Rafael Kakazu
- Department of Orthopedics, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Andrew Cohen
- Connecticut Children's Medical Center, Hartford, Connecticut, USA
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Kaplan DJ, Mojica ES, Ortega PF, Triana J, Strauss EJ, Jazrawi LM, Gonzalez-Lomas G. Posterior tibial tubercle measured by the sagittal TT-TG distance correlates with increased risk for patellofemoral chondral lesions. Knee Surg Sports Traumatol Arthrosc 2022; 30:3733-3741. [PMID: 35513456 DOI: 10.1007/s00167-022-06988-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 04/11/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the variation in tibial tubercle sagittal alignment in patients with and without patellofemoral (PF) cartilage wear. METHODS This was a single-centre, retrospective review of patients that underwent a cartilage restoration procedure for isolated PF cartilage wear from 2014 to 2020. Patients were matched in a 1:2 ratio for age, sex and BMI to partial meniscectomy patients as controls. The sagittal TT-TG (sTT-TG) distance was measured on preoperative axial T2 magnetic resonance imaging (MRI) and was defined as the distance between a point at the nadir of the trochlear cartilage and the most anterior point of the tibial tubercle. RESULTS One hundred and forty patients (47 cartilage restoration, 94 meniscectomy) were included. Mean age, BMI, and height for the total cohort were 34.01 ± 8.7, 26.6 ± 6.4, and 173.0 ± 17.7 respectively, with 78 males (55%) and 63 females (45%). There were no significant differences between groups for age, BMI or sex (n.s). The cartilage restoration group (- 2.5 mm ± 5.9) was found to have a significantly more posterior (negative) sTT-TG compared to the meniscectomy group (1.72 mm ± 6.7) (p < 0.001). Interrater reliability was excellent (ICC = 0.931, p < 0.001). Patients with less than - 3.4 mm sTT-TG were 2.74 times more likely to have a cartilage restoration procedure compared to those with greater than - 3.4 mm (OR 2.7, 95% CI 1.3-5.85). Patients with < - 10 mm posterior translation were 13.7× (CI 1.6-111.1) more likely to have a cartilage restoration procedure. CONCLUSION Patients that underwent isolated cartilage restoration procedures had a significantly more posterior tibial tubercle than partial meniscectomy controls based on the sagittal TT-TG. The more posterior the tubercle, the more likely the patient had a cartilage restoration procedure. Surgeons should consider the sTT-TG measurement in patients presenting with anterior knee pain, particularly patellofemoral lesions. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Daniel J Kaplan
- Department of Orthopaedic Surgery, Division of Sports Medicine, New York University Langone Orthopaedic Hospital, 301 E 17th Street, New York, NY, 10003, USA.
| | - Edward S Mojica
- Department of Orthopaedic Surgery, Division of Sports Medicine, New York University Langone Orthopaedic Hospital, 301 E 17th Street, New York, NY, 10003, USA
| | - Paola F Ortega
- Department of Orthopaedic Surgery, Division of Sports Medicine, New York University Langone Orthopaedic Hospital, 301 E 17th Street, New York, NY, 10003, USA
| | - Jairo Triana
- Department of Orthopaedic Surgery, Division of Sports Medicine, New York University Langone Orthopaedic Hospital, 301 E 17th Street, New York, NY, 10003, USA
| | - Eric J Strauss
- Department of Orthopaedic Surgery, Division of Sports Medicine, New York University Langone Orthopaedic Hospital, 301 E 17th Street, New York, NY, 10003, USA
| | - Laith M Jazrawi
- Department of Orthopaedic Surgery, Division of Sports Medicine, New York University Langone Orthopaedic Hospital, 301 E 17th Street, New York, NY, 10003, USA
| | - Guillem Gonzalez-Lomas
- Department of Orthopaedic Surgery, Division of Sports Medicine, New York University Langone Orthopaedic Hospital, 301 E 17th Street, New York, NY, 10003, USA
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Waaler PAS, Jellestad T, Hysing-Dahl T, Elvehøy E, Inderhaug E. Insall proximal realignment with/without tibial tubercle osteotomy for recurrent patellar instability yields acceptable medium- to long-term results but risk of osteoarthritis progression is considerable. J Exp Orthop 2022; 9:64. [PMID: 35793010 PMCID: PMC9259772 DOI: 10.1186/s40634-022-00502-x] [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: 05/12/2022] [Accepted: 06/22/2022] [Indexed: 11/10/2022] Open
Abstract
PURPOSE The purpose of this study was to evaluate clinical and radiological results in patients operated for recurrent patellar instability with a surgical approach consisting of Insall proximal realignment with/without tibial tubercle osteotomy (TTO). METHODS Patients that underwent surgery for recurrent patellar instability at one centre with a uniform technique between 2004 and 2020 were included. Eligible patients were assessed by clinical examination and the disease-specific Banff Patellofemoral Instability Instrument 2.0 (BPII 2.0). Pre- and postoperative radiographs were analysed for patellofemoral osteoarthritis (OA) according to Iwano. Preoperative Magnetic Resonance Imaging (MRI) and radiographs were analysed for anatomical risk factors for patellar instability. Student t-test, chi-square test and ANOVA-analyses were used to investigate whether anatomical risk factors and/or patient characteristics could predict an inferior outcome. RESULTS Forty-six patients (47 knees) were included at a mean follow-up time of 6.6 years (SD 4.6; range 1-17). Mean BPII 2.0 score was 60.4 (SD 18.4; range 26-98), and 10.6% (n = 5) had suffered a postoperative redislocation. Progression to evident patellofemoral OA was seen in 15% of the patients (p < 0.05). The presence of pathoanatomic risk factors did not correlate with recurrent postoperative instability or inferior BPII 2.0 score at the final evaluation. CONCLUSION Patients treated with the current approach reported acceptable medium- to long-term results, but the risk of patellofemoral OA progression is significant. These findings add to the knowledge of expected outcomes after procedures involving Insall proximal realignment, and can guide clinical decision making for surgeons using similar methods. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Per Arne Skarstein Waaler
- Department of Orthopaedic Surgery, Førde Health Thrust, Førde Central Hospital, Svanehaugvegen 2, 6812, Førde, Norway.
| | - Truls Jellestad
- Department of Orthopaedic Surgery, Førde Health Thrust, Lærdal Hospital, Førde, Norway
| | - Trine Hysing-Dahl
- Department of Rehabilitation, Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Elise Elvehøy
- Department of Physiotherapy, Førde Health Thrust, Lærdal Hospital, Førde, Norway
| | - Eivind Inderhaug
- Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, Faculty of Medicine, University of Bergen, Bergen, Norway
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10
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Luczak SB, Cheng C, Hedgecock JP, Brimacombe M, Pace JL. Patellar Height Correlates Modestly With Trochlear Dysplasia: A Magnetic Resonance Imaging Analysis. Arthrosc Sports Med Rehabil 2022; 4:e1031-e1037. [PMID: 35747649 PMCID: PMC9210383 DOI: 10.1016/j.asmr.2022.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 02/16/2022] [Indexed: 11/07/2022] Open
Abstract
Purpose To evaluate whether there is a correlation between the position of the patella and trochlear morphology in patients with and without patellar instability using exclusively MRI measurements. Methods MRI scans of knees in patients with patellofemoral instability and knees of patients with an ACL (anterior cruciate ligament) tear as a control group were reviewed. Measurements of patellar position (Canton-Deschamps ratio, Patellar Trochlear Index, and lateral patellar inclination) and trochlear morphology (lateral trochlear inclination and sulcus angle) were obtained from each scan. Bivariate and multivariate analysis was performed to identify correlations between study group, demographics, and patellofemoral joint measurements. Results There were 70 knees in the patellofemoral instability group and 60 knees in the control group. Bivariate analysis showed a significant difference in all measurements between the patellar instability group and the control group. Multivariate analysis showed modest correlations between patellar position and trochlear morphology. The Caton-Deschamps (CD) ratio correlated with patellar trochlear index (P < .001) and lateral trochlear inclination (P < .001). The respective R-square goodness of fit was 41.1%. Patellar trochlear index correlated with CD ratio (P < .001), lateral trochlear inclination (P < .001), lateral patellar inclination (P < .001), and patellar instability group (P = .011). The R-sq goodness of fit was 37.3%. Lateral patellar inclination correlated with patellar trochlear index (P < .001), Lateral trochlear inclination (P < .001), and age at first dislocation or injury (P = .02). The R-sq goodness of fit was 68.56%. Conclusions Using MRI-based measurements of the patellofemoral joint, we identified modest, but significant, correlations between measures of patellar height (patellar trochlear index, CD ratio, and lateral patellar inclination) and trochlear dysplasia. This correlation is unclear and is likely multifactorial, but on the basis of this work, a causal relationship between trochlear dysplasia and patella alta cannot be established. Clinical Relevance Radiographic evaluation of the patella and how it relates to the surrounding boney anatomy provides important information regarding our understanding of patella instability and its treatment.
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11
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Ormeci T, Turkten I, Sakul BU. Radiological evaluation of patellofemoral instability and possible causes of assessment errors. World J Methodol 2022; 12:64-82. [PMID: 35433342 PMCID: PMC8984217 DOI: 10.5662/wjm.v12.i2.64] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 10/27/2021] [Accepted: 02/10/2022] [Indexed: 02/06/2023] Open
Abstract
Patellofemoral instability (PI) is the disruption of the patella’s relationship with the trochlear groove as a result of abnormal movement of the patella. To identify the presence of PI, conventional radiographs (anteroposterior, lateral, and axial or skyline views), magnetic resonance imaging, and computed tomography are used. In this study, we examined four main instability factors: Trochlear dysplasia, patella alta, tibial tuberosity–trochlear groove distance, and patellar tilt. We also briefly review some of the other assessment methods used in the quantitative and qualitative assessment of the patellofemoral joint, such as patellar size and shape, lateral trochlear inclination, trochlear depth, trochlear angle, and sulcus angle, in cases of PI. In addition, we reviewed the evaluation of coronal alignment, femoral anteversion, and tibial torsion. Possible causes of error that can be made when evaluating these factors are examined. PI is a multi-factorial problem. Many problems affecting bone structure and muscles morphologically and functionally can cause this condition. It is necessary to understand normal anatomy and biomechanics to make more accurate radiological measurements and to identify causes. Knowing the possible causes of measurement errors that may occur during radiological measurements and avoiding these pitfalls can provide a more reliable road map for treatment. This determines whether the disease will be treated medically and with rehabilitation or surgery without causing further complications.
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Affiliation(s)
- Tugrul Ormeci
- Department of Radiology, School of Medicine, İstanbul Medipol University, Istanbul 34200, Turkey
| | - Ismail Turkten
- Department of Anatomy, School of Medicine, İstanbul Medipol University, Istanbul 34820, Beykoz, Turkey
| | - Bayram Ufuk Sakul
- Department of Anatomy, School of Medicine, İstanbul Medipol University, Istanbul 34820, Beykoz, Turkey
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12
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Su Q, Zhang Y, Zhang Y, Li J, Xue C, Ge H, Cheng B. Multivariate Analysis of Associations between Patellofemoral Instability and Gluteal Muscle Contracture: A Radiological Analysis. J Pers Med 2022; 12:jpm12020242. [PMID: 35207730 PMCID: PMC8877690 DOI: 10.3390/jpm12020242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/18/2022] [Accepted: 01/27/2022] [Indexed: 02/01/2023] Open
Abstract
The purpose of this study was to investigate the associations between gluteal muscle contracture (GMC) severity and patellofemoral instability and evaluate the reliability of novel indicators by multivariate analysis. Clinical and imaging data from 115 patients with GMC were collected for retrospective analysis. Two novel indicators were used to evaluate GMC severity (knee flexion angle and hip flexion angle, feet distance), and two additional novel parameters were used to reflect patellofemoral instability [patellar displacement vector (L, α), patella-femoral trochlear (P-FT) area, and femoral-trochlear-patella (FT-P) area]. In this study, patients with moderate contracture were dominant, and 35.65% also experienced anterior knee pain after physical activity. Ordered logistic regression analysis indicated that a more serious GMC represented a higher risk of lateral tilt and lateral displacement of the patella. Multivariate analysis showed that feet distance was a reliable indicator for evaluating the severity of GMC. The results showed that the more serious the GMC, the more significant the difference between the P-FT area and the FT-P area of the patellofemoral joint space. L, patellar tilt angle, patellar congruency angle, and lateral patellofemoral angle were independent risk factors for this difference. A more serious GMC represents a higher risk of patellar subluxation.
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Affiliation(s)
- Qihang Su
- Department of Orthopedics, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, No.301 Yanchang Middle Road, Shanghai 200072, China; (Q.S.); (Y.Z.); (Y.Z.); (C.X.); (H.G.)
| | - Yi Zhang
- Department of Orthopedics, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, No.301 Yanchang Middle Road, Shanghai 200072, China; (Q.S.); (Y.Z.); (Y.Z.); (C.X.); (H.G.)
| | - Yuanzhen Zhang
- Department of Orthopedics, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, No.301 Yanchang Middle Road, Shanghai 200072, China; (Q.S.); (Y.Z.); (Y.Z.); (C.X.); (H.G.)
| | - Jie Li
- Department of Orthopedics, Zhabei Central Hospital, No.619 Zhong Hua Xin Road, Jingan District, Shanghai 200070, China;
| | - Chao Xue
- Department of Orthopedics, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, No.301 Yanchang Middle Road, Shanghai 200072, China; (Q.S.); (Y.Z.); (Y.Z.); (C.X.); (H.G.)
| | - Hengan Ge
- Department of Orthopedics, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, No.301 Yanchang Middle Road, Shanghai 200072, China; (Q.S.); (Y.Z.); (Y.Z.); (C.X.); (H.G.)
| | - Biao Cheng
- Department of Orthopedics, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, No.301 Yanchang Middle Road, Shanghai 200072, China; (Q.S.); (Y.Z.); (Y.Z.); (C.X.); (H.G.)
- Correspondence: ; Tel.: +86-13681973702
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13
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Fuchs A, Feucht MJ, Dickschas J, Frings J, Siegel M, Yilmaz T, Schmal H, Izadpanah K. Interobserver reliability is higher for assessments with 3D software-generated models than with conventional MRI images in the classification of trochlear dysplasia. Knee Surg Sports Traumatol Arthrosc 2022; 30:1654-1660. [PMID: 34423397 PMCID: PMC9033701 DOI: 10.1007/s00167-021-06697-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 08/10/2021] [Indexed: 11/11/2022]
Abstract
PURPOSE Trochlear dysplasia is a significant risk factor for patellofemoral instability. The severity of trochlear dysplasia is commonly evaluated based on the Dejour classification in axial MRI slices. However, this often leads to heterogeneous assessments. A software to generate MRI-based 3D models of the knee was developed to ensure more standardized visualization of knee structures. The purpose of this study was to assess the intra- and interobserver agreements of 2D axial MRI slices and an MRI-based 3D software generated model in classification of trochlear dysplasia as described by Dejour. METHODS Four investigators independently assessed 38 axial MRI scans for trochlear dysplasia. Analysis was made according to Dejour's 4 grade classification as well as differentiating between 2 grades: low-grade (types A + B) and high-grade trochlear dysplasia (types C + D). Assessments were repeated following a one-week interval. The inter- and intraobserver agreement was determined using Cohen's kappa (κ) and Fleiss kappa statistic (κ). In addition, the proportion of observed agreement (po) was calculated for assessment of intraobserver agreement. RESULTS The assessment of the intraobserver reliability with regard to the Dejour-classification showed moderate agreement values both in the 2D (κ = 0.59 ± 0.08 SD) and in the 3D analysis (κ = 0.57 ± 0.08 SD). Considering the 2-grade classification, the 2D (κ = 0.62 ± 0.12 SD) and 3D analysis (κ = 0.61 ± 0.19 SD) each showed good intraobserver matches. The analysis of the interobserver reliability also showed moderate agreement values with differences in the subgroups (2D vs. 3D). The 2D evaluation showed correspondences of κ = 0.48 (Dejour) and κ = 0.46 (high / low). In the assessment based on the 3D models, correspondence values of κ = 0.53 (Dejour) and κ = 0.59 (high / low) were documented. CONCLUSION Overall, moderate-to-good agreement values were found in all groups. The analysis of the intraobserver reliability showed no relevant differences between 2 and 3D representation, but better agreement values were found in the 2-degree classification. In the analysis of interobserver reliability, better agreement values were found in the 3D compared to the 2D representation. The clinical relevance of this study lies in the superiority of the 3D representation in the assessment of trochlear dysplasia, which is relevant for future analytical procedures as well as surgical planning. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Andreas Fuchs
- Department of Orthopedic Surgery and Traumatology, Freiburg University Hospital, Albert Ludwigs University Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany.
| | - Matthias J. Feucht
- Orthopädische Klinik Paulinenhilfe, Diakonieklinikum Stuttgart, Rosenbergstr. 38, 70176 Stuttgart, Germany
| | - Jörg Dickschas
- grid.7708.80000 0000 9428 7911Klinik Für Orthopädie Und Unfallchirurgie, Klinikum Bamberg, Buger Strasse 80, 96049 Bamberg, Germany
| | - Jannik Frings
- grid.13648.380000 0001 2180 3484Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany
| | - Markus Siegel
- grid.7708.80000 0000 9428 7911Department of Orthopedic Surgery and Traumatology, Freiburg University Hospital, Albert Ludwigs University Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany
| | - Tayfun Yilmaz
- grid.7708.80000 0000 9428 7911Department of Orthopedic Surgery and Traumatology, Freiburg University Hospital, Albert Ludwigs University Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany
| | - Hagen Schmal
- grid.7708.80000 0000 9428 7911Department of Orthopedic Surgery and Traumatology, Freiburg University Hospital, Albert Ludwigs University Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany
| | - Kaywan Izadpanah
- grid.7708.80000 0000 9428 7911Department of Orthopedic Surgery and Traumatology, Freiburg University Hospital, Albert Ludwigs University Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany
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14
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Fones L, Jimenez AE, Cheng C, Chevalier N, Brimacombe MB, Cohen A, Pace JL. Trochlear Dysplasia as Shown by Increased Sulcus Angle Is Associated With Osteochondral Damage in Patients With Patellar Instability. Arthroscopy 2021; 37:3469-3476. [PMID: 33964393 DOI: 10.1016/j.arthro.2021.04.054] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 04/14/2021] [Accepted: 04/23/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The primary study objective was to describe the incidence of osteochondral damage (OD) in our cohort of patients with patellar instability (PI). The secondary objective was to assess for associations between patient demographic characteristics, duration of PI, and quantitative radiographic measurements of anatomic risk factors for PI and OD in this cohort. METHODS A retrospective chart review identified patients treated for PI at a tertiary referral center between 2013 and 2018. Patients were evaluated for osteochondral injury with either magnetic resonance imaging if treated nonoperatively or operative reports if treated surgically. The Caton-Deschamps ratio, proximal tibial tubercle-to-trochlear groove (pTT-TG) distance, distal tibial tubercle-to-trochlear groove (dTT-TG) distance, lateral trochlear inclination (LTI) angle, lateral patellar inclination (LPI) angle, and sulcus angle were calculated from magnetic resonance imaging scans. Trochlear dysplasia is an important risk factor for PI that can be reliability quantified by the pTT-TG distance, dTT-TG distance, LTI angle, sulcus angle, and LPI angle. Demographic data including age at first instability event, sex, body mass index, symptom duration, and number of dislocations were documented. RESULTS A total of 125 knees in 118 patients (average age, 13.9 ± 3.4 years; 48% female patients) with PI were identified. Within this cohort, 67% were treated surgically and 53% had OD. No association was identified between osteochondral injury and age, sex, body mass index, symptom duration, LTI angle, LPI angle, dTT-TG distance, pTT-TG distance, or number of dislocations. An increased sulcus angle (more dysplasia) showed a statistically significant association with osteochondral pathology (P = .021), and higher sulcus angles were statistically significantly associated with acute osteochondral fracture compared with chondral injury (P = .001). CONCLUSIONS Using quantitative analysis of trochlear dysplasia, this study identified a significant association between trochlear dysplasia (sulcus angle) and the incidence of OD in our cohort of patients with PI. The frequency of dislocation or subluxation and patient demographic characteristics were not significantly associated with OD. LEVEL OF EVIDENCE Level III, retrospective prognostic study.
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Affiliation(s)
- Lilah Fones
- University of Connecticut School of Medicine, Farmington, Connecticut, U.S.A
| | - Andrew E Jimenez
- Department of Orthopedic Surgery, University of Connecticut School of Medicine, Farmington, Connecticut, U.S.A..
| | - Chris Cheng
- University of Connecticut School of Medicine, Farmington, Connecticut, U.S.A
| | - Nicole Chevalier
- Elite Sports Medicine, Connecticut Children's Medical Center, Farmington, Connecticut, U.S.A
| | - Michael B Brimacombe
- Department of Research, Connecticut Children's Medical Center, Hartford, Connecticut, U.S.A
| | - Andrew Cohen
- Elite Sports Medicine, Connecticut Children's Medical Center, Farmington, Connecticut, U.S.A
| | - J Lee Pace
- Department of Orthopedic Surgery, University of Connecticut School of Medicine, Farmington, Connecticut, U.S.A.; Elite Sports Medicine, Connecticut Children's Medical Center, Farmington, Connecticut, U.S.A
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15
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Martinez-Cano JP, Chica J, Martinez-Arboleda JJ, Rincón-Escobar E, Zamudio-Castilla L, Renjifo M, Martinez-Rondanelli A. Patellofemoral Dislocation Recurrence After a First Episode: A Case-Control Study. Orthop J Sports Med 2021; 9:2325967120981636. [PMID: 33614800 PMCID: PMC7869156 DOI: 10.1177/2325967120981636] [Citation(s) in RCA: 3] [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: 10/08/2020] [Accepted: 11/19/2020] [Indexed: 01/17/2023] Open
Abstract
Background: Lateral patellar dislocation can become a recurrent problem after the first
episode. Identifying those patients who are at increased risk of
redislocation is important for the treatment decision-making process. Purpose: To identify clinical and radiologic risk factors for recurrence of patellar
dislocation after a first episode. Study Design: Case-control study; Level of evidence, 3. Methods: The study included patients with lateral patellar dislocation and a 1-year
minimum follow-up who were seen between 2011 and 2018. Patients aged 10 to
65 years were included. Patient characteristics, physical examination
(patellar apprehension, J sign), and radiographs were reviewed. The
Caton-Deschamps and Insall-Salvati ratios were used to evaluate patella
alta. High-grade trochlear dysplasia was defined as Dejour types B, C, and
D. Results: A total of 130 patients (139 knees) with primary lateral patellar dislocation
were included. Recurrent dislocation was seen in 83 knees (59.71%). Stepwise
logistic regression analysis demonstrated that Caton-Deschamps ratio ≥1.15
(OR, 2.39; 95% CI, 1.09-5.22; P = .029), age <21 years
(OR, 2.53; 95% CI, 1.11-5.77; P = .027), and high-grade
trochlear dysplasia (OR, 4.17; 95% CI, 1.90-9.17; P <
.001) were significantly associated with patellar redislocation. Based on
the presence of these factors, the probability of dislocation after a first
lateral patellar dislocation was 31.2% with no factors present, 36.6% with
any 1 factor present, 71.7% with any 2 factors present, and 86.2% if all 3
conditions were present. Conclusion: The results of this study indicated that patella alta, high-grade trochlear
dysplasia, and age <21 years were independent risk factors for patellar
redislocation after a first episode, with an additive effect when they were
present together. This may help to guide the type of treatment for these
patients.
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