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Martinique VB, Alessandra C, Sylvain G, Sally L, Ahmad F, Jean-Noel A, Matthieu O. Prevalence of trochlear dysplasia in an 1162 retrospective cohort study using CT scans. BMC Musculoskelet Disord 2024; 25:555. [PMID: 39020350 PMCID: PMC11253468 DOI: 10.1186/s12891-024-07579-8] [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: 01/11/2024] [Accepted: 06/10/2024] [Indexed: 07/19/2024] Open
Abstract
HYPOTHESIS/PURPOSE The prevalence of trochlear dysplasia is common in different populations. BACKGROUND The prevalence of trochlear dysplasia in the general population, categorised by sex, race, age, and body mass index, has been sparse. This study aimed to define the prevalence of trochlear dysplasia based on the latter categories. STUDY DESIGN Cohort retrospective study. METHODS 1162 skeletal mature healthy femora were obtained from a CT-scan-based modelling system (SOMA). Thin slice CT scans were acquired exclusively for medical indications such as polytrauma (20%), CT angiography (70%) and other reasons (i.e. Total Joint Replacement) (10%). Trochlear dysplasia was measured using Pfirmann's method. Patient demographics such as age, race and sex were recorded. RESULTS The overall prevalence of trochlear dysplasia is 4.5% and is far more common in Asian female patients compared to Caucasian, African and Middle Eastern knees. CONCLUSION Overall, the prevalence of dysplasia in the general population was determined to be 4.5%, with female patients being more likely to suffer from the condition. Patients of Asian and Caucasian race were more likely to have trochlear dysplasia, while Middle Eastern male patients displayed more dysplastic values than their female counterparts.
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Affiliation(s)
- Vella-Baldacchino Martinique
- Department of Surgery & Cancer, MSk Lab - Imperial College London, Sir Michael Uren Hub, 86 Wood Ln, London, W12 0BZ, UK.
- AP-HM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopedics and Traumatology, Aix-Marseille University, CNRS, ISM, Marseille, France.
- Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St. Marguerite Hospital, 270, boulevard Sainte-Marguerite, BP 29, Marseille, 13274, France.
| | - Cipolla Alessandra
- AP-HM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopedics and Traumatology, Aix-Marseille University, CNRS, ISM, Marseille, France
- Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St. Marguerite Hospital, 270, boulevard Sainte-Marguerite, BP 29, Marseille, 13274, France
- University of Turin, CTO Hospital (C.T.O. Centro Traumatologico Ortopedico), Via Gianfranco Zuretti, 29, Torino, 10126, TO, Italy
| | - Guy Sylvain
- AP-HM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopedics and Traumatology, Aix-Marseille University, CNRS, ISM, Marseille, France
- Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St. Marguerite Hospital, 270, boulevard Sainte-Marguerite, BP 29, Marseille, 13274, France
| | | | | | - Argenson Jean-Noel
- AP-HM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopedics and Traumatology, Aix-Marseille University, CNRS, ISM, Marseille, France
- Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St. Marguerite Hospital, 270, boulevard Sainte-Marguerite, BP 29, Marseille, 13274, France
| | - Ollivier Matthieu
- AP-HM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopedics and Traumatology, Aix-Marseille University, CNRS, ISM, Marseille, France
- Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St. Marguerite Hospital, 270, boulevard Sainte-Marguerite, BP 29, Marseille, 13274, France
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Baumann-Jungmann PM, Giesler P, Schneider J, Jung M, Karampinos DC, Weidlich D, Gersing AS, Baumann FA, Imhoff AB, Woertler K, Bamberg F, Holwein C. MR imaging after patellar MACI and MPFL reconstruction: a comparison of isolated versus combined procedures. Skeletal Radiol 2024; 53:1319-1332. [PMID: 38240761 DOI: 10.1007/s00256-024-04582-x] [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: 10/18/2023] [Revised: 01/05/2024] [Accepted: 01/07/2024] [Indexed: 05/15/2024]
Abstract
OBJECTIVE To qualitatively and quantitatively evaluate the 2.5-year MRI outcome after Matrix-associated autologous chondrocyte implantation (MACI) at the patella, reconstruction of the medial patellofemoral ligament (MPFL), and combined procedures. METHODS In 66 consecutive patients (age 22.8 ± 6.4years) with MACI at the patella (n = 16), MPFL reconstruction (MPFL; n = 31), or combined procedures (n = 19) 3T MRI was performed 2.5 years after surgery. For morphological MRI evaluation WORMS and MOCART scores were obtained. In addition quantitative cartilage T2 and T1rho relaxation times were acquired. Several clinical scores were obtained. Statistical analyses included descriptive statistics, Mann-Whitney-U-tests and Pearson correlations. RESULTS WORMS scores at follow-up (FU) were significantly worse after combined procedures (8.7 ± 4.9) than after isolated MACI (4.3 ± 3.6, P = 0.005) and after isolated MPFL reconstruction (5.3 ± 5.7, P = 0.004). Bone marrow edema at the patella in the combined group was the only (non-significantly) worsening WORMS parameter from pre- to postoperatively. MOCART scores were significantly worse in the combined group than in the isolated MACI group (57 ± 3 vs 88 ± 9, P < 0.001). Perfect defect filling was achieved in 26% and 69% of cases in the combined and MACI group, respectively (P = 0.031). Global and patellar T2 values were higher in the combined group (Global T2: 34.0 ± 2.8ms) and MACI group (35.5 ± 3.1ms) as compared to the MPFL group (31.1 ± 3.2ms, P < 0.05). T2 values correlated significantly with clinical scores (P < 0.005). Clinical Cincinnati scores were significantly worse in the combined group (P < 0.05). CONCLUSION After combined surgery with patellar MACI and MPFL reconstruction inferior MRI outcomes were observed than after isolated procedures. Therefore, patients with need for combined surgery may be at particular risk for osteoarthritis.
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Affiliation(s)
- Pia M Baumann-Jungmann
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany.
- Department of Radiology, Kantonsspital Graubünden, Chur, Switzerland.
| | - Paula Giesler
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany
| | - Julia Schneider
- Department of Orthopaedic Sports Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Matthias Jung
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany
| | - Dimitrios C Karampinos
- Department of Radiology, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Dominik Weidlich
- Department of Radiology, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Alexandra S Gersing
- Department of Radiology, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
- Department of Neuroradiology, University Hospital, LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Frederic A Baumann
- Department of Vascular Medicine, Hospital of Schiers, Schiers, Switzerland
| | - Andreas B Imhoff
- Department of Orthopaedic Sports Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Klaus Woertler
- Department of Radiology, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany
| | - Christian Holwein
- Department of Orthopaedic Sports Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
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Carretero JM, Rodríguez L, García-González R, Arsuaga JL. Main morphological characteristics and sexual dimorphism of hominin adult femora from the Sima de los Huesos Middle Pleistocene site (Sierra de Atapuerca, Spain). Anat Rec (Hoboken) 2024; 307:2575-2605. [PMID: 37794824 DOI: 10.1002/ar.25331] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 08/28/2023] [Accepted: 08/28/2023] [Indexed: 10/06/2023]
Abstract
The excellent fossil record from Sima de los Huesos (SH) includes three well-known complete adult femora and several partial specimens that have not yet been published in detail. This fossil record provides an opportunity to analyze the morphology of European pre-Neandertal adult femur and its variation with different evolution patterns. Currently, there are a minimum of five adult individuals (males or females). In this study, we compiled previously published basic anatomical and biometric characteristics of SH adult femora, emphasizing the most relevant features compared to other recent and fossil hominins. The SH femora exhibited a primitive morphological pattern common to all non-Homo sapiens femora, as well as most of the Neandertal traits. Therefore, the complete Upper Pleistocene Neandertal pattern was well-established in Middle Pleistocene ancestors long before the proper Neandertals appeared. Additionally, we highlight that the SH and Neandertal femora share some morphological traits and proportions with modern humans that hold sexual significance in our species, regardless of size. Keeping this in mind, we discussed the sex determination of the complete SH specimens and re-evaluated sex allocation in two of them.
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Affiliation(s)
- José-Miguel Carretero
- Dpto. de Ciencias Históricas y Geografía, Laboratorio de Evolución Humana, Universidad de Burgos, Burgos, Spain
- Unidad Asociada de I+D+i al CSIC, Vidrio y Materiales del Patrimonio Cultural (VIMPAC), Burgos, Spain
| | - Laura Rodríguez
- Dpto. de Ciencias Históricas y Geografía, Laboratorio de Evolución Humana, Universidad de Burgos, Burgos, Spain
- Area de Antropología Física, Departamento de Biodiversidad y Gestión Ambiental, Universidad de León, León, Spain
| | - Rebeca García-González
- Dpto. de Ciencias Históricas y Geografía, Laboratorio de Evolución Humana, Universidad de Burgos, Burgos, Spain
| | - Juan-Luis Arsuaga
- Centro UCM-ISCIII de Investigación sobre Evolución y Comportamiento Humanos, Madrid, Spain
- Facultad de Ciencias Geológicas, Departamento de Paleontología, Universidad Complutense de Madrid, Madrid, Spain
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Lee JY, Kim SE, Kwon OH, Kim Y, Son TG, Han HS, Ro DH. Shallow trochlear groove and narrow medial trochlear width at the proximal trochlea in patients with trochlear dysplasia: A three-dimensional computed tomography analysis. Knee Surg Sports Traumatol Arthrosc 2024; 32:1434-1445. [PMID: 38563648 DOI: 10.1002/ksa.12166] [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: 10/23/2023] [Revised: 03/05/2024] [Accepted: 03/10/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE Although the Dejour classification is the primary classification system for evaluating trochlear dysplasia, concerns have been raised about its reliability owing to its qualitative criteria and challenges associated with obtaining accurate radiographs. This study aimed to quantify trochlear dysplasia using three-dimensional (3D) computed tomography (CT) reconstruction with novel parameters related to the transepicondylar axis (TEA). METHODS Sixty patients were enrolled, including 20 with trochlear dysplasia and 40 healthy controls. The 3D CT model was generated using the Materialise Interactive Medical Image Control System software. The following six parameters were measured in eight consecutive planes at 15° intervals (planes 0-105): the distance from the TEA to the most cortical point of the lateral condyle ('LP-TEA', where LP stands for lateral peak), medial condyle ('MP-TEA', MP for medial peak) and deepest point of the trochlea ('TG-TEA', TG for trochlear groove). The distances from the medial epicondyle (MEC) to the corresponding TEA points were measured ('LP-MEC', 'MP-MEC' and 'TG-MEC'). RESULTS In the dysplasia group, TG-TEA (planes 0, 15 and 30) and MP-MEC (planes 0, 15 and 30) were significantly greater than those in the control group (all p < 0.05 for planes of TG-TEA and MP-MEC). For type A dysplasia, LP-MEC (plane 0) was greater than that in the control group. For type B dysplasia, the MP-MEC (planes 0 and 15) and TG-TEA (planes 0 and 15) were greater than those of the control group. For type D dysplasia, MP-MEC (planes 0, 15 and 30) and TG-TEA (planes 0 and 15) were elevated. CONCLUSION The 3D CT reconstruction analysis established a reproducible method for quantifying osseous trochlear morphology. Patients with trochlear dysplasia had a shallow TG and narrow medial trochlear width at tracking angles of 0°-30°. This finding corroborates the clinical manifestations of recurrent patellar instability that occur during early flexion. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Joon Young Lee
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sung Eun Kim
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Oh Hyo Kwon
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | | | | | - Hyuk-Soo Han
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Du Hyun Ro
- Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Republic of Korea
- CONNECTEVE Co., Ltd, Seoul, Republic of Korea
- Innovative Medical Technology Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
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Snow M, Singh N, Rix L, Haikal M. No Correlation Exists Between Tibial- and Femoral-Based Measurements of Patella Alta in a Population With Chronic Patellofemoral Pain or Instability Undergoing Patella Distalization. Arthroscopy 2024:S0749-8063(24)00092-6. [PMID: 38340969 DOI: 10.1016/j.arthro.2024.01.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 01/23/2024] [Accepted: 01/28/2024] [Indexed: 02/12/2024]
Abstract
PURPOSE To investigate whether the patellotrochlear index (PTI) predicts patella alta as determined by tibial-based methods of Insall-Salvati (IS) and Caton-Deschamp (CDI) indexes in a pathological population (with patellofemoral pain and/or instability), in addition to determining whether PTI and sagittal patellofemoral engagement (SPE) correlate with trochlea length as determined by lateral condyle index (LCI). METHODS Patients with confirmed patella alta (IS/CDI ratio >1.2) undergoing tibial tubercle osteotomy for patellofemoral pain/instability with an available magnetic resonance imaging (MRI) scans were included. Patients who had undergone previous soft-tissue realignment, previous surgery, or trauma to the extensor mechanism were excluded. Two raters measured the IS, CDI, PTI, SPE, LCI, and knee flexion angle (KFA) on MRI. Interobserver reliability and correlation between measurements were calculated. RESULTS In total, 71 knees were included. PTI (0.73), SPE (0.836), LCI (0.701), and KFA (0.8) demonstrated good- to near-excellent interobserver reliability. IS (0.65) and CDI (0.66) demonstrated moderate interobserver reliability. PTI and SPE showed the strongest significant correlation (0.8112, P = 2.2 × 10-16). IS and CD (0.39, P = .0007) showed a moderate significant correlation. PTI and KFA (0.53, P = 1.685 × 10-6) and SPE and KFA (0.61, P = 1.991 × 10-8) had a significant moderate correlation. LCI and KFA (-0.37, P = .0017) showed a significant moderate negative correlation. All other measurement indices correlated poorly and were insignificant. A total of 94.4% of the knees were defined as having patella alta using IS, with the remaining 5.6% having a raised CDI. Only 14% of cases had an IS of >1.2, a CDI >1.2, and a PTI <0.125, which increased to 39% (28/71) when the threshold for PTI was increased to <0.28. CONCLUSIONS There was no correlation between tibial (IS and CD) and femoral methods (PTI and SPE) of quantifying patella alta. PTI and SPE did not correlate with trochlea length as measured by LCI. PTI, SPE, and LCI are significantly affected by the KFA during MRI. LEVEL OF EVIDENCE Level IV, retrospective diagnostic radiographic investigation.
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Affiliation(s)
- Martyn Snow
- The Royal Orthopaedic Hospital, Birmingham, United Kingdom; Robert Jones and Agnes Hunt Orthopaedic Hospital Foundation Trust, Oswestry, United Kingdom; Centre for Regenerative Medicine Research, Keele University, Staffordshire, United Kingdom
| | - Nishant Singh
- Robert Jones and Agnes Hunt Orthopaedic Hospital Foundation Trust, Oswestry, United Kingdom
| | - Larissa Rix
- Robert Jones and Agnes Hunt Orthopaedic Hospital Foundation Trust, Oswestry, United Kingdom; Centre for Regenerative Medicine Research, Keele University, Staffordshire, United Kingdom
| | - Mohammad Haikal
- The Royal Orthopaedic Hospital, Birmingham, United Kingdom; Tanta University, Tanta, Egypt.
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Jacob S, Mahalingam H. Medial condyle hypoplasia in adolescent and young adult patients with trochlear dysplasia: a retrospective study. Radiol Bras 2023; 56:321-326. [PMID: 38504818 PMCID: PMC10948159 DOI: 10.1590/0100-3984.2023.0051] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 09/13/2023] [Accepted: 10/15/2023] [Indexed: 03/21/2024] Open
Abstract
Objective To determine the association between medial femoral condyle hypoplasia and trochlear dysplasia by analyzing the knee magnetic resonance imaging scans of young patients with or without trochlear dysplasia. Materials and Methods This was a retrospective analysis of magnetic resonance imaging scans of the knees of young individuals (16-35 years of age): 30 patients with trochlear dysplasia and 30 individuals with no signs of patellofemoral instability. The ratios between the depth, width, and height of the medial and lateral femoral condyles (dLC/dMC, wLC/wMC, and hLC/hMC, respectively) were calculated, as was the ratio between the width of the medial condyle and the total width of the femur (wMC/FW). All of the values were determined in consensus by two radiologists. Results We evaluated 60 patients: 30 with trochlear dysplasia and 30 without. The mean dLC/dMC, wLC/wMC, and hLC/hMC ratios were higher in the patients than in the controls (p < 0.05), whereas the mean wMC/FW ratio was lower in the patients (p < 0.05). The optimal cutoff values, obtained by calculating the areas under the receiver operating characteristic curves, were 1.0465 for the dLC/dMC ratio (76% sensitivity and 63.3% specificity), 0.958 for the wLC/wMC ratio (80% sensitivity and 73.3% specificity), and 1.080 for the hLC/hMC ratio (93.3% sensitivity and 93.3% specificity). Conclusion Our findings confirm our hypothesis that trochlear dysplasia is associated with medial condyle hypoplasia.
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Affiliation(s)
- Sruthi Jacob
- Department of Radiodiagnosis, Sri Ramachandra Institute of Higher Education and
Research, Chennai, Tamil Nadu, India
| | - Harshavardhan Mahalingam
- Department of Radiodiagnosis, Sri Ramachandra Institute of Higher Education and
Research, Chennai, Tamil Nadu, India
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Samelis PV, Koulouvaris P, Savvidou O, Mavrogenis A, Samelis VP, Papagelopoulos PJ. Patellar Dislocation: Workup and Decision-Making. Cureus 2023; 15:e46743. [PMID: 38021800 PMCID: PMC10631568 DOI: 10.7759/cureus.46743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2023] [Indexed: 12/01/2023] Open
Abstract
Acute patellar dislocation (PD) is usually a problem of adolescents and young adults. In most cases, it is a sports-related injury. It is the result of an indirect force on the knee joint, which leads to valgus and external rotation of the tibia relative to the femur. PD is unlikely to occur on a knee with normal patellofemoral joint (PFJ) anatomy. Acute PD consists of an acute injury of the ligamentous medial patellar stabilizers in the background of factors predisposing to patellar instability. These factors are classified into three groups. The first group refers to the integrity of the ligamentous medial patellar restraints, particularly, the medial patellofemoral ligament (MPFL). The second group refers to an abnormal PFJ anatomy, which renders the patella inherently unstable inside the trochlea. The third group refers to the overall axial and torsional profile of the lower limb and to systemic factors, such as ligament laxity and neuromuscular coordination of movement. PD at a younger age is associated with an increased number and severity of patellar instability predisposing factors and lower stress to dislocate the patella. Acute primary PD is usually treated conservatively, while surgical treatment is reserved for recurrent PD. The aim of treatment is to restore the stability and function of the PFJ and to reduce the risk of patellar redislocation. Surgical procedures to treat patellar instability are classified into non-anatomic and anatomic procedures. Non-anatomic procedures are extensor mechanism realignment techniques that aim to center the patella into the trochlear groove. Anatomic procedures aim to restore the PFJ anatomy (ruptured ligaments, osteochondral fractures), which has been severed after the first incident of PD. Anatomic procedures, especially MPFL reconstruction, are more effective in preventing recurrent PD, compared with non-anatomic techniques. Theoretically, all factors that affect PFJ stability should be evaluated and, if possible, addressed. This is practically impossible. Considering that the MPFL ruptures in almost all PDs, MPFL reconstruction is the primary procedure, which is currently selected by most surgeons as a first-line treatment for patients with recurrent PD. Restoration of the axial and torsional alignment of the lower limbs is also increasingly implemented by surgeons. Non-anatomic surgical techniques, such as tibial-tuberosity osteotomy, are used as an adjunct to anatomic procedures. In the presence of multiple PFJ instability factors, acute MPFL reconstruction may be the treatment of choice for acute primary PD as well. Skeletal immaturity of the patient precludes osseous procedures to avoid premature physis closure and subsequent limb deformity. Unfortunately, restoration of the patient's previous activity level or participation in more strenuous sports is questionable and not easy to predict. In the case of competitive athletes, PD may prevent participation in elite levels of sports.
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Affiliation(s)
- Panagiotis V Samelis
- Orthopaedics, Children's General Hospital Panagiotis and Aglaia Kyriakou, Athens, GRC
- Orthopaedics, Attikon University Hospital, Athens, GRC
| | - Panagiotis Koulouvaris
- Orthopaedic Surgery, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | - Olga Savvidou
- Orthopaedics, Attikon University Hospital, Athens, GRC
| | - Andreas Mavrogenis
- Orthopaedics, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
| | | | - Panayiotis J Papagelopoulos
- Orthopaedic Surgery, National and Kapodistrian University of Athens School of Medicine, Athens, GRC
- Orthopaedics, Attikon University Hospital, Athens, GRC
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Morphometric Parameters and MRI Morphological Changes of the Knee and Patella in Physically Active Adolescents. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020213. [PMID: 36837415 PMCID: PMC9965593 DOI: 10.3390/medicina59020213] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 01/16/2023] [Accepted: 01/19/2023] [Indexed: 01/25/2023]
Abstract
Background and Objectives: The immature skeleton in a pediatric population exposed to frequent physical activity might be extremely prone to injuries, with possible consequences later in adulthood. The main aim of this study is to present specific morphometric parameters and magnetic resonance imaging (MRI) morphological changes of the knee and patella in a physically active pediatric population. Additionally, we wanted to investigate the morphological risk factors for patellar instability. Materials and Methods: The study included the MRI findings of 193 physically active pediatric patients with knee pain. The participants underwent sports activities for 5 to 8 h per week. Two divisions were performed: by age and by patellar type. We evaluated three age groups: group 1 (age 11-14), group 2 (age 15-17), and group 3 (age 18-21 years). In addition, participants were divided by the patellar type (according to Wiberg) into three groups. The following morphometric parameters were calculated: lateral trochlear inclination (LTI), the tibial tubercle-trochlear groove distance (TT-TG), trochlear facet asymmetry (TFA), Insall-Salvati index, modified Insall-Salvati index, Caton-Deschamps index, articular overlap, morphology ratio and contact surface ratio. Results: We found a statistically significant association between patellar type groups in LTI (p < 0.001), TFA (p < 0.001), Insal-Salvati (p = 0.001) index, and Caton-Deschamps index (p = 0.018). According to age groups, we found statistical significance in the Caton-Deschamps index (p = 0.039). The most frequent knee injury parameter, according to Wiberg, in physically active pediatric patients was patella type 2 in boys and type 3 in girls. Conclusions: The MRI morphometric parameters observed in our study might be factors of prediction of knee injury in physically active children. In addition, it might be very useful in sports programs to improve the biomechanics of the knee in order to reduce the injury rate in sports-active children.
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Reinholz AK, Till SE, Crowe MM, Hevesi M, Saris DB, Stuart MJ, Krych AJ. Grooveplasty Compared With Trochleoplasty for the Treatment of Trochlear Dysplasia in the Setting of Patellar Instability. Arthrosc Sports Med Rehabil 2022; 5:e239-e247. [PMID: 36866307 PMCID: PMC9971888 DOI: 10.1016/j.asmr.2022.11.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 11/13/2022] [Indexed: 12/27/2022] Open
Abstract
Purpose To compare the clinical efficacy in the resolution of patellar instability, patient-reported outcomes (PROs), and complication and reoperation rates between patients who underwent grooveplasty (proximal trochleoplasty) and patients who underwent trochleoplasty as part of a combined patellofemoral stabilization procedure. Methods A retrospective chart review was performed to identify a cohort of patients who underwent grooveplasty and a cohort who underwent trochleoplasty at the time of patellar stabilization. Complications, reoperations, and PRO scores (Tegner, Kujala, and International Knee Documentation Committee scores) were collected at final follow-up. The Kruskal-Wallis test and Fisher exact test were performed when appropriate, and P < .05 was considered significant. Results Overall, 17 grooveplasty patients (18 knees) and 15 trochleoplasty patients (15 knees) were included. Seventy-nine percent of patients were female, and the average follow-up period was 3.9 years. The mean age at first dislocation was 11.8 years overall; most patients (65%) had more than 10 lifetime instability events and 76% of patients underwent prior knee-stabilizing procedures. Trochlear dysplasia (Dejour classification) was similar between cohorts. Patients who underwent grooveplasty had a higher activity level (P = .007) and a higher degree of patellar facet chondromalacia (P = .008) at baseline. At final follow-up, no patients had recurrent symptomatic instability after grooveplasty compared with 5 patients in the trochleoplasty cohort (P = .013). There were no differences in postoperative International Knee Documentation Committee scores (P = .870), Kujala scores (P = .059), or Tegner scores (P = .052). Additionally, there were no differences in complication rates (17% in grooveplasty cohort vs 13% in trochleoplasty cohort, P > .999) or reoperation rates (22% vs 13%, P = .665). Conclusions Proximal trochlear reshaping and removal of the supratrochlear spur (grooveplasty) in patients with severe trochlear dysplasia may offer an alternative strategy to complete trochleoplasty for the treatment of trochlear dysplasia in complex cases of patellofemoral instability. Grooveplasty patients showed less recurrent instability and similar PROs and reoperation rates compared with trochleoplasty patients. Level of Evidence Level III, retrospective comparative study.
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Affiliation(s)
- Anna K. Reinholz
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Sara E. Till
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Matthew M. Crowe
- Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, Florida, U.S.A
| | - Mario Hevesi
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Daniel B.F. Saris
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Michael J. Stuart
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Aaron J. Krych
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A.,Address correspondence to Aaron J. Krych, M.D., Mayo Clinic, 200 First St SW, Rochester, MN 55905, U.S.A.
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Change of the cross-sectional area of vastus medialis oblique in patients with recurrent patellar dislocation treated by tibial tubercle transfer combined with medial patellofemoral ligament reconstruction on axial CT. J Orthop Surg Res 2022; 17:469. [PMID: 36307822 PMCID: PMC9617303 DOI: 10.1186/s13018-022-03367-z] [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: 04/06/2022] [Accepted: 10/18/2022] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To investigate the change of the cross-sectional area (CSA) of vastus medialis oblique (VMO) in patients with recurrent patellar dislocation (RPD) treated by tibial tubercle transfer combined with medial patellofemoral ligament (MPFL) reconstruction by imaging methods, and to guide clinical treatment and rehabilitation. METHODS From October 2015 to March 2022, 23 patients with RPD who underwent tibial tubercle transfer combined with MPFL reconstruction were retrospectively enrolled. All patients were assessed by CT in the supine position with the knee fully extended and the quadriceps relaxed. The CSA of VMO and the ratio of CSA of VMO to body weight (CSA/BW) were measured at the upper pole of the patella, 5 mm above the upper pole of the patella and 5 mm below the upper pole of patella. The differences of measured parameters were compared before surgery and at follow-up, including CSA of VMO and CSA/BW. Test level α = 0.05. RESULTS The tibial tubercle-trochlear groove (TT-TG) distance was significantly reduced at follow-up compared with that before surgery (27.91 ± 1.95 mm vs 12.33 ± 1.07 mm, P < 0.001). The CSA of VMO was significantly increased at follow-up compared with that before surgery at 5 mm below the upper pole of the patella (473.06 ± 106.32 mm2 vs 562.97 ± 157.90 mm2, P < 0.001), at the upper pole of the patella (641.23 ± 188.45 mm2 vs 700.23 ± 177.55 mm2, P = 0.029), and at 5 mm above the upper pole of the patella (788.25 ± 238.62 mm2 vs 849.79 ± 180.84 mm2, P = 0.018). The CSA/BW was significantly increased at follow-up compared with that before surgery at 5 mm below the upper pole of the patella (7.83 ± 2.52 mm2/kg vs 9.22 ± 3.54 mm2/kg, P < 0.001), at the upper pole of the patella (10.48 ± 3.62 mm2/kg vs 11.42 ± 4.14 mm2/kg, P = 0.020), and at 5 mm above the upper pole of the patella (12.86 ± 4.65 mm2/kg vs 13.68 ± 3.86 mm2/kg, P = 0.017). CONCLUSION After tibial tubercle transfer combined with MPFL reconstruction, CSA of VMO increased in patients with RPD, which will help to enhance patellar stability and reduce recurrence.
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Spang RC, Jahandar A, Meyers KN, Nguyen JT, Maher SA, Strickland SM. Dysplastic Patellofemoral Joints Lead to a Shift in Contact Forces: A 3D-Printed Cadaveric Model. Am J Sports Med 2021; 49:3344-3349. [PMID: 34415194 DOI: 10.1177/03635465211031427] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The distribution of contact forces across the dysplastic patellofemoral joint has not been adequately quantified because models cannot easily mimic the dysplasia of both the trochlea and the patella. Thus, the mechanical consequences of surgical treatments to correct dysplasia cannot be established. PURPOSE/HYPOTHESIS The objective of this study was to quantify the contact mechanics and kinematics of normal, mild, and severely dysplastic patellofemoral joints using synthetic mimics of the articulating surfaces on cadavers. We tested the hypothesis that severely dysplastic joints would result in significantly increased patellofemoral contact forces and abnormal kinematics. STUDY DESIGN Controlled laboratory study. METHOD Patellofemoral dysplasia was simulated in 9 cadaveric knees by replacing the native patellar and trochlear surfaces with synthetic patellar and trochlear implants. For each knee, 3 synthetic surface geometries (normal, showing no signs of dysplasia; mild, exemplifying Dejour type A; and severe, exemplifying Dejour type B) were randomized for implantation and testing. Patellar kinematics and the sum of forces acting on the medial and lateral patellar facets were computed for each knee and for each condition at 10° increments from 0° to 70° of flexion. RESULTS A pronounced lateral shift in the weighted center of contact of the lateral facet occurred for severely dysplastic knees from 20° to 70° of flexion. Compared with normal geometries, lateral patellar facet forces exhibited a significant increase only with mild dysplasia from 50° to 70° of flexion and with severe dysplasia at 70° of flexion. No measurable differences in medial patellar facet mechanics or joint kinematics occurred. CONCLUSION Our hypothesis was rejected: Severely dysplastic joints did not result in significantly increased patellofemoral contact forces and abnormal kinematics in our cadaveric simulation. Rather, severe dysplasia resulted in a pronounced lateral shift in contact forces across the lateral patellar facet, while changes in kinematics and the magnitude of contact forces were not significant. CLINICAL RELEVANCE Including dysplasia of both the patella and trochlea is required to fully capture the mechanics of this complex joint. The pronounced lateralization of contact force in severely dysplastic patellofemoral joints should be considered to avoid cartilage overload with surgical manipulation.
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Do the quadriceps and hamstring muscles have an effect on patella stability in trochlear dysplasia? Pol J Radiol 2021; 86:e232-e238. [PMID: 34093920 PMCID: PMC8147712 DOI: 10.5114/pjr.2021.105850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 10/19/2020] [Indexed: 01/02/2023] Open
Abstract
Introduction Trochlear dysplasia (TD) is a condition that is characterized by the presence of either a flat or convex trochlear, which impedes the stability of the patellofemoral joint (PFJ). The PFJ function is dependent on many different structures that surround the knee joint. The aim of this study was to analyse all the muscle components around the PFJ and identify whether gross muscle imbalance could contribute to the stability of the patella in TD. Material and methods The average cross-sectional area (CSA) and cross-sectional area ratio (CSAR) of each muscle of the thigh region in subtypes of TD was evaluated and compared to normal knee joints. Ninety-eight patients (196 knees in total) were included in the study. Results Of the 196 knee joints that were reviewed, 10 cases were found to be normal. In total, 186 cases were positive for TD. The majority consisted of type C. The hamstring muscles showed variable results. The vastus medialis muscle was larger in comparison to the vastus lateralis muscle over all the different TD subtypes; however, no statistical significance was identified. There was a marked statistical significance between the quadriceps and hamstring muscles, especially when comparing this to the normal knees within our cohort. Conclusions This study revealed no significant difference in the effect of the thigh muscle CSA on the stability of the PFJ in TD. Further research is required to establish the roles of the different muscles around PFJ in the prevention of TD dislocation.
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Marcheggiani Muccioli GM, Lullini G, Grassi A, Macchiarola L, Cammisa E, Maccaferri B, Rinaldi VG, Di Paolo S, Zaffagnini S. Good results are reported at 60-month follow-up after medial patello-femoral ligament reconstruction with fascia lata allograft for recurrent patellar dislocation. Knee Surg Sports Traumatol Arthrosc 2021; 29:1191-1196. [PMID: 32651802 DOI: 10.1007/s00167-020-06142-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/02/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE The aim of this study was to evaluate the efficacy of a new minimally invasive surgical technique for the reconstruction of the medial patellofemoral ligament (MPFL) with fascia lata allograft at 60-month minimum follow-up. METHODS Nineteen consecutive patients with chronic recurrent patellar dislocation were treated with MPFL reconstruction (53% isolate procedure, 47% in combination with other treatments). Seventeen patients (11 males/6 females) were available at 60-month follow-up and were clinically evaluated with validated scores. New episodes of patellar dislocation were considered failures. Radiographic and CT scan evaluation were executed preoperatively and at 60-month follow-up. RESULTS All clinical scores improved from preoperative assessment to 24-month and 60-month follow-up (p < 0.001). Kujala score increased from 61.2 ± 18.1 to 86.7 ± 8.7 and 82.1 ± 10.2; KOOS increased from 54.5 ± 19 to 86.8 ± 9.6 and 84.3 ± 7.6; VAS for pain decreased from 5.1 ± 2.2 to 2.4 ± 1.5 and 1.7 ± 1.2; Tegner score increased from 3 [2-4] to 5 [3-8] and 5 [3-9], respectively. Objective IKDC improved too. No significant improvements between the 24-month and 60-month follow-up evaluations were recorded. Anterior knee pain was reported in two patients (12%). Treatment failure, a new episode of patellar dislocation 25 months after the surgery, was observed in one patient (6%). Radiographic OA changes were not statistically significant between preop and 60-month follow-up. Tuberosity-troclear groove (TT-TG) distance and the patellar tilt angle were subjected to significant changes due to MPFL reconstruction and associated procedures. CONCLUSION MPFL reconstruction with fascia lata allograft, alone or combined with other procedures, is a reliable treatment option for recurrent patellar dislocation with a success rate of 94% and without cartilage deterioration at 60-month follow-up. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Giulio Maria Marcheggiani Muccioli
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.
- DIBINEM, University of Bologna, via di Barbiano, 1/10, c/o Lab Biomeccanica ed Innovazione Tecnologica, 40136, Bologna, Italy.
| | - Giada Lullini
- Laboratorio di Analisi del Movimento e di Valutazione Funzionale Protesi, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- DIBINEM, University of Bologna, via di Barbiano, 1/10, c/o Lab Biomeccanica ed Innovazione Tecnologica, 40136, Bologna, Italy
| | - Alberto Grassi
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Luca Macchiarola
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Eugenio Cammisa
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Bruna Maccaferri
- Medicina Fisica e Riabilitativa, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Vito Gaetano Rinaldi
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Di Paolo
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Zaffagnini
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- DIBINEM, University of Bologna, via di Barbiano, 1/10, c/o Lab Biomeccanica ed Innovazione Tecnologica, 40136, Bologna, Italy
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Weight bearing versus conventional CT for the measurement of patellar alignment and stability in patients after surgical treatment for patellar recurrent dislocation. LA RADIOLOGIA MEDICA 2021; 126:869-877. [PMID: 33660189 PMCID: PMC8154791 DOI: 10.1007/s11547-021-01339-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 02/14/2021] [Indexed: 10/27/2022]
Abstract
PURPOSE To compare weight-bearing cone-beam computer tomography (CBCT) and conventional computer tomography (CT)-based measurements of patellofemoral alignment and stability in patients surgically treated for recurrent patellar dislocation. These scans implied respectively single-leg up-right posture, the knee flexed, and lower limb muscles activation, versus supine position with the knee extended. METHODS A total of 17 patients (11 males/6 females) after surgical reconstruction with fascia lata allograft for recurrent patellofemoral dislocation were analyzed at 60-month follow-up. Tilt and congruence angles and tibial tuberosity-trochlear groove (TT-TG) offset were measured on images obtained from CBCT and conventional CT scans by three independent and expert radiologists. Paired t tests were performed to compare measurements obtained from the two scans. Inter-rater reliability was assessed using a two-way mixed-effects model intra-class correlation coefficient (ICC). RESULTS Only TT-TG offset was found significantly smaller (p < 0.001) in CBCT (mean 9.9 ± 5.3 mm) than in conventional CT (mean 15.9 ± 4.9 mm) scans. ICC for tilt and congruence angles and for TT-TG offset ranged between 0.80-0.94 with measurements in CBCT scans, between 0.52 and0.78 in conventional CT. CONCLUSION In patients surgically treated for recurrent patellar dislocation, TT-TG offset was found overestimated with conventional CT. All measurements of patellofemoral stability and alignment were found more consistent when obtained with weight-bearing CBCT compared to conventional CT.
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Grammens J, Van Haver A, Danckaers F, Booth B, Sijbers J, Verdonk P. Small medial femoral condyle morphotype is associated with medial compartment degeneration and distinct morphological characteristics: a comparative pilot study. Knee Surg Sports Traumatol Arthrosc 2021; 29:1777-1789. [PMID: 32797248 PMCID: PMC8126545 DOI: 10.1007/s00167-020-06218-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 08/06/2020] [Indexed: 01/17/2023]
Abstract
PURPOSE Early-onset degeneration of the knee is linked to genetics, overload, injury, and potentially, knee morphology. The purpose of this study is to explore the characteristics of the small medial femoral condyle, as a distinct knee morphotype, by means of a landmark-based three-dimensional (3D) analysis and statistical parametric mapping. METHODS Sixteen knees with a small medial femoral condyle (SMC) were selected from a database of patients with distinct knee joint anatomy and 16 gender-matched knees were selected from a control group database. 3D models were generated from the medical imaging. After normalization for size, a set of pre-defined landmark-based parameters was analysed for the femur and tibia. Local shape differences were evaluated by matching all bone surfaces onto each other and comparing the distances to the mean control group bone shape. RESULTS The small medial condyle group showed a significant association with medial compartment degeneration and had a 4% and 13% smaller medial condyle anteroposteriorly and mediolaterally, whereas the distal femur was 3% wider mediolaterally. The lateral condyle was 2% smaller anteroposteriorly and 8% wider mediolaterally. The complete tibial plateau was 3% smaller mediolaterally and the medial tibial plateau was 6% smaller. CONCLUSION A new knee morphotype demonstrated an increased risk for medial compartment degeneration and was differentiated from a healthy control group based on the following morphological characteristics: a smaller medial femoral condyle and medial tibial plateau, a wider lateral femoral condyle and a wider distal femur on a smaller tibial plateau. This pilot study suggests a role for the SMC knee morphotype in the multifactorial process of medial compartment degeneration. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Jonas Grammens
- Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Belgium. .,imec-VisionLab, Department of Physics, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Belgium.
| | - Annemieke Van Haver
- Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium ,MoRe Institute, Stevenslei 20, 2100 Deurne, Belgium
| | - Femke Danckaers
- imec-VisionLab, Department of Physics, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Brian Booth
- imec-VisionLab, Department of Physics, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Jan Sijbers
- imec-VisionLab, Department of Physics, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium
| | - Peter Verdonk
- Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium ,Antwerp Orthopaedic Centre Monica Hospitals, Stevenslei 20, 2100 Deurne, Belgium
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Burge AJ, Jawetz ST. Advanced Magnetic Resonance Imaging in Osteoarthritis. Semin Musculoskelet Radiol 2020; 24:355-366. [PMID: 32992364 DOI: 10.1055/s-0040-1708822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Osteoarthritis (OA) is one of the most common causes of disability throughout the world. Current therapeutic strategies are aimed at preventing the development and delaying the progression of OA, as well as repairing or replacing worn articular surfaces, because the regeneration of lost hyaline articular cartilage is not currently a clinically feasible option. Imaging is useful in formulating treatment strategies in patients at risk for OA, allowing assessment of risk factors, the degree of preexisting tissue damage, and posttreatment monitoring. Magnetic resonance imaging (MRI), in particular, provides in-depth evaluation of these patients, with optimal clinical sequencing allowing sensitive assessment of chondral signal and morphology, and the addition of advanced MRI techniques facilitating comprehensive evaluation of joint health, with increased sensitivity for changes in articular cartilage and surrounding joint tissues.
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Affiliation(s)
- Alissa J Burge
- Department of Radiology and Imaging (MRI), MRI Laboratory, Hospital for Special Surgery, New York
| | - Shari T Jawetz
- Department of Radiology and Imaging, Hospital for Special Surgery, New York
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Otto A, Tscholl PM, Pääsuke R, Herbst E, Willinger L, Imhoff AB, Brucker PU. Neither lateral patellar facet nor patellar size are altered in patellofemoral unstable patients: a comparative magnetic resonance imaging analysis. Knee Surg Sports Traumatol Arthrosc 2020; 28:1064-1071. [PMID: 31456062 DOI: 10.1007/s00167-019-05660-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 08/05/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE It remains unclear if morphologic patterns of the patella itself predispose to patellar instability. This study examined established patellar landmarks in relation to the femoral condyle width to clarify differences of patellar morphologies in patellofemoral stable and unstable patients. METHODS Magnetic Resonance Imaging of 50 subjects (20.7 ± 4.4 years; 17 males, 33 females) with patellofemoral instability (study group, SG) and 50 subjects (25.3 ± 5.8 years; 31 males, 19 females) with anterior cruciate ligament rupture (control group, CG) were analyzed. Corresponding patellar value indices (PW-I; LPF-I 1; LPF-I 2) in relation to the femoral condyle width (FCW) were evaluated after the measurement of absolute patellar dimension [patellar width (PW); direct length of the lateral patellar facet (LPF-1); projected length of the lateral patellar facet (LPF-2)]. The patellar shape according to Wiberg, trochlear dysplasia, patellar height, and tibial tubercle-trochlear groove (TT-TG) distance were determined. RESULTS The SG showed a significantly longer absolute (LPF 2) (P = 0.041) and relative (LPF-I 1, LPF-I 2) (P < 0.001) lateral facet of the patella. No significant differences were evaluable for the relative patellar width (PW-I) (ns). A patellar shape type 3 (P = 0.001) as well as a higher position of the patella and TT-TG-distance (P < 0.001) were significantly more often present in the SG. CONCLUSION There are several bony alterations associated with patellofemoral instability, but our data did not show a significantly smaller lateral patellar facet or relative patellar width that could facilitate a patellar dislocation. This helps surgeons, that are considering to surgically address the patella in cases of patellofemoral instability, to better understand its morphologic pattern. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Alexander Otto
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany.,Department of Trauma, Orthopaedic, Plastic and Hand Surgery, University Hospital of Augsburg, Augsburg, Germany.,Department of Orthopaedic Surgery, UConn Musculoskeletal Institute, University of Connecticut, Farmington, CT, USA
| | - Philippe M Tscholl
- Division of Orthopaedics and Trauma Surgery, Geneva University Hospital, Geneva, Switzerland.,Department of Orthopaedic Surgery, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Reedik Pääsuke
- Department of Traumatology and Orthopaedics, Tartu University Hospital, Tartu, Estonia
| | - Elmar Herbst
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Lukas Willinger
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Andreas B Imhoff
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
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Knee orthopedic problems in newborns and infancy: a review. Curr Opin Pediatr 2020; 32:113-119. [PMID: 31789974 DOI: 10.1097/mop.0000000000000859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW We present the reader with insight on the most common disorders of the knee in newborns and infants. Knee issues in this population may confuse the first contact physicians due to certain peculiarities of the immature immune system, small size and underdevelopment of joint anatomy. Data presented here are recent and significant, and something to bear in mind when caring for children of this age. RECENT FINDINGS With the advent of new diagnostic methods, a shift in the causative agent of pediatric knee infections has been noted. Minimally invasive methods such as arthrocentesis and arthroscopy are successfully employed in treatment of knee problems in newborns and infants. A trial of conservative therapy in congenital patellar instability can give good results, and obviate the need for surgery in some cases. Various syndromes that affect the knee have specific characteristics that need to be recognized early to avoid problems in the future. SUMMARY Although rare, knee problems in infants can and do occur. Their cause varies significantly and good outcomes require a multidisciplinary approach. Early diagnosis, referral and initiation of treatment protocols can significantly influence the fate of the joint and with it the patients' functional status for life.
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Rajakulasingam R, Murphy J, Bache C, James S, Botchu R. Is acetabular morphology related to trochlear dysplasia? J Clin Orthop Trauma 2020; 11:S82-S85. [PMID: 31992924 PMCID: PMC6977165 DOI: 10.1016/j.jcot.2019.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 05/23/2019] [Accepted: 06/10/2019] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To evaluate the correlation between trochlear dysplasia and acetabular coverage. MATERIALS AND METHODS 109 retrospective CT studies referred from the young adult knee clinic were independently reviewed by two observers. Anterior acetabular (AASA) and posterior acetabular (PASA) sector angles were calculated bilaterally on axial CT. Trochlear dysplasia was graded using the Dejour classification (A-D). ANOVA test was used. RESULTS Dejour types A, B and D trochlear dysplasia were associated with a significantly increased AASA (P value = 0.0011). CONCLUSION Our results demonstrate a significant relationship between trochlear dysplasia and anterior acetabular coverage, as measured by AASA.
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Affiliation(s)
- R. Rajakulasingam
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - J. Murphy
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - C.E. Bache
- Department of Orthopaedics, Royal Orthopaedic Hospital, Birmingham, UK
| | - S.L. James
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
| | - R. Botchu
- Department of Musculoskeletal Radiology, Royal Orthopaedic Hospital, Birmingham, UK
- Corresponding author. Department of Musculoskeletal Radiology, The Royal Orthopedic Hospital, Bristol Road South, Northfield, Birmingham, UK.
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Vermeulen D, van der Valk MR, Kaas L. Plaster, splint, brace, tape or functional mobilization after first-time patellar dislocation: what's the evidence? EFORT Open Rev 2019; 4:110-114. [PMID: 30993012 PMCID: PMC6440297 DOI: 10.1302/2058-5241.4.180016] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
With an incidence of 5.8 per 100,000 per year, patellar dislocations are commonly seen in the emergency department. Surprisingly, there are only a few studies available that focus on the results of the different non-surgical treatment options after first-time patellar dislocation. The aim of this review is to provide an overview of the most recent and relevant studies on the rationales and results of the non-surgical treatment for first-time patellar dislocation. Patellar instability mainly affects young and active patients, with a peak incidence of 29 per 100 000 per year in adolescents. The medial patellofemoral ligament, a main passive restraint for lateral translation of the patella, is torn in lateral patellofemoral dislocations. Treatment of first-time patellar dislocation can be either conservative or surgical. There are two options in conservative management of first-time patellar dislocation: immobilization using a cylinder cast or removable splint, or, second, functional mobilization after applying a brace or patellar tape. The current available literature of conservative treatment after a first-time patellar dislocation is little and of low quality of evidence. Conclusions should be drawn with care, new research focussing on non-surgical treatment is therefore strongly needed.
Cite this article: EFORT Open Rev 2019;4:110-114. DOI: 10.1302/2058-5241.4.180016
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Affiliation(s)
- Daan Vermeulen
- Department of Orthopaedic Surgery, St. Antonius Hospital, Nieuwegein, Utrecht, The Netherlands
| | - Mara Rosa van der Valk
- Department of Orthopaedic Surgery, St. Antonius Hospital, Nieuwegein, Utrecht, The Netherlands
| | - Laurens Kaas
- Department of Orthopaedic Surgery, St. Antonius Hospital, Nieuwegein, Utrecht, The Netherlands
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What is the chance that a patella dislocation will happen a second time: update on the natural history of a first time patella dislocation in the adolescent. Curr Opin Pediatr 2018; 30:65-70. [PMID: 29176355 DOI: 10.1097/mop.0000000000000568] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
PURPOSE OF REVIEW Patellar instability occurs mainly in young patients and shows a high incidence of concomitant cartilage injuries. Recently there has been a strong attempt to identify risk factors and enhance imaging techniques to detect patients with an increased risk for recurrent patella dislocation.We describe current findings on factors associated with recurrent patella dislocation in the adolescent. RECENT FINDINGS Trochlear dysplasia, patellar height, patellar tilt, tibial tuberosity-trochlear groove distance, skeletal maturity, and history of contralateral patellar dislocation are well known significant risk factors for recurrence in adolescent patients. Predictive models to calculate risk of recurrence have been reported recently. The Patellar Instability Severity Score was the first to include demographic and anatomic factors, which is of major value when counseling patients and relatives. SUMMARY Several classification systems to predict the rate of recurrence after primary patella dislocation have been presented over the last years. Anatomic risk factors such as skeletal immaturity, trochlear morphology, patellar height, patellar tilt, and elevated tibial tuberosity-trochlear groove distance have been investigated. However, there is still a lack of knowledge as to how single risk factors or their interaction with each other may contribute.
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