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Buzzatti L, Keelson B, Héréus S, Van den Broeck J, Scheerlinck T, Van Gompel G, Vandemeulebroucke J, De Mey J, Buls N, Cattrysse E. Investigating patellar motion using weight-bearing dynamic CT: normative values and morphological considerations for healthy volunteers. Eur Radiol Exp 2024; 8:106. [PMID: 39298011 DOI: 10.1186/s41747-024-00505-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Accepted: 08/21/2024] [Indexed: 09/21/2024] Open
Abstract
BACKGROUND Patellar instability is a well-known pathology in which kinematics can be investigated using metrics such as tibial tuberosity tracheal groove (TTTG), the bisect offset (BO), and the lateral patellar tilt (LPT). We used dynamic computed tomography (CT) to investigate the patellar motion of healthy subjects in weight-bearing conditions to provide normative values for TTTG, BO, and LPT, as well as to define whether BO and LPT are affected by the morphology of the trochlear groove. METHODS Dynamic scanning was used to acquire images during weight-bearing in 21 adult healthy volunteers. TTTG, BO, and LPT metrics were computed between 0° and 30° of knee flexion. Sulcus angle, sulcus depth, and lateral trochlear inclination were calculated and used with the TTTG for simple linear regression models. RESULTS All metrics gradually decreased during eccentric movement (TTTG, -6.9 mm; BO, -12.6%; LPT, -4.3°). No significant differences were observed between eccentric and concentric phases at any flexion angle for all metrics. Linear regression between kinematic metrics towards full extension showed a moderate fit between BO and TTTG (R2 0.60, β 1.75) and BO and LPT (R2 0.59, β 1.49), and a low fit between TTTG and LPT (R2 0.38, β 0.53). A high impact of the TTTG distance over BO was shown in male participants (R2 0.71, β 1.89) and patella alta individuals (R2 0.55, β 1.91). CONCLUSION We provided preliminary normative values of three common metrics during weight-bearing dynamic CT and showed the substantial impact of lateralisation of the patella tendon over patella displacement. RELEVANCE STATEMENT These normative values can be used by clinicians when evaluating knee patients using TTTG, BO, and LPT metrics. The lateralisation of the patellar tendon in subjects with patella alta or in males significantly impacts the lateral displacement of the patella. KEY POINTS Trochlear groove morphology had no substantial impact on motion prediction. The lateralisation of the patellar tendon seems a strong predictor of lateral displacement of the patella in male participants. Participants with patella alta displayed a strong fit between the patellar lateral displacement and tilt. TTTG, BO, and LPT decreased during concentric movement. Concentric and eccentric phases did not show differences for all metrics.
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Affiliation(s)
- Luca Buzzatti
- School of Allied Health, Anglia Ruskin University (ARU), Cambridge, UK.
- Experimental Anatomy Research Group (EXAN), Vrije Universiteit Brussel (VUB), Brussels, Belgium.
| | - Benyameen Keelson
- Department of Radiology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
- Department of Electronics and Informatics (ETRO), Vrije Universiteit Brussel (VUB), Brussel, Belgium
- imec, Leuven, Belgium
| | - Savanah Héréus
- Experimental Anatomy Research Group (EXAN), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Jona Van den Broeck
- Experimental Anatomy Research Group (EXAN), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Thierry Scheerlinck
- Department of Orthopaedic Surgery and Traumatology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Gert Van Gompel
- Department of Radiology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Jef Vandemeulebroucke
- Department of Electronics and Informatics (ETRO), Vrije Universiteit Brussel (VUB), Brussel, Belgium
- imec, Leuven, Belgium
| | - Johan De Mey
- Department of Radiology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Nico Buls
- Department of Radiology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Erik Cattrysse
- Experimental Anatomy Research Group (EXAN), Vrije Universiteit Brussel (VUB), Brussels, Belgium
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Kwak YH, Ko YJ, Kwon H, Koh YG, Aldosari AM, Nam JH, Kang KT. Application of a machine learning and optimization method to predict patellofemoral instability risk factors in children and adolescents. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 39033342 DOI: 10.1002/ksa.12372] [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: 03/26/2024] [Revised: 07/03/2024] [Accepted: 07/08/2024] [Indexed: 07/23/2024]
Abstract
PURPOSE Conservative treatment remains the standard approach for first-time patellar dislocations. While risk factors for patellofemoral instability, a common paediatric injury, are well-established in adults, data concerning the progression of paediatric recurrent patellar dislocation remain scarce. A reproducible method was developed to quantitatively assess the patellofemoral morphology and anatomic risk factors in paediatric patients using magnetic resonance imaging (MRI) and machine learning analysis. METHODS Data were analyzed from a retrospective review (2005-2022) of paediatric patients diagnosed with acute lateral patellar dislocation (54 patients) who underwent MRI and were compared with an age-based control group (54 patients). Patellofemoral, tibial, tibiofemoral and patellar height parameters were measured. Differences between groups were analyzed with respect to MRI parameters. The potential diagnostic utility of the parameters was assessed via machine learning and genetic algorithm analyses. RESULTS Significant differences were observed between the two groups in six patellofemoral morphological parameters. Regarding patellar height morphological parameters, all methods exhibited significant between-group differences. Among the tibia and tibiofemoral morphological parameters, only the tibial tubercle-trochlear groove distance exhibited significant differences between the two groups. No sex-related differences were present. Significant variations were observed in patellar height parameters, particularly in the Koshino-Sugimoto (KS) index, which had the highest area under the curve (AUC: 0.87). Using genetic algorithms and logistic regression, our model excelled with seven key independent variables. CONCLUSION KS index and Wiberg index had the strongest association with lateral patellar dislocation. An optimized logistic regression model achieved an AUC of 0.934. Such performance is considered clinically relevant, indicating the model's effectiveness for the intended application. LEVEL OF EVIDENCE Level Ⅲ.
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Affiliation(s)
- Yoon Hae Kwak
- Department of Orthopedic Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
| | - Yu Jin Ko
- Cell & Developmental Biology, University of Rochester, Rochester, New York, USA
| | - Hyunjae Kwon
- Department of Orthopedic Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
| | - Yong-Gon Koh
- Department of Orthopaedic Surgery, Joint Reconstruction Center, Yonsei Sarang Hospital, Seoul, Korea
| | - Amaal M Aldosari
- Department of Orthopedic Surgery, Al Noor Specialist Hospital, Makkah, Saudi Arabia
| | - Ji-Hoon Nam
- Department of Mechanical Engineering, Yonsei University, Seoul, Korea
- Skyve R&D LAB, Seoul, Korea
| | - Kyoung-Tak Kang
- Department of Mechanical Engineering, Yonsei University, Seoul, Korea
- Skyve R&D LAB, Seoul, Korea
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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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Jud L, Hartmann M, Vlachopoulos L, Zimmermann SM, Ackermann J, Fucentese SF. Increased tibial tuberosity torsion has the greatest predictive value in patients with patellofemoral instability compared to other commonly assessed parameters. Knee Surg Sports Traumatol Arthrosc 2024; 32:1179-1186. [PMID: 38504510 DOI: 10.1002/ksa.12151] [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: 12/08/2023] [Revised: 02/29/2024] [Accepted: 03/04/2024] [Indexed: 03/21/2024]
Abstract
PURPOSE The multifactorial nature of patellofemoral instability requires a comprehensive assessment of the affected patients. While an association between tibial tuberosity (TT) torsion and patellofemoral instability is known, its specific effect has not yet been investigated. This study investigated the effect of TT torsion on patellofemoral instability. METHODS This retrospective cohort study compared patients who underwent surgical intervention for patellofemoral instability and asymptomatic controls. TT torsion was measured in addition to other commonly assessed risk factors for patellofemoral instability using standardised computed tomography (CT) data of the lower extremities. The diagnostic performances of the assessed parameters were evaluated using receiver operating characteristic curve analysis and odds ratios (ORs) were calculated. RESULTS The patellofemoral instability group consisted of 79 knees, compared to 72 knees in the asymptomatic control group. Both groups differed significantly in all assessed parameters (p < 0.001), except for tibial torsion (n.s.). Among all parameters, TT torsion presented the best diagnostic performance for predicting patellar instability with an area under the curve of 0.95 (95% confidence interval [CI], 0.91-0.98; p < 0.001). A cut-off value of 17.7° yielded a 0.87 sensitivity and 0.89 specificity to predict patellar instability (OR, 55.2; 95% CI, 20.5-148.6; p < 0.001). CONCLUSION Among the evaluated risk factors, TT torsion had the highest predictive value for patellofemoral instability. Patients with TT torsions ≥ 17.7° showed a 55-fold increased probability of patellofemoral instability. Therefore, TT torsion should be included in the assessment of patients with patellofemoral instability. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Lukas Jud
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Martin Hartmann
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Lazaros Vlachopoulos
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Stefan M Zimmermann
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Jakob Ackermann
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Sandro F Fucentese
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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Li K, Xu C, Dong Z, Ji G, Wang F. Reliability of Tibial Tubercle-Trochlear Groove Distance for Assessing Tibial Tubercle Lateralization: A Study Comparing Different Anatomic References. Orthop J Sports Med 2024; 12:23259671241239965. [PMID: 38601189 PMCID: PMC11005510 DOI: 10.1177/23259671241239965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 10/05/2023] [Indexed: 04/12/2024] Open
Abstract
Background The tibial tubercle-trochlear groove (TT-TG) distance is a measurement used to quantitatively assess tibial tubercle lateralization (TTL), and it has important reference value for the treatment of patellar dislocation (PD). However, TT-TG distance accuracy has been questioned, so many new parameters have been proposed. Purpose To compare which of the TT-TG, tibial tubercle-midepicondyle (TT-ME), tibial tubercle-Roman arch (TT-RA), tibial tubercle-tibial intercondylar midpoint (TT-TIM), and tibial tubercle-mid inter-epicondyle trochlea intersection (TT-MIELTI) distances better reflect TTL in patients with PD. Study Design Cohort study (diagnosis); Level of evidence, 3. Methods A total of 96 patients who had undergone surgery for PD and 96 patients without PD (controls) were included in the study. The patients had all undergone computed tomography examination. The TT-TG, TT-ME, TT-RA, TT-TIM, TT-MIELTI distances and the TTL distance were measured independently by 2 surgeons in a blinded and randomized fashion. The t test was used to detect whether the parameters were significantly different between the 2 groups. The TTL distance was used as a reference value for lateralization of tibial tubercle. Pearson correlation coefficients were calculated to determine correlations between the defined measurements. Results The intra- and interobserver reliability of the defined measurements was excellent. All parameters except for TT-TIM distance were significantly larger in the PD group than the control group (P < .01 for all). There was a moderate correlation (r = 0.601) between the TT-TG distance and TTL, and other parameters were less correlated with TTL. Conclusion Among 5 the parameters tested, the TT-TG distance still had the highest correlation with TTL and was able to reflect TTL better in patients with PD. The role of TT-TIM distance in the assessment of PD needs further study.
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Affiliation(s)
- Kehan Li
- Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Chenyue Xu
- Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Zhenyue Dong
- Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Gang Ji
- Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Fei Wang
- Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
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Guo H, Zhou K, Sun Z, Feng A, Qin S, Liu L, Sun R, Wang X. Morphological Changes of the Posterior Femoral Condyle After Medial Patellar Retinaculum Plasty in Skeletally Immature Patients With Recurrent Patellar Dislocation and Trochlear Dysplasia. Orthop J Sports Med 2024; 12:23259671231225671. [PMID: 38304055 PMCID: PMC10832434 DOI: 10.1177/23259671231225671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 08/17/2023] [Indexed: 02/03/2024] Open
Abstract
Background Surgical correction for recurrent patellar dislocation (RPD) can improve femoral trochlear morphology; nonetheless, the effects of surgical correction on femoral condyle morphology are unclear. Purpose To investigate the morphological changes in the posterior femoral condyle in skeletally immature patients with RPD and trochlear dysplasia (TD) after surgical correction. Study Design Cohort study; Level of evidence, 3. Methods A total of 20 skeletally immature patients with bilateral RPD and TD were included in this study. For each patient, the knee that was dislocated more frequently or had sustained a recent injury was treated with medial patellar retinaculum plasty (group S; n = 20 knees), and the asymptomatic or only occasionally dislocated contralateral knee was treated conservatively (group C; n = 20 knees). The lengths of the anterior medial and lateral femoral condyles and the lengths of the posterior medial and lateral femoral condyles were evaluated preoperatively and at the final follow-up. Trochlear morphological characteristics, tibial tuberosity-trochlear groove distance, and patellar tilt angle were compared between preoperative and final follow-up values with the 2-sample paired Student t test and were compared between groups S and C with the independent-samples t test. Results The mean follow-up time was 60.7 ± 4.8 months. No knee in group S experienced a redislocation, whereas 80% (16/20) of knees in group C experienced a dislocation. There were significant group differences in the ratio of the posterior medial femoral condyle (PMFC) to the posterior lateral femoral condyle (PLFC) (group S, 1.08 ± 0.05; group C, 1.14 ± 0.06; P = .042). There was no significant difference in the ratio of the anterior lateral femoral condyle to the anterior medial femoral condyle (group S, 1.16 ± 0.13; group C, 1.18 ± 0.09; P = .635). In group S, all trochlear morphological characteristics and patellofemoral joint characteristics improved compared with preoperatively (P≤ .047 for all). In addition, all values significantly differed between groups S and C at the final follow-up (P≤ .044 for all). Conclusion The study findings demonstrated that the morphology of the posterior femoral condyle in skeletally immature patients with bilateral RPD and TD changes after surgical correction, with the PLFC growing faster than the PMFC.
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Affiliation(s)
- Hailong Guo
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Kezhen Zhou
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Zhiwen Sun
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Ao Feng
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Shiqi Qin
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Lei Liu
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Ran Sun
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Xiaofeng Wang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
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Danielsen O, Poulsen TA, Eysturoy NH, Mortensen ES, Hölmich P, Barfod KW. Trochlea dysplasia, increased TT-TG distance and patella alta are risk factors for developing first-time and recurrent patella dislocation: a systematic review. Knee Surg Sports Traumatol Arthrosc 2023; 31:3806-3846. [PMID: 36854995 DOI: 10.1007/s00167-022-07255-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 11/23/2022] [Indexed: 03/02/2023]
Abstract
PURPOSE The aim of the study was to perform a systematic review and best knowledge synthesis of the present literature concerning biomechanical risk factors for developing first-time and recurrent patella dislocation. METHODS The study was performed as a systematic review following PRISMA guidelines. PubMed and EMBASE were systematically searched. Studies investigating participants with risk factors for first-time as well as recurrent patella dislocation were included. The records were screened, and data extracted independently by two researchers supervised by a third independent assessor. The study was registered in PROSPERO. RESULTS A total of 6233 records were screened, and 50 studies met the inclusion criteria. The biomechanical risk factors: trochlear dysplasia, increased tibial tuberosity-trochlear groove distance (TT-TG), and patella alta were found to be statistically significantly associated with patella dislocation in several publications and were thus recognized as risk factors for patella dislocation. The soft-tissue stabilizers: longer and thinner MPFL ligament, increased number of type 2C and decreased number of type 1 muscle fibers, and joint laxity were found to be statistically significantly associated with patella dislocation in a few publications, but due to limited evidence, no conclusion was made on this matter. CONCLUSION There is strong evidence in the literature that abnormalities of bony stabilizers, trochlear dysplasia, increased TT-TG distance, and patella alta are risk factors for patella dislocation. There is less evidence that soft-tissue stabilizers are risk factors. The study emphasizes the importance of a thorough investigation of bony stabilizers in clinical decision-making. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Oddrún Danielsen
- National Hospital of the Faroe Islands, J.C. Svabosgøta 41-49, 100, Tórshavn, Faroe Islands.
| | - Turið Akraberg Poulsen
- National Hospital of the Faroe Islands, J.C. Svabosgøta 41-49, 100, Tórshavn, Faroe Islands
| | | | | | - Per Hölmich
- Sports Orthopedic Research Center, Copenhagen, (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Kettegård Allé 30, 2650, Hvidovre, Denmark
| | - Kristoffer Weisskirchner Barfod
- Sports Orthopedic Research Center, Copenhagen, (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Kettegård Allé 30, 2650, Hvidovre, Denmark
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Huang L, Qian ZH, Yang Z, Lv XM, Feng C. Comparison of Habitual Versus Recurrent Patellar Dislocation in Children and Adolescents: Differences in Radiological Features. Orthop J Sports Med 2023; 11:23259671231180574. [PMID: 37465209 PMCID: PMC10350775 DOI: 10.1177/23259671231180574] [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: 01/20/2023] [Accepted: 03/09/2023] [Indexed: 07/20/2023] Open
Abstract
Background Recurrent patellar dislocation (RPD) and habitual patellar dislocation (HPD) in flexion are frequently encountered in children and adolescents. Purpose To compare the radiological features of RPD and HPD in children and adolescents. Study Design Cross-sectional study; Level of evidence, 3. Methods Imaging data were collected from patients aged 9 to 15 years who received surgical treatment for HPD or RPD at a single institution between June 2015 and September 2020. The prevalence of trochlear dysplasia, tibial tubercle lateralization, and lower limb rotational deformity was assessed through hip/knee/ankle computed tomography (CT) using the following quantitative indicators: trochlear depth index, lateral trochlear inclination, sulcus angle, tibial tubercle-trochlear groove (TT-TG) distance, ratio of TT-TG distance to femoral width, TT-TG angle, femoral anteversion angle, and tibial external rotation angle. The morphology of trochlea and patella were graded on knee CT using the Dejour and Wiberg classification. The Insall-Salvati index and Caton-Deschamps index were used to evaluate the height of the patella on lateral view radiographs. To evaluate lower limbs malalignment, the mechanical lateral distal femoral angle and medial proximal tibial angle were measured on weightbearing full-length radiographs. The collected data were analyzed and compared between the HPD and RPD groups. Results Enrolled were 15 patients (21 knees) diagnosed with HPD and 18 patients (22 knees) diagnosed with RPD. The age of first dislocation was significantly younger in the HPD group (7.6 ± 3.4 vs 11.2 ± 1.4 years; P = 0.003). Knees in the HPD group had a significantly higher proportion of Dejour type C dysplasia (57.1% vs 4.5%; P < .005) and Wiberg type 3 patella (66.7% vs 9.1%; P < .001). There were statistically significant differences between the groups in the trochlear depth index (HPD vs RPD: 1.1 ± 1.7 vs 2.2 ± 1.5 mm; P = .039), sulcus angle (170.3° ± 13.7° vs 157.3° ± 16.0°; P = .007), Insall-Salvati index (1.1 ± 0.2 vs 1.3 ± 0.2; P = .034), and tibial external rotation angle (31.3° ± 7.8° vs 38.4° ± 8.5°; P = .009). Conclusion Patients in the HPD group presented with poorer trochlear and patellar development, lower patellar height, and less tibial external rotation compared with patients in the RPG group.
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Affiliation(s)
- Lin Huang
- Pediatric Orthopedics Department, Beijing Jishuitan Hospital, Beijing, China
| | - Zhan-Hua Qian
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Zheng Yang
- Pediatric Orthopedics Department, Beijing Jishuitan Hospital, Beijing, China
| | - Xue-min Lv
- Pediatric Orthopedics Department, Beijing Jishuitan Hospital, Beijing, China
| | - Chao Feng
- Pediatric Orthopedics Department, Beijing Jishuitan Hospital, Beijing, China
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Femoral Anteversion Measured by the Surgical Transepicondylar Axis Is Correlated with the Tibial Tubercle-Roman Arch Distance in Patients with Lateral Patellar Dislocation. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020382. [PMID: 36837583 PMCID: PMC9959396 DOI: 10.3390/medicina59020382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 02/11/2023] [Accepted: 02/14/2023] [Indexed: 02/18/2023]
Abstract
Background and Objectives: Various predisposing factors for lateral patellar dislocation (LPD) have been identified, but the relation between femoral rotational deformity and the tibial tubercle-Roman arch (TT-RA) distance remains elusive. Materials and Methods: We conducted this study including 72 consecutive patients with unilateral LPD. Femoral anteversion was measured by the surgical transepicondylar axis (S-tAV), and the posterior condylar reference line (P-tAV), TT-RA distance, trochlear dysplasia, knee joint rotation, patellar height, and hip-knee-ankle angle were measured by CT images or by radiographs. The correlations among these parameters were analyzed, and the parameters were compared between patients with and without a pathological TT-RA distance. Binary regression analysis was performed, and receiver operating characteristic curves were obtained. Results: The TT-RA distance was correlated with S-tAV (r = 0.360, p = 0.002), but the correlation between P-tAV and the TT-RA distance was not significant. S-tAV had an AUC of 0.711 for predicting a pathological TT-RA, with a value of >18.6° indicating 54.8% sensitivity and 82.9% specificity. S-tAV revealed an OR of 1.13 (95% CI [1.04, 1.22], p = 0.003) with regard to the pathological TT-RA distance by an adjusted regression model. Conclusions: S-tAV was significantly correlated with the TT-RA distance, with a correlation coefficient of 0.360, and was identified as an independent risk factor for a pathological TT-RA distance. However, the TT-RA distance was found to be independent of P-tAV.
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Bozzo I, Laverdière C, Corban J, Ge S, Pauyo T, Bernstein M. Equation predicting tibial-tuberosity to trochlear-groove distance following supratubercle osteotomy: Radiographic proof of concept. Clin Biomech (Bristol, Avon) 2023; 102:105892. [PMID: 36652877 DOI: 10.1016/j.clinbiomech.2023.105892] [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: 07/08/2022] [Revised: 12/13/2022] [Accepted: 01/10/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND Supratubercle tibial rotational osteotomies are useful in patellar stabilizing procedures with high tibial-tuberosity to trochlear-groove distance caused by excessive external tibial torsion. An investigation determined one degree of internal tibial rotation results in 0.68 mm reduction of tibial-tuberosity to trochlear-groove distance, but did not account for anatomical variability. METHODS This is a radiographic proof of concept for equation validation. We compared two different derived equations, a complex four-variable and simplified two-variable equation, to the literature relationship and true measured value from CT imaging. Bilateral pre-operative CTs of 37 patients, evaluated for malalignment, were reviewed retrospectively. We virtually simulated derotations of five, ten and fifteen degrees, and compared the reduction in tibial-tuberosity to trochlear-groove distance measured radiologically from CTs to the one predicted by our equation. FINDINGS The difference between the true change in tibial-tuberosity to trochlear-groove distance and that obtained using our four-variable was statistically insignificant for all derotation angles (p > 0.05), and the two-variable equation it was statistically insignificant for five and fifteen degrees of derotation (p > 0.05). Conversely, the true values were statistically different from those found using the published relationship (p < 0.05 for all). INTERPRETATION This new equation accounts for individual patient anatomy, for a more accurate relationship between internal rotation of the distal segment of the tibia and the subsequent decrease in the tibial-tuberosity to trochlear-groove distance. The change was overestimated using the linear relationship, which may result in under correction. Future studies will assess true post-operative distance change following osteotomy.
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Affiliation(s)
- Isabella Bozzo
- Faculty of Medicine, McGill University, 3605 Rue de la Montagne, Montréal, Québec H3G 2M1, Canada.
| | - Carl Laverdière
- Division of Orthopaedic Surgery, McGill University Health Center, Montreal General Hospital Site, 1650 Cedar Ave, Montreal, Quebec H3G 1A4, Canada
| | - Jason Corban
- Division of Orthopaedic Surgery, McGill University Health Center, Montreal General Hospital Site, 1650 Cedar Ave, Montreal, Quebec H3G 1A4, Canada
| | - Susan Ge
- Division of Orthopaedic Surgery, McGill University Health Center, Montreal General Hospital Site, 1650 Cedar Ave, Montreal, Quebec H3G 1A4, Canada
| | - Thierry Pauyo
- Division of Orthopaedic Surgery, McGill University Health Center, Montreal General Hospital Site, 1650 Cedar Ave, Montreal, Quebec H3G 1A4, Canada; Shriners Hospital for Children-Canada, 1003 Decarie Blvd, Montreal, Québec H4A 0A9, Canada
| | - Mitchell Bernstein
- Division of Orthopaedic Surgery, McGill University Health Center, Montreal General Hospital Site, 1650 Cedar Ave, Montreal, Quebec H3G 1A4, Canada; Shriners Hospital for Children-Canada, 1003 Decarie Blvd, Montreal, Québec H4A 0A9, Canada
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Hevesi M, Dandu N, Credille K, Wang Z, Zavras AG, Cregar WM, Trasolini NA, Yanke AB. Factors That Affect the Magnitude of Tibial Tubercle-Trochlear Groove Distance in Patients With Patellar Instability. Am J Sports Med 2023; 51:25-31. [PMID: 36412555 DOI: 10.1177/03635465221136535] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Tibial tubercle-trochlear groove (TT-TG) distance is a risk factor for recurrent patellar dislocation and is often included in algorithmic treatment of instability. The underlying factors that determine TT-TG have yet to be clearly described in orthopaedic literature. PURPOSE/HYPOTHESIS The purpose of our study was to determine the underlying anatomic factors contributing to TT-TG distance. We hypothesized that degree of tubercle lateralization and knee rotation angle may substantially predict TT-TG. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS All patients evaluated for patellar instability at a single institution between 2013 and 2021 were included. Patients with previous knee osseous procedures were excluded. TT-TG and its anatomic relationship to patellofemoral measures, including dysplasia, femoral anteversion, tibial tubercle lateralization, knee rotation angle, and tibial torsion, were measured and subsequently quantified using univariate and multivariable analysis. RESULTS In total, 76 patients met the inclusion criteria (46 female, 30 male; mean ± SD age, 20.6 ± 8.6 years) and were evaluated. Mean TT-TG was 16.2 ± 5.4 mm. On univariate analysis, increasing knee rotation angle (P < .01), tibial tubercle lateralization (P = .02), and tibial torsion (P = .01) were associated with increased TT-TG. In dysplastic cases, patients without medial hypoplasia (Dejour A or B) demonstrated significantly increased TT-TG (18.1 ± 5.4 mm) as compared with those with medial hypoplasia (Dejour C or D; TT-TG: 14.9 ± 5.2 mm; P = .02). Multivariable analysis revealed that increased knee rotation angle (+0.43-mm TT-TG per degree; P < .01) and tubercle lateralization (+0.19-mm TT-TG per percentage lateralization; P < .01) were statistically significant determinants of increased TT-TG distance. Upon accounting for these factors, tibial torsion, trochlear width, and medial hypoplasia were no longer significant components in predicting TT-TG (P≥ .54). Of note, all patients with TT-TG ≥20 mm had tibial tubercle lateralization ≥68%, a knee rotation angle ≥5.8°, or both factors concurrently. CONCLUSION TT-TG distance is most influenced by knee rotation angle and tibial tubercle lateralization.
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Affiliation(s)
- Mario Hevesi
- Midwest Orthopaedics at Rush, Chicago, Illinois, USA.,Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Navya Dandu
- Midwest Orthopaedics at Rush, Chicago, Illinois, USA
| | | | - Zachary Wang
- Midwest Orthopaedics at Rush, Chicago, Illinois, USA
| | | | | | | | - Adam B Yanke
- Midwest Orthopaedics at Rush, Chicago, Illinois, USA
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12
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Assessment of the reliability and validity of imaging measurements for patellofemoral instability: an updated systematic review. Skeletal Radiol 2022; 51:2245-2256. [PMID: 35794393 DOI: 10.1007/s00256-022-04110-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/28/2022] [Accepted: 06/28/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To provide an update on the reliability and validity of all radiological measures used to assess patients presenting with patellofemoral instability. METHODS A search of the CINHAL, EMBASE, MEDLINE, and SCOPUS databases and the Cochrane library was conducted. All studies assessing the validity, reliability, sensitivity, and specificity of radiological measures of the patellofemoral joints of patients with patellofemoral instability from 2010 onwards were considered for inclusion. Discrimination validity, inter- and intra-observer reliability, and the sensitivity and specificity of specific imaging measures were evaluated. RESULTS Seventy-three studies met the selection criteria and were included for analysis. We identified eight radiological measures in four categories with good reliability and validity: the tibial tubercle to trochlear groove distance, specific measures of patellar height (Blackburne-Peel index, Caton-Deschamps index and Insall-Salvati ratios), three measures of trochlear dysplasia (sulcus angle, trochlear depth, and lateral trochlear inclination), and the tibial tubercle to posterior cruciate ligament distance. No included studies examined the reliability and validity of patellofemoral instability ultrasound measures. CONCLUSION Our updated review demonstrated good inter- and intra-observer reliability and discrimination validity for the tibial tubercle-trochlear groove distance, specific patellar height, and trochlear dysplasia measures on MRI. The tibial tubercle to posterior cruciate ligament distance, an indirect measure of rotational asymmetry, was a valid and reliable measure on MRI. Due to a lack of assessments across more than one study, there are a variety of proposed measures with insufficient evidence to determine their validity, reliability, sensitivity, and specificity.
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13
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Ackermann J, Hasler J, Graf DN, Fucentese SF, Vlachopoulos L. The effect of native knee rotation on the tibial-tubercle-trochlear-groove distance in patients with patellar instability: an analysis of MRI and CT measurements. Arch Orthop Trauma Surg 2022; 142:3149-3155. [PMID: 33978809 DOI: 10.1007/s00402-021-03947-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 05/03/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND This study aimed to quantify the effect of lower limb rotational parameters on the difference in the tibial-tubercle-trochlear-groove (TTTG) distance when assessed with magnetic resonance imaging (MRI) and computed tomography (CT) in patients with patellar instability. It was hypothesized that an increased native knee rotation angle significantly contributes to an underestimation of TTTG by MRI. METHODS Forty patients with patellar instability who had undergone standard radiographs, MRI and CT scans were included in this retrospective study. A musculoskeletal radiologist assessed all imaging for TTTG, femoral and tibial rotation, knee rotation and flexion angle, and trochlear dysplasia. ΔTTTG was defined as the TTTG measured on MRI subtracted from the TTTG measured on CT. Statistical analysis determined the effect of these parameters on the calculated difference between TTTG when measured on CT and MRI. RESULTS Equal knee flexion in MRI and CT resulted in a ΔTTTG of 0.1 ± 0.3 mm compared to 4.0 ± 3.3 mm in patients with different knee flexion angles in both imaging acquisitions (p = 0.036). The knee rotation angle measured on CT (native knee rotation angle) was negatively correlated with ΔTTTG (r = - 0.365; p = 0.002), while neither tibial nor femoral rotation showed any associations with TTTG (n.s.). Trochlear dysplasia did not show any significant correlation with ΔTTTG, regardless of classification by Dejour or Lippacher (n.s.). Both the native knee rotation angle and the MRI knee flexion angle were independent predictors of ΔTTTG, yet with an opposing effect (knee rotation: 95% Confidence Interval [CI] for β - 0.468 to - 0.154, p < 0.001; knee flexion 95% CI for β 0.292 to 0.587, p < 0.001). Patients with a native knee rotation angle > 20° showed a ΔTTTG of - 5.8 ± 4.0 mm (MRI rather overestimates TTTG) compared to 0.9 ± 4.1 mm Δ TTTG (MRI rather underestimates TTTG) in patients with < 20° native knee rotation angle. CONCLUSION The native knee rotation angle is an independent, inversely correlated predictor of ΔTTTG, thus opposing the effect of knee flexion during MRI acquisition. Consequently, these results suggest that not only knee flexion but also knee rotation should be appreciated when assessing TTTG during patellar instability diagnostic evaluation as it can potentially lead to a false estimation of the TTTG distance on MRI. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Jakob Ackermann
- Department of Orthopedics, University Hospital Balgrist, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
| | - Julian Hasler
- Department of Orthopedics, University Hospital Balgrist, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Dimitri Nicolas Graf
- Department of Radiology, University Hospital Balgrist, University of Zurich, Zurich, Switzerland
| | - Sandro F Fucentese
- Department of Orthopedics, University Hospital Balgrist, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Lazaros Vlachopoulos
- Department of Orthopedics, University Hospital Balgrist, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
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Dong Z, Zhang X, Xu C, Ji G, Niu Y, Wang F. The tibial tubercle-posterior cruciate ligament (TT-PCL) distance does not truly reflect the lateralization of the tibial tubercle. Knee Surg Sports Traumatol Arthrosc 2022; 30:3470-3479. [PMID: 35366078 DOI: 10.1007/s00167-022-06927-2] [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: 04/22/2021] [Accepted: 02/23/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE The role of the tibial tubercle-posterior cruciate ligament (TT-PCL) and tibial tubercle-trochlear groove (TT-TG) in recurrent patellar instability (RPI) remains unclear. This study aims to confirm the validity of the TT-TG and TT-PCL in predicting RPI and to verify whether the TT-PCL can truly reflect the lateralization of the tibial tubercle. METHODS A total of 50 patients with RPI and 50 controls were recruited and underwent magnetic resonance imaging examinations. The TT-TG, TT-PCL, and tibial tubercle lateralization (TTL) were measured independently by two authors in a blinded and randomized fashion. T-test was used for parametric variances and the Mann-Whitney U and Chi-square tests were used for non-parametric variances. Pearson's product moment correlation coefficients were calculated to determine correlations between the defined measurements. The intraclass correlation coefficient was used to assess the reliability of the measurements. RESULTS All defined measurements showed excellent intra- and inter-observer reliability. The TT-TG distance, TT-PCL distance, and TTL were significantly greater in the PI group than in the control group. The AUC was highest for the TT-TG distance compared with that for the TT-PCL distance, and TTL were 0.798, 0.764, and 0.769, with the calculated cut-off value of 12.5 mm, 16.5 mm, and 66.1 percentages. There was a moderate correlation (r = 0.595) between the TT-TG distance and TTL, and a weak correlation (r = 0.430) between the TT-PCL distance and TTL. CONCLUSION Both the TT-TG distance and TT-PCL distance can be measured with excellent reliability on magnetic resonance imaging. The TT-TG distance, rather than the TT-PCL distance, has a better performance in predicting RPI. Most interestingly, the TT-PCL distance cannot reflect the real lateralization of TT. This study provides new information to evaluate TTL in patients with RPI. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Zhenyue Dong
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China
| | - Xiaoxiao Zhang
- Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China
| | - Chenyue Xu
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China
| | - Gang Ji
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China
| | - Yingzhen Niu
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China
| | - Fei Wang
- Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China.
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Xu C, Cui Z, Yan L, Chen Z, Wang F. Anatomical Components Associated With Increased Tibial Tuberosity-Trochlear Groove Distance. Orthop J Sports Med 2022; 10:23259671221113841. [PMID: 36003969 PMCID: PMC9393578 DOI: 10.1177/23259671221113841] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 05/17/2022] [Indexed: 11/29/2022] Open
Abstract
Background: Increased tibial tuberosity–trochlear groove (TT-TG) distance is an important
indicator of medial tibial tubercle transfer in the surgical management of
lateral patellar dislocation (LPD). Changes to TT-TG distance are determined
by a combination of several anatomical factors. Purpose: To (1) determine the anatomical components related to increased TT-TG
distance and (2) quantify the contribution of each to identify the most
prominent component. Study Design: Case-control study; Level of evidence, 3. Methods: Included were 80 patients with recurrent LPD and 80 age- and body mass
index–matched controls. The 2 groups were compared in TT-TG distance and its
related anatomical components: tibial tubercle lateralization (TTL),
trochlear groove medialization, femoral anteversion, tibiofemoral rotation
(TFR), tibial torsion, and mechanical axis deviation (MAD). The Pearson
correlation coefficient (r) was calculated to evaluate the
association between increased TT-TG distance and its anatomical parameters,
and factors that met the inclusion criteria of P < .05
and r ≥ 0.30 were analyzed via stepwise multivariable
linear regression analysis to predict TT-TG distance. Results: The LPD and control groups differed significantly in TT-TG distance, TTL,
TFR, and MAD (P < .001 for all). Increased TT-TG
distance was significantly positively correlated with TTL
(r = 0.376; P < .001), femoral
anteversion (r = 0.166; P = .036), TFR
(r = 0.574; P < .001), and MAD
(r = 0.415; P < .001), and it was
signficantly negatively correlated with trochlear groove medialization
(r = −0.178; P = .024). The stepwise
multivariable analysis revealed that higher TTL, excessive knee external
rotation, and excessive knee valgus were statistically significant
predictors of greater TT-TG distance (P < .001 for all).
The standardized estimates that were used for evaluating the predictive
values were larger for TFR compared with those for TTL and MAD. Conclusion: TTL, TFR, and MAD were the main independent anatomical components associated
with increased TT-TG distance, with the most prominent component being TFR.
The association of TT-TG distance to each component analyzed in our study
may help guide surgical planning.
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Affiliation(s)
- Chenyue Xu
- Third Affiliated Hospital, Hebei Medical University, Shijiazhuang, Hebei, China
| | - Zhaoxia Cui
- Hebei Medical University, Shijiazhuang, Hebei, China
| | - Lirong Yan
- Hebei Medical University, Shijiazhuang, Hebei, China
| | - Zheng Chen
- Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Fei Wang
- Third Affiliated Hospital, Hebei Medical University, Shijiazhuang, Hebei, China
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Shah NS, Kyriakedes JC, Liu RW. An MRI-based Study to Investigate If the Patella is Truly Centred between the Femoral Condyles in the Coronal Plane. Strategies Trauma Limb Reconstr 2022; 17:63-67. [PMID: 35990177 PMCID: PMC9357791 DOI: 10.5005/jp-journals-10080-1561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background An AP knee radiograph is considered adequate if the patella is centred between the femoral condyles. Our previous studies demonstrated a tendency for lateral patellar deviation on an AP view orthogonal to the posterior femoral condyles. However, findings were based on cadaveric samples limited by the lack of soft tissue effects on patellar positioning. Materials and methods After excluding those with deformity or damage to osseous or ligamentous structures, 106 knee MRI scans were randomly selected. Patellar centring was calculated as a percentage of total distal femoral intercondylar width and represented how lateral the centre of the patella is located with respect to the midpoint of the femoral condyles. Multiple regression analysis was performed to determine the relationship between patellar centring and age, gender, anatomic lateral distal femoral angle (aLDFA), medial proximal tibial angle (MPTA) and tibial tuberosity to trochlear groove (TT-TG) distance. Results There were 35 males and 71 females included in the study with a mean age of 29 ± 14 years. Mean patellar centring was 8 ± 4%. There was a statistically significant correlation between TT-TG distance and positive (lateral) patellar centring (standardised β = 0.36, p <0.01). There were no associations between aLDFA and MPTA with patellar centring. Conclusion This study demonstrates that the patella is rarely perfectly centred and is usually positioned slightly laterally within the femoral condyles in an AP view orthogonal to the posterior aspect of the femoral condyles. The use of supine MRI scans makes this data relevant to a patient on the operating room table. How to cite this article Shah NS, Kyriakedes JC, Liu RW. An MRI-based Study to Investigate If the Patella is Truly Centred between the Femoral Condyles in the Coronal Plane. Strategies Trauma Limb Reconstr 2022;17(2):63–67.
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Affiliation(s)
- Nihar S Shah
- Division of Pediatric Orthopaedic Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
- Nihar S Shah, Division of Pediatric Orthopaedic Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America, Phone: +3098307469, e-mail:
| | - James C Kyriakedes
- Division of Pediatric Orthopaedic Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United States of America
| | - Raymond W Liu
- Department of Pediatric Orthopaedics, Rainbow Babies and Children's Hospital at Case Western Reserve University, Cleveland, Ohio, United States of America
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Qi Y, Liu J, Sun M, Wang Z. Correlation Analysis between Tibial Tuberosity-Trochlear Groove Distance and Other Patellar Stability Parameters in Young and Middle-aged Populations. Orthop Surg 2022; 14:1817-1826. [PMID: 35711121 PMCID: PMC9363713 DOI: 10.1111/os.13370] [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: 03/31/2021] [Revised: 05/23/2022] [Accepted: 05/23/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The exact mechanism of patellofemoral instability has not been clearly clarified. The current study aims to explore the correlation between the tibial tuberosity-trochlear groove (TT-TG) distance and other patellar stability parameters. METHODS A total of 60 individuals aged 18 to 40 years who underwent knee computed tomography (CT) examination between September 2014 and December 2017 were retrospectively recruited. Five reference sites were selected on the femoral trochlear articular surface in every CT image. The TT-TG distance and the trochlear groove angles (TGA) at the five reference sites were measured. The patellar ligament length (PLL), patellar length (PL), medial patellar retinaculum length (MPRL) and lateral patellar retinaculum length (LPRL) were quantitatively analyzed. The TT-TG distances on different knee sides or in different sexes were compared. The relationships between the TT-TG distance and TGA, PLL/PL, MPRL, and LPRL were analyzed by Spearman's method. Comparison analysis among patellar stability parameters was analyzed using ANOVA or two-tailed Student's t test. RESULTS Variance analysis revealed no significant differences in the TT-TG distances among the five positions of the femoral trochlea (F = 0.67, P = 0.62) but significant differences among the five femoral TGAs at the five reference sites (F = 380.37, P < 0.01). Notably, an increasing tendency of the TT-TG distance was observed in the sexes (male, range 16.61-19.68 mm; female, range 14.37-17.38 mm) and knee sides (left knee, range 14.37-18.43 mm; right knee, range 15.80-19.68 mm). The TGA at site 1 of the femoral trochlear cartilage was the largest, with an angle of 151.97° ± 10.4°, and then gradually decreased to the smallest when the cartilage disappeared at site 5, with an angle of 92.05° ± 10.01°. Interestingly, there was a positive relationship between the TT-TG distance at site 1 and TGA in the right knees of males (r = 0.490, P = 0.033) as well as LPRL in the left knees of males (r = -0.420; P = 0.046). There were no correlations between the TT-TG distance and the other patellar stability parameters, including TGA, PLL/PL, MPRL, and LPRL. CONCLUSION Among young and middle-aged populations, patella surgeries should be carefully determined based on the comprehensive consideration of these patellar stability parameters rather than the TT-TG distance alone. Differences in sex and knee side should also be considered.
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Affiliation(s)
- Yang Qi
- Department of Radiology, Tianjin Hospital, Tianjin, China
| | - Jingyan Liu
- Department of Radiology, Tianjin Hospital, Tianjin, China
| | - Man Sun
- Department of Radiology, Tianjin Hospital, Tianjin, China
| | - Zhi Wang
- Department of Radiology, Tianjin Hospital, Tianjin, China
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Wu G, Cao Y, Song G, Li Y, Zheng T, Zhang H, Zhang Z. The Increased Tibiofemoral Rotation: A Potential Contributing Factor for Patellar Maltracking in Patients with Recurrent Patellar Dislocation. Orthop Surg 2022; 14:1469-1475. [PMID: 35698275 PMCID: PMC9251321 DOI: 10.1111/os.13358] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 05/15/2022] [Accepted: 05/18/2022] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE The purpose of this study was to analyze the relationship between tibiofemoral rotation and patellar maltracking in patients with recurrent patellar dislocation. METHODS A total of 143 consecutive knees (118 patients) with clinically diagnosed recurrent patellar dislocation from January 2018 to December 2019 were retrospectively analyzed. Patellar tilt angle and bisect offset index were recorded on axial CT to assesses the severity of patellar maltracking. Tibiofemoral rotation angle is measured by comparing the angle between the posterior femoral and tibial condylar lines on three-dimensional CT. The Pearson correlation was calculated to investigate the association between tibiofemoral rotation angle and patellar maltracking. Patients were divided into the rotation group (≥15°) and control group (<15°) based on the value of tibiofemoral rotation and a further comparison was performed. To further clarify the complicated relationship among tibial tubercle-trochlear groove (TT-TG), tibial tubercle-posterior cruciate ligament distance (TT-PCL), tibiofemoral rotation, and patellar maltracking, patients were divided into four subgroups according to the value of TT-TG and TT-PCL. RESULTS The mean preoperative tibiofemoral rotation angle was 12° ± 6° (range, 0°-31°). Pearson correlation between patellar maltracking parameters (bisect offset index, patellar tilt angle) and various bony deformities found that the tibiofemoral rotation angle was moderately correlated with bisect offset index (r = 0.451, p < 0.001) and patellar tilt angle (r = 0.462, p < 0.001). Further results demonstrated that bisect offset index (152.1 vs 121.2, p < 0.001) and patellar tilt angle (41.2° vs 33.5°, p < 0.001) were significantly higher in the rotation group than that in control group. For patients with a TT-TG distance of >20 mm, the increased TT-TG distance was mainly caused by tibiofemoral rotation angle in group C (TT-TG > 20 mm, TT-PCL < 24 mm) and predominantly induced by tibial tubercle lateralization in group D (TT-TG > 20 mm, TT-PCL > 24 mm). Bisect offset index and patellar tilt angle were significantly higher in the group C than group D. CONCLUSION The increased tibiofemoral rotation angle is associated with patellar maltracking in patients with recurrent patellar dislocation. Patients with increased tibiofemoral rotation angle usually have more severe patellar maltracking.
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Affiliation(s)
- Guan Wu
- Sports Medicine Service, Beijing jishuitan hospital, Beijing, China
| | - YanWei Cao
- Sports Medicine Service, Beijing jishuitan hospital, Beijing, China
| | - GuanYang Song
- Sports Medicine Service, Beijing jishuitan hospital, Beijing, China
| | - Yue Li
- Sports Medicine Service, Beijing jishuitan hospital, Beijing, China
| | - Tong Zheng
- Sports Medicine Service, Beijing jishuitan hospital, Beijing, China
| | - Hui Zhang
- Sports Medicine Service, Beijing jishuitan hospital, Beijing, China
| | - ZhiJun Zhang
- Sports Medicine Service, Beijing jishuitan hospital, Beijing, China
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19
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Chen J, Wu C, Ye Z, Zhao J, Xie G. Tibial Tuberosity-Trochlear Groove Distance and Its Components in Patients with and without Episodic Patellar Dislocation: A Study of 781 Knees. J Bone Joint Surg Am 2022; 104:504-511. [PMID: 34851325 DOI: 10.2106/jbjs.21.00656] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purposes of the present study were (1) to measure the tibial tuberosity-trochlear groove distance and its components with the knee in extension, (2) to determine their diagnostic performance in distinguishing between patients with and without episodic patellar dislocation, and (3) to investigate the relationship of each component to the total tibial tuberosity-trochlear groove distance. METHODS We retrospectively reviewed computed tomography (CT) images of the knee joint in a group of patients with episodic patellar dislocation and a group of control subjects who were treated for another type of knee disorder in our institution between 2015 and 2021. Tibial tuberosity-trochlear groove distance, tibial tubercle lateralization, trochlear groove medialization, and knee rotation were measured on axial images. Partial correlation analysis of the measured parameters was performed after adjusting for remaining variables. Receiver operating characteristic (ROC) curves and the areas under the ROC curves (AUCs) were assessed to assess the diagnostic accuracy. A subgroup analysis based on femoral trochlear dysplasia classification was also performed. RESULTS After screening of 653 patients (947 knees) in our hospital's patient registry, a total of 521 patients (781 knees) were analyzed, including 541 knees (69.3%) with episodic patellar dislocation and 240 knees (30.7%) without episodic patellar dislocation (control group). The tibial tuberosity-trochlear groove distance demonstrated the best diagnostic performance, with the AUC being significantly better than that for other parameters (p < 0.001). The tibial tuberosity-trochlear groove distance was moderately to strongly correlated with knee rotation and trochlear groove medialization in the control and episodic patellar dislocation groups (p < 0.001). However, tibial tubercle lateralization showed a weak correlation with the tibial tuberosity-trochlear groove distance in the control group and moderate correlation in the episodic patellar dislocation group (p < 0.001). Knees with a type-D femoral trochlea had a significantly greater tibial tuberosity-trochlear groove distance than those with a type-A, B, or C femoral trochlea (p ≤ 0.011). CONCLUSIONS Tibial tuberosity-trochlear groove distance, a reliable predictor of episodic patellar dislocation, was affected more by knee rotation and trochlear groove medialization and was less affected by tibial tubercle lateralization, and it increased with an increasing grade of femoral trochlear dysplasia. The correlation of the tibial tuberosity-trochlear groove distance and its components as noted in the current study will help to achieve a better understanding of the tibial tuberosity-trochlear groove distance. LEVEL OF EVIDENCE Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Jiebo Chen
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
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20
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Leite CBG, Santos TP, Giglio PN, Pécora JR, Camanho GL, Gobbi RG. Tibial Tubercle Osteotomy With Distalization Is a Safe and Effective Procedure for Patients With Patella Alta and Patellar Instability. Orthop J Sports Med 2021; 9:2325967120975101. [PMID: 33553451 PMCID: PMC7829522 DOI: 10.1177/2325967120975101] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 09/14/2020] [Indexed: 01/17/2023] Open
Abstract
Background: Tibial tubercle osteotomy with concomitant distalization for the treatment of
patellar instability remains controversial, as it may cause anterior knee
pain and chondral degeneration. Purpose: To evaluate radiographic, clinical, and functional outcomes in patients who
had patellar instability with patella alta and underwent tibial tubercle
osteotomy with distalization (TTO-d) as well as medial patellofemoral
ligament reconstruction. Study Design: Case series; Level of evidence, 4. Methods: Included in this study were 25 patients (31 cases) (mean age at surgery, 28.7
years; range, 14-33 years) with patellar instability and patella alta who
underwent TTO-d with minimum 1-year follow-up. The Caton-Deschamps index
(CDI), tibial tubercle–trochlear groove (TT-TG) distance, and amount of
distalization were assessed. Clinical and functional variables included
J-sign, anterior knee pain, apprehension test, Tegner activity level, and
Kujala score. Results: The mean follow-up period was 2.62 years. The mean TT-TG was 16.15 mm (range,
7-24 mm); the mean CDI changed from 1.37 (1.25-1.7) preoperatively to 1.02
(0.9-1.12) postoperatively (P = .001); and the mean amount
of tibial tubercle distalization was 8.80 mm (range, 4-16 mm). Lateral
release (22 cases; 71.0%), medialization of tibial tubercle (17 cases;
54.8%), and autologous chondrocyte implantation (4 cases; 12.9%) were other
associated procedures. The J-sign improved in 30 cases (96.8%;
P = .001), and there was a complete resolution of
anterior knee pain in 22 cases (71.0%; P = .001). An
exploratory analysis showed that patellar cartilage defect severity was
correlated with persistent pain (P = .005). The
apprehension test became negative in all cases (P = .001).
The median Kujala score increased from 52 to 77 (P = .001),
and the median Tegner activity level improved from 3 to 4
(P = .001). No cases of osteotomy nonunion were
reported. One case (3.2%) of patellar instability recurrence and 3 cases
(6.5%) with painful hardware were observed. Conclusion: TTO-d resulted in good radiographic, clinical, and functional outcomes
providing proper patellar stability to patients with patella alta. TTO-d
appears to be a safe and efficient procedure with low complication rates,
providing an additional tool for the personalized treatment of patellar
instability.
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Affiliation(s)
- Chilan B G Leite
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Társis P Santos
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Pedro N Giglio
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - José R Pécora
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Gilberto L Camanho
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Riccardo G Gobbi
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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21
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Zink C, Schlehr MR. Working Dog Structure: Evaluation and Relationship to Function. Front Vet Sci 2020; 7:559055. [PMID: 33195533 PMCID: PMC7606876 DOI: 10.3389/fvets.2020.559055] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 09/03/2020] [Indexed: 11/13/2022] Open
Abstract
Working dogs help to keep society and individuals safe, secure, and healthy. To perform their varied functions, it is critical to select dogs that are structurally sound and capable of demonstrating power, coordination and agility. Characteristics such as size and substance, head and axial skeletal structure, chest size and conformation, and thoracic and pelvic limb angulation should be evaluated to select the optimal combination of characteristics to suit the tasks to which each dog will be assigned. This review provides guidance on how to evaluate each of these structural components and discusses the contributions of those body parts to a working dog's function.
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Affiliation(s)
- Chris Zink
- Zink Integrative Sports Medicine, Ellicott City, MD, United States
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22
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Tibial tuberosity-tibial intercondylar midpoint distance measured on computed tomography scanner is not biased during knee rotation and could be clinically more relevant than current measurement systems. INTERNATIONAL ORTHOPAEDICS 2020; 45:959-970. [PMID: 33037445 DOI: 10.1007/s00264-020-04820-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 09/15/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The purpose of this retrospective cross-sectional case-control study was to evaluate an alternative imaging test for lateralization of the tibial tuberosity, unbiased towards knee rotation. METHODS On axial CT images of 129 knees, classified as cases (two or more patellar luxations) and controls (no patellar luxations), two raters gauged the standard tibial tuberosity-trochlear groove (TT-TG) distance, tibial tuberosity-femoral intercondylar midpoint (TT-FIM) distance, and new tibial tuberosity-tibial intercondylar midpoint (TT-TIM) distance singly, and knee longitudinal rotation angles (LRAs), and the presence of femoral trochlear dysplasia (FTD) jointly. RESULTS All imaging tests intercorrelated and discriminated between stability groups. TT-TIM had the lowest values with the highest precision. Though poorly, TT-TG and TT-FIM negatively correlated with age and LRAs regarding femur, but positively with presence of FTD, whereas TT-TIM was unbiased. The accuracy of TT-TG (> 20 mm), TT-FIM (> 20 mm), and TT-TIM (> 13 mm) was good with almost perfect reproducibility. Only TT-TIM was sex-biased (p = 0.009), with > 12 mm cut-off in females and (presumably) > 14 mm in males. CONCLUSION TT-TIM is an alternative imaging test for lateralization of the tibial tuberosity, unbiased towards knee rotation.
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23
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Song SY, Kim TS, Seo YJ. Initial conservative treatment of osteochondral fracture of the patella following first-time patellar dislocation. BMC Musculoskelet Disord 2020; 21:617. [PMID: 32943024 PMCID: PMC7499907 DOI: 10.1186/s12891-020-03641-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 09/10/2020] [Indexed: 01/03/2023] Open
Abstract
Background There has been no gold standard of the initial treatment strategy for acute patellar dislocation (APD) with osteochondral fracture (OCF). Hence the study aim is firstly, to review and compare clinical outcomes of patients who underwent conservative treatment for APD with or without OCF. Secondly, to characterize the location and size of fracture fragment. Methods Sixty-nine consecutive patients who were retrospectively evaluated after first-time APD over a 2- year period were divided into two groups (group 1 (n = 24): APD with OCF and group 2 (n = 45): APD only). Magnetic resonance imaging (MRI) was used to assess patients with APD and OCF from the medial patella. All patients were treated with a supervised course of immobilization followed by progressive range of motion and strength exercise protocol. History of a recurrent dislocation, radiologic and functional scores were analyzed. Results Redislocation rate was 31.2% in group 1 and 26.6% in group 2, showing no significant difference between the two groups (p = 0.690). Intergroup differences in terms of final Kujala and IKDC scores were not significant (p = 0.117 and p = 0.283, respectively). Fracture sites of the patella in group 1 were classified as follows: patellar medial margin (12), inferomedial facet (7), and inferomedial facet involving central ridge (5). In the subgroup of patient with OCF of the inferomedial facet of the patella, the fragments were found in the lateral gutter and did not cause pain or mechanical symptoms. Thus, loose body removal was not performed. However, all five patients with large OCF involving the central ridge of the patella failed non-operative treatment with recurrent dislocations, ultimately requiring fragment refixation and medial retinacular imbrication. Conclusions First, APD patients with OCFs of medial margin or inferomedial facet showed similar redislocation rates and functional knee scores with those without OCFs after conservative treatment. Second, initial conservative treatment failed in some APD patients with large OCF, especially when OCFs were fractured from inferomedial facet involving central ridge. Surgery should be considered with this type.
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Affiliation(s)
- Si Young Song
- Department of Orthopaedic Surgery, Hallym University Dongtan Sacred Heart Hospital, 7, Keunjaebong-gil, Hwaseong-si, Gyeonggi-do, Republic of Korea
| | - Tae-Soung Kim
- Department of Orthopaedic Surgery, Hallym University Dongtan Sacred Heart Hospital, 7, Keunjaebong-gil, Hwaseong-si, Gyeonggi-do, Republic of Korea
| | - Young-Jin Seo
- Department of Orthopaedic Surgery, Hallym University Dongtan Sacred Heart Hospital, 7, Keunjaebong-gil, Hwaseong-si, Gyeonggi-do, Republic of Korea.
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24
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Shu L, Ni Q, Yang X, Chen B, Wang H, Chen L. Comparative study of the tibial tubercle-trochlear groove distance measured in two ways and tibial tubercle-posterior cruciate ligament distance in patients with patellofemoral instability. J Orthop Surg Res 2020; 15:209. [PMID: 32513201 PMCID: PMC7278153 DOI: 10.1186/s13018-020-01726-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 05/25/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND A comparative analysis of the strengths and weaknesses of three different methods for radiologic evaluation of patellofemoral instability (PFI). METHODS Computed tomography (CT) and magnetic resonance imaging (MRI) were performed in 47 patients with or without PFI. The tibial tubercle-trochlear groove (TT-TG) distance was measured by two observers through conventional CT and three-dimensional CT reconstruction (TDR-TT-TG) respectively and the tibial tubercle-posterior cruciate ligament (TT-PCL) distance with MRI. The intraclass correlation coefficient (ICC) was used to evaluate the interobserver reliability. In addition, the differences of three measurements between different patients were compared. The consistency of TT-TG and TDR-TT-TG was analyzed by the Bland-Altman method. RESULTS The ICCs of three measurements were high between two observers; the results were TT-TG (ICC = 0.852), TDR-TT-TG (ICC = 0.864), and TT-PCL (ICC = 0.758). The values of PFI patients were significantly higher than those of non-PFI patients, and the mean TT-TG, TDR-TT-TG, and TT-PCL distance in patients with PFI were 19.0 ± 3.8 mm, 19.0 ± 3.7 mm, and 25.1 ± 3.6 mm, respectively. There was no statistically significant difference between the TT-TG distance and the TDR-TT-TG distance, we found no significant difference. The Bland-Altman analysis showed that the TDR-TT-TG distance was in good agreement with the TT-TG distance. CONCLUSION All three methods can be used to assess PFI; the TDR-TT-TG measurement method has superior operability and better interobserver consistency. It may be an alternative method to the conventional TT-TG distance measurement.
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Affiliation(s)
- Lei Shu
- Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Qubo Ni
- Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Xu Yang
- Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Biao Chen
- Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Hua Wang
- Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Liaobin Chen
- Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.
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25
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Yoon KH, Kim EJ, Kwon YB, Hwang IU, Kim SG. Comparison of Clinical and Radiological Outcomes Between Transosseous Tunnel and Suture Anchor Patellar Fixation for Medial Patellofemoral Ligament Reconstruction: A Cohort Study With 2-Year Follow-up. Orthop J Sports Med 2020; 8:2325967120917660. [PMID: 32490024 PMCID: PMC7238806 DOI: 10.1177/2325967120917660] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Several surgical methods have been developed for medial patellofemoral ligament reconstruction (MPFLR). However, the question of which patellar fixation method, suture anchor (SA) or transosseous tunnel (TO) fixation, achieves better overall outcomes remains to be answered. HYPOTHESIS SA patellar fixation will present comparable clinical outcomes and a lower complication rate compared with TO patellar fixation for MPFLR. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS We retrospectively reviewed the outcomes of 46 patients who underwent MPFLR with either TO fixation (n = 21; mean age, 24.4 ± 6.1 years) or SA fixation (n = 25; mean age, 24.1 ± 12.1 years) for the treatment of recurrent patellar dislocation. Clinical findings (International Knee Documentation Committee [IKDC] subjective score, Lysholm score, and Tegner activity score), radiological findings (congruence angle and patellar tilt angle), and complications (redislocation, patellar fracture, patellofemoral osteoarthritis progression, infection, and stiffness) were compared between the TO and SA groups at the 2-year follow-up visit. RESULTS The mean postoperative IKDC subjective and Lysholm scores did not differ significantly between groups. However, postoperative Tegner activity scores were significantly higher in the TO group than in the SA group (TO, 5.8 ± 1.4; SA, 4.9 ± 1.2; P = .012). Congruence angle did not differ significantly between the groups (TO, -3.2 ± 22.8; SA, -7.6 ± 17.8; P = .464). Patellar tilt angle was lower in the TO group than in the SA group (TO, 10.5 ± 5.4; SA, 13.7 ± 2.8; P = .015). During the follow-up period, the TO group had 1 redislocation and 2 patellar fractures, whereas the SA group had no redislocations or fractures. Patellofemoral osteoarthritis progression was significantly higher in the TO group than in the SA group at the 2-year follow-up visit (TO, 9/21; SA, 2/25; P = .006). CONCLUSION Both TO and SA patellar fixation methods for MPFLR showed improved clinical outcomes. When compared with TO fixation, SA fixation presented comparable clinical outcomes and a lower complication rate.
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Affiliation(s)
- Kyoung Ho Yoon
- Department of Orthopaedic Surgery, Kyung Hee University Hospital,
Seoul, Republic of Korea
| | - Eung Ju Kim
- Department of Orthopaedic Surgery, Kyung Hee University Hospital,
Seoul, Republic of Korea
| | - Yoo Beom Kwon
- Department of Orthopaedic Surgery, Kyung Hee University Hospital,
Seoul, Republic of Korea
| | - In Uk Hwang
- Department of Orthopaedic Surgery, Kyung Hee University Hospital,
Seoul, Republic of Korea
| | - Sang-Gyun Kim
- Department of Orthopedic Surgery, Korea University Ansan Hospital,
Gyeongki-do, Republic of Korea
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