Patellofemoral Case Study: Patella Instability, High TT-TG, Patella Alta + Trochlear Dysplasia in a Skeletally Mature Female

2021 ◽  
pp. 117-123
Author(s):  
Jason L. Koh ◽  
Andrew Cosgarea ◽  
Phillippe Neyret ◽  
Elizabeth A. Arendt
Keyword(s):  
Trochlear Dysplasia ◽  
Mature Female ◽  
Patella Alta ◽  
Patella Instability

scholarly journals The occurrence of albinism in roe deer: A case study

2018 ◽  
Vol 74 (1) ◽  
pp. 6036-2018
Author(s):  
MARIAN FLIS ◽  
EUGENIUSZ R. GRELA ◽  
DARIUSZ GUGAŁA ◽  
BOGUSŁAW RATAJ
Keyword(s):  
Roe Deer ◽  
Mature Female ◽  
The Other ◽  
Hunting Season ◽  
Partial Albinism ◽  
Phenotypic Features

Two cases of albinism in roe deer were reported in the Lublin region in the spring of 2017. Both animals were females. One of them was a mature female roe deer with partial albinism. The other was a young roe deer (kid) born in the previous hunting season, which was a true albino, most probably descended from a female roe deer with pseudo-leukoderma. Since the eyes of these animals could not be examined, it was impossible to conclude about their leucism. No male roe deer in a group of 14 animals showed phenotypic features of albinism. This confirms that albinism in roe deer occurs very rarely, because it is conditioned by recessive alleles, and its phenotypic manifestations can take many forms..

Risk Factors and Time to Recurrent Ipsilateral and Contralateral Patellar Dislocations

2017 ◽  
Vol 45 (9) ◽  
pp. 2105-2110 ◽  
Author(s):  
Tyson C. Christensen ◽  
Thomas L. Sanders ◽  
Ayoosh Pareek ◽  
Rohith Mohan ◽  
Diane L. Dahm ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cumulative Incidence ◽  
Patellar Dislocation ◽  
Patellar Instability ◽  
Trochlear Dysplasia ◽  
Patella Alta ◽  
Time To Recurrence ◽  
Lateral Patellar Dislocation ◽  
Ipsilateral Recurrence ◽  
First Time

Background: Previous studies have reported variable rates of recurrent lateral patellar instability mainly because of limited cohort sizes. In addition, there is currently a lack of information on contralateral patellar instability. Purpose: To evaluate the rate of recurrent ipsilateral patellar dislocations and contralateral patellar dislocations after a first-time lateral patellar dislocation. Additionally, risk factors associated with recurrent dislocations (ipsilateral or contralateral) and time to recurrence were investigated. Study Design: Cohort study; Level of evidence, 3. Methods: This population-based study included 584 patients with a first-time lateral patellar dislocation occurring between 1990 and 2010. A retrospective review was conducted to gather information about the injury, subsequent dislocations (ipsilateral or contralateral), and structural characteristics including trochlear dysplasia, patella alta, and tibial tubercle to trochlear groove (TT-TG) distance. Risk factors were assessed to delineate associations with subsequent dislocations and time to recurrence. Results: At a mean follow-up of 12.4 years, 173 patients had ipsilateral recurrence, and 25 patients had a subsequent contralateral dislocation. At 20 years, the cumulative incidence of ipsilateral recurrence was 36.0%, while the cumulative incidence of contralateral dislocations was 5.4%. Trochlear dysplasia (odds ratio [OR], 18.1), patella alta (OR, 10.4), age <18 years at the time of the first dislocation (OR, 2.4), elevated TT-TG distance (OR, 2.1), and female sex (OR, 1.5) were associated with recurrent ipsilateral dislocations. Time to recurrence was significantly decreased in patients with trochlear dysplasia (23.0 months earlier time to recurrence; P < .001), elevated TT-TG distance (18.5 months; P < .001), patella alta (16.4 months; P = .001), and age <18 years at the time of the first dislocation (15.4 months; P < .001). Risk factors for subsequent contralateral dislocations included patella alta and trochlear dysplasia. Conclusion: At 20 years after a first-time lateral patellar dislocation, the cumulative incidence of recurrent ipsilateral patellar dislocations was 36.0%, compared with 5.4% for contralateral dislocations. Trochlear dysplasia, elevated TT-TG distance, patella alta, age <18 years at the time of the first dislocation, and female sex were associated with ipsilateral recurrence. Trochlear dysplasia, elevated TT-TG distance, patella alta, and age <18 years at the time of the first dislocation were predictive of a statistically significant decrease in time to recurrence.

scholarly journals Identifying Patients With Patella Alta and/or Severe Trochlear Dysplasia Through the Presence of Patellar Apprehension in Higher Degrees of Flexion

2020 ◽  
Vol 8 (6) ◽  
pp. 232596712092548
Author(s):  
Matthew Colatruglio ◽  
David C. Flanigan ◽  
Sarah Harangody ◽  
Robert A. Duerr ◽  
Christopher C. Kaeding ◽  
...  
Keyword(s):  
Knee Flexion ◽  
Patellar Instability ◽  
Trochlear Dysplasia ◽  
Patella Alta ◽  
Tibial Tubercle ◽  
Trochlear Groove ◽  
Type B ◽  
Level Of Evidence ◽  
Sulcus Angle ◽  
Recurrent Patellar Instability

Background: Recurrent patellar instability is frequently treated surgically with reconstruction of the medial patellofemoral ligament (MPFL). Patients with significant patella alta, trochlear dysplasia, and/or an elevated tibial tubercle–trochlear groove (TT-TG) distance may benefit from a concurrent bony procedure such as tibial tubercle osteotomy or trochleoplasty. The indications to perform such procedures are traditionally based on imaging criteria but remain controversial. Patellar apprehension is common in patients with patellar instability but typically resolves in higher degrees of knee flexion. Hypothesis: The persistence of patellar apprehension at greater than 60° of knee flexion is associated with patella alta, an increased TT-TG distance, and trochlear dysplasia. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 76 patients with recurrent patellar instability were prospectively identified in a sports medicine clinic. Patellar apprehension was evaluated in each patient. Apprehension was defined as the patient reporting that the patella felt unstable to lateral patellar translation. Apprehension was first assessed at full knee extension and repeatedly assessed as the knee was flexed in 10° intervals, as measured using a goniometer. The degree of flexion at which patellar apprehension disappeared was recorded. Plain radiographs and magnetic resonance imaging (MRI) scans were obtained for all patients. Patellar height was assessed with the Caton-Deschamps (CD) index, and trochlear morphology was assessed through measurements of the sulcus angle and depth on MRI and classified using the Dejour classification system. Imaging measurements of patients in whom apprehension resolved by 60° of knee flexion were compared with measurements for those with apprehension that persisted deeper into flexion. Results: Apprehension resolved by 60° of flexion in 56 patients and persisted into deeper flexion in 20 patients. The patients with a delayed resolution of apprehension demonstrated a higher CD index; elevated TT-TG distance; increased sulcus angle; decreased sulcus depth; and higher incidence of Dejour type B, C, or D dysplasia (all P < .05). Of the 20 patients with a delayed resolution of apprehension, 18 had either Dejour type B, C, or D dysplasia or a CD index of at least 1.30. A delayed resolution of apprehension was present in 11 of the 16 patients with Dejour type B, C, or D dysplasia. Conclusion: Overall, 90% of patients with significant patella alta and the majority of patients with high-grade trochlear dysplasia demonstrated patellar apprehension that persisted beyond 60° of knee flexion. Additionally, 90% of patients with persistent apprehension had significant patella alta and/or trochlear dysplasia. Further work is needed to evaluate the utility of these findings to inform surgical decision-making in this population.

Anatomic Risk Factors for Focal Cartilage Lesions in the Patella and Trochlea: A Case-Control Study

2019 ◽  
Vol 47 (10) ◽  
pp. 2444-2453 ◽  
Author(s):  
Luiz Felipe Ambra ◽  
Betina B. Hinckel ◽  
Elizabeth A. Arendt ◽  
Jack Farr ◽  
Andreas H. Gomoll
Keyword(s):  
Risk Factors ◽  
Trochlear Dysplasia ◽  
Cartilage Lesion ◽  
Patella Alta ◽  
Lesion Group ◽  
Control Group ◽  
Trochlear Groove ◽  
Patellar Tilt ◽  
Sulcus Angle ◽  
Cartilage Lesions

Background:Focal cartilage lesions in the patellofemoral (PF) joint are common. Several studies correlated PF risk factors with PF instability, anterior knee pain, and PF arthritis; however, there is a lack of evidence correlating those factors to PF focal cartilage lesions.Purpose:To evaluate the influence of the anatomic PF risk factors in patients with isolated focal PF cartilage lesions.Study Design:Cross-sectional study; Level of evidence, 3.Methods:Patients with isolated PF focal cartilage lesions were included in the cartilage lesion group, and patients with other pathologies and normal PF cartilage were included in the control group. Multiple PF risk factors were accessed on magnetic resonance imaging scans: patellar morphology (patellar width, patellar thickness, and patellar angle), trochlear morphology (trochlear sulcus angle, lateral condyle index, and trochlear sulcus depth), patellar height (Insall-Salvati ratio and Caton-Deschamps index), axial patellar positioning (patellar tilt, angle of Fulkerson), and quadriceps vector (tibial tuberosity–trochlear groove distance).Results:A total of 135 patients were included in the cartilage lesion group and 100 in the control group. As compared with the control group, the cartilage lesion group had a higher sulcus angle ( P = .0007), lower trochlear sulcus depth ( P < .0001), lower angle of Fulkerson ( P < .0001), lower patellar width ( P = .0003), and higher Insall-Salvati ratio ( P < .0001). From the patients in the cartilage lesion group, 36% had trochlear dysplasia; 27.6%, patella alta; and 24.7%, abnormal patellar tilt. These parameters were more frequent in the cartilage lesion group ( P < .0001). Trochlear lesions were more frequent in men, presented at an older age, and had fewer associated anatomic risk factors. Patellar lesions, conversely, were more frequent in women, presented at younger age, and were more closely associated with anatomic risk factors.Conclusion:PF anatomic abnormalities are significantly more common in patients with full-thickness PF cartilage lesions. Trochlear dysplasia, patella alta, and excessive lateral patellar tilt are the most common correlated factors, especially in patellar lesions.

scholarly journals Objective Quantification of Trochlea Dysplasia: Assessment of Morphology Difference Between Control and Chronic Patellofemoral Instability Patients

2017 ◽  
Vol 5 (4_suppl4) ◽  
pp. 2325967117S0013
Author(s):  
Andreas Voss ◽  
Andrea Achtnich ◽  
Shin Sanghin ◽  
Akin M. Murakami ◽  
Cory Edgar
Keyword(s):  
Trochlear Dysplasia ◽  
Patellofemoral Instability ◽  
Volumetric Analysis ◽  
Patella Instability ◽  
Control Cohort ◽  
X Ray ◽  
Significant Difference ◽  
Trochlea Dysplasia ◽  
The Difference ◽  
Gender Based

Aims and Objectives: Trochlear dysplasia is an important risk factor associated with patellofemoral instability, but it remains difficult to classify with consistency. Currently there is no objective way to quantify the dysplasia. The purpose of this study to define and quantify objectively the trochlea morphology by volume and length via computed tomography (CT). Hypothesis: A significant difference in trochlea groove volume and length is present within a cohort of patients with recurrent patellofemoral instability if compared to a control cohort of similar patients. Materials and Methods: One-hundred control patients (136 knees) were retrospectively reviewed and compared to 36 consecutive patients (72 knees) who were treated surgically for recurrent patella instability and known trochlea dysplasia based on a lateral x-ray. Trochlea morphology was analyzed from a pre-operative CT and data presented as trochlear sulcus volume trochlea length. To determine where along the trochlea length dysplasia is most variable, the trochlea length was radiographically divided into thirds, volume was quantified along that section and compared to control trochlea. Results: A significant difference in trochlea morphology exists between cohorts, volume (1.98 vs 3.77 cm3) and length (31.97 vs 34.66 mm). However, there appears to be a gender based difference in trochlea morphology. The trochlea volumetric analysis between the female cohorts (L: 2.02 cm3 vs. 2.94 cm3, R: 1.95 cm3 vs. 2.93 cm3) demonstrated significant less volume in instability patients (p<0.001). The proximal 30% of trochlea contributed the majority of dysplasia difference determined by comparing mean trochlea volume, 95% of the difference. This difference decreased in distal sections, 53% and 32% respectively. The total trochlea length did not appear to be significant (L: p=0.858, R: p=0.913). It appears dysplasia alone may not directly lead to symptoms demonstrated by trochlea volumetric comparisons within symptomatic recurrent patella instability and contralateral asymptomatic patella (p=0.274). Conclusion: The authors believe this reproducible technique can be used to quantify the trochlea morphology into measurements to be used describing the severity of the dysplasia. The data confirms that symptomatic trochlea dysplasia is a “proximal” process affecting early knee flexion contact between patella and trochlea.

scholarly journals Distalization Of Tibial Tubercle For Patella Stabilization: Does Length Of Distalization Or Residual Patella Alta Effect Outcome?

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0030
Author(s):  
Andrew Schmiesing ◽  
Marta Engelking ◽  
Julie Agel ◽  
Elizabeth A. Arendt
Keyword(s):  
Surgical Procedure ◽  
Trochlear Dysplasia ◽  
Patella Alta ◽  
High Rate ◽  
Tibial Tubercle ◽  
Patella Dislocation ◽  
Patella Height ◽  
Increased Risk ◽  
Increase Fracture Risk ◽  
Lateral Patella

Objectives: Distalization of the tibial tubercle (DTT) is a surgical procedure to help stabilize the patella when patella alta is present. The purpose of this study is to: evaluate the accuracy of our operative intervention (i.e. how often is patella height normalization achieved). correlate post-operative (residual) patella alta with recurrent patellar instability correlate the mm of distal displacement with negative outcomes Methods: Data was collected retrospectively on consecutive patients who underwent DTT as part of their surgical procedure for recurrent lateral patella dislocation. All patients had concurrent medial patella ligament reconstruction (MPFLR), performed by a single surgeon between 2009-2015. Data collected included demographics, pre-and post-operative imaging measurements related to patella alta and trochlear dysplasia on MRI and plain radiographs, recurrent lateral patella dislocations, and complications including fracture and knee arthrofibrosis. Surgical planning including the assessment of the Caton-Deschamps index (CD) on sagittal radiographic imaging. The surgical goal was to have a final CD between 1.0 -1.2, or a maximum distance moved of 15 mm in cases of severe patella alta. When CD was within normal limits due to patellar anatomy, we used as a proxy the patellar-trochlear index (PTI), aiming for a PTI of 25% judged intra-operatively. Results: 89 patients underwent DTT over a 7-year period. There were 21 (24%) males/68 (76%) females. Mean (range): age 21 (13-45), BMI 25.8 (17-44.6). Pre-op imaging measurements were: IS ratio 1.5 (1.18-2.06), CD ratio 1.4 (1.05 -1.93), lateral patella tilt 24.7º (1º-53º), TT-TG 18.6 mm (8-28), sulcus angle 158º (123-180), PTI 29% (5-70). Post-operative mean CD was 1.09 (0.92 -1.67). The amount of distalization averaged 9.8 (range 4 to 15). 13 patients had residual patella alta (CD>1.2). One patient with residual patella alta re-dislocated (CD=1.25). The most extreme residual patella alta (1.67) had a pre-op CD of 1.97 and was distalized 15 mm. There was no patellar baja. 6 patients (6%) had frank recurrent patellar dislocation; postoperative patella height in this group averaged 1.11 (1.02 -1.25), indicating that re-dislocation was not due to residual patella alta. Tibia fracture (4%) was not related to mm of distalization; mean (10) /range 8-15 mm. Arthrofibrosis requiring manipulation was needed in 11 patients (13%) whose mean distalization was 11.8 mm (9-15 mm). This distance was significantly different (p=0.009) from those not requiring manipulation. Conclusion: Distalization of TT leads to a high rate of normalization of patellar height measurements, with 94% patella stabilization. Residual patella alta was not associated with an increased risk of recurrence (p=0.57). Distalizing the tibial tubercle up to 15 mm did not increase fracture risk, however there was an increase in arthrofibrosis requiring manipulation.

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