How Do Axial Scan Orientation Deviations Affect the Measurements of Knee Anatomical Parameters Associated with Patellofemoral Instability? A Simulated Computed Tomography Study

2017 ◽  
Vol 31 (05) ◽  
pp. 425-432 ◽  
Author(s):  
Ran Xiong ◽  
Cheng Chen ◽  
Li Yin ◽  
Xiaoyuan Gong ◽  
Jiangming Luo ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Cruciate Ligament ◽  
Patellofemoral Instability ◽  
Ct Scanning ◽  
Tibial Tubercle ◽  
Trochlear Groove ◽  
Patellar Tilt ◽  
Sulcus Angle ◽  
Scan Data ◽  
Anatomical Parameters

AbstractThe purpose of this study was to detect the correlation between axial scan orientation discrepancy and the knee anatomical parameters associated with patellofemoral instability during computed tomography (CT) scanning. CT scan data of 16 knees from 16 healthy subjects were retrieved. The reslicing processes were performed to simulate different axial scan orientations generated due to leg adduction/abduction during CT scanning. Eight parameters (tibial tubercle to trochlear groove [TT-TG], tibial tubercle to posterior cruciate ligament [TT-PCL], patellar tilt, lateral trochlear inclination, sulcus angle, trochlear depth, trochlear facet asymmetry, and trochlear condyle asymmetry) of five angles (neutral zero, 4/8 degrees of adduction and 4/8 degrees abduction) were quantified. All eight parameters showed varying degrees of deviations to the different axial scan orientations. TT-TG, patellar tilt, lateral trochlear inclination, and trochlear condyle asymmetry were relatively sensitive to axial scan orientation changes, whereas TT-PCL, sulcus angle, trochlear depth, and trochlear facet asymmetry were relatively insensitive. Although the sensitivities are various, surgeons should be aware of this situation and make necessary corrections.

The Difference between Computed Tomography and Magnetic Resonance Imaging Measurements of Tibial Tubercle–Trochlear Groove Distance for Patients with or without Patellofemoral Instability: A Systematic Review and Meta-analysis

2019 ◽  
Vol 33 (08) ◽  
pp. 768-776 ◽  
Author(s):  
Si Heng Sharon Tan ◽  
Beatrice Ying Lim ◽  
Kiat Soon Jason Chng ◽  
Chintan Doshi ◽  
Francis K.L. Wong ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Computed Tomography ◽  
Magnetic Resonance ◽  
Patellofemoral Instability ◽  
Tibial Tubercle ◽  
Control Group ◽  
Trochlear Groove ◽  
Resonance Imaging ◽  
The Mean ◽  
Ct And Mri

AbstractThe tibial tubercle–trochlear groove (TT–TG) distance was originally described for computed tomography (CT) but has recently been used on magnetic resonance imaging (MRI) without sufficient evidence demonstrating its validity on MRI. The current review aims to evaluate (1) whether there is a difference in the TT–TG distances measured using CT and MRI, (2) whether both the TT–TG distances measured using CT and MRI could be used to differentiate between patients with or without patellofemoral instability, and (3) whether the same threshold of 15 to 20 mm can be applied for both TT–TG distances measured using CT and MRI. The review was conducted using the preferred reporting items for systematic reviews and meta-analyses (PRSIMA) guidelines. All studies that compared TT–TG distances either (1) between CT and MRI or (2) between patients with and without patellofemoral instability were included. A total of 23 publications were included in the review. These included a total of 3,040 patients. All publications reported the TT–TG distance to be greater in patients with patellofemoral instability as compared to those without patellofemoral instability. This difference was noted for both TT–TG distances measured on CT and on MRI. All publications also reported the TT–TG distance measured on CT to be greater than that measured on MRI (mean difference [MD] = 1.79 mm; 95% confidence interval [CI]: 0.91–2.68). Pooling of the studies revealed that the mean TT–TG distance for the control group was 12.85 mm (95% CI: 11.71–14.01) while the mean TT–TG distance for patients with patellofemoral instability was 18.33 mm (95% CI: 17.04–19.62) when measured on CT. When measured on MRI, the mean TT–TG distance for the control group was 9.83 mm (95% CI: 9.11–10.54), while the mean TT–TG distance for patients with patellofemoral instability was 15.33 mm (95% CI: 14.24–16.42). Both the TTTG distances measured on CT and MRI could be used to differentiate between patients with and without patellofemoral instability. Patients with patellofemoral instability had significantly greater TT–TG distances than those without. However, the TT–TG distances measured on CT were significantly greater than that measured on MRI. Different cut-off values should, therefore, be used for TT–TG distances measured on CT and on MRI in the determination of normal versus abnormal values. Pooling of all the patients included in the review then suggest for 15.5 ± 1.5 mm to be used as the cut off for TT–TG distance measured on CT, and for 12.5 ± 2 mm to be used as the cut-off for TT–TG distance measured on MRI. The Level of evidence for this study is IV.

Association of Patellofemoral Morphology and Alignment With the Radiographic Severity of Patellofemoral Osteoarthritis

2021 ◽  
Author(s):  
Yike Dai ◽  
Heyong Yin ◽  
Chongyang Xu ◽  
Hongrui Zhang ◽  
Ai Guo ◽  
...  
Keyword(s):  
Tibial Tubercle ◽  
Type I ◽  
Trochlear Groove ◽  
Patellofemoral Osteoarthritis ◽  
Patellar Tilt ◽  
Sulcus Angle ◽  
Patella Height ◽  
Radiographic Severity ◽  
Type Iii

Abstract Background: Risk factors for the progression of patellofemoral osteoarthritis (PFOA) are poorly understood. This research aims to evaluate the association between patellofemoral joint (PFJ) morphology and alignment with the radiographic severity of PFOA.Methods: A retrospective analysis of CT scan and lateral radiograph data were acquired in patients with PFOA. The radiographic severity of PFOA and tibiofemoral OA (TFOA), lateral and medial trochlear inclination angle, sulcus angle and the Wiberg classification of patella morphology, the congruence angle, patellar tilt angle, and lateral patellar angles, and tibial tubercle trochlear groove distance (TT-TG), patella height (i.e., Caton-Deschamps index) were assessed using CT scans and sagittal radiographs of the knee. All the PFJ morphology and alignment data were divided into quarters and the relationship between each measure and the severity of PFOA was investigated.Results: By studying 150 patients with PFOA, we found a U-shaped relationship between the Caton-Deschamps index and the severity of PFOA (P <0.001). A lower value of sulcus angle and lateral patellar angle, a higher value of congruence angle, and type III patella were associated with more severity of lateral PFOA. Compared with the highest quarter of each measure, the adjusted odds ratios (OR) of the severity of PFOA in the lowest quarter of sulcus angle, lateral patellar angle, and congruence angle, and type I patella was 8.80 (p=0.043), 16.51 (P <0.001), 0.04(P <0.001), and 0.18 (p=0.048) respectively.Conclusions: Extreme value of patella height, a higher value of lateral patellar displacement and lateral patellar tilt, lower value of sulcus angle, and type III patella were associated with more severity of PFOA.

scholarly journals Increased tibial tubercle-trochlear groove and patellar height indicate a higher risk of recurrent patellar dislocation following medial reefing

2021 ◽  
Author(s):  
Marc-Daniel Ahrend ◽  
Tobias Eisenmann ◽  
Moritz Herbst ◽  
Boyko Gueorguiev ◽  
Gabriel Keller ◽  
...  
Keyword(s):  
Patellar Dislocation ◽  
Recurrent Dislocation ◽  
Patellar Height ◽  
Tibial Tubercle ◽  
Trochlear Groove ◽  
Recurrent Patellar Dislocation ◽  
Patellar Tilt ◽  
Level Of Evidence ◽  
Sulcus Angle ◽  
Patellar Shift

Abstract Purpose Identifying anatomical risk factors on recurrent dislocation after medial reefing is important for deciding surgical treatment. The present study aimed to retrospectively analyze the preoperative magnetic resonance imaging (MRI)-based parameters of patients treated with medial reefing and whether these parameters lead to a higher risk of recurrent dislocation. Methods Fifty-five patients (18.6 ± 6.6 years) who underwent medial reefing after primary traumatic patellar dislocation (84% with medial patellofemoral ligament [MPFL] rupture) were included. Patients were followed up for at least 24 months postoperatively (3.8 ± 1.2 years) to assess the incidence of recurrent patellar dislocation. In patients without recurrent dislocation, the Kujala and subjective IKDC scores were assessed. Moreover, the tibial tubercle-trochlear groove (TT-TG), sulcus angle, patellar tilt, patellar shift, and lateral trochlea index (LTI) were measured. The patellar height was measured using the Caton-Dechamps (CDI), Blackburne-Peel (BPI), and Insall-Salvati index (ISI). The cohort was subclassified into two groups with and without recurrent dislocation. Differences between groups were analyzed with respect to the MRI parameters. Results Forty percent had a pathological sulcus angle of > 145°, 7.2% had an LTI of < 11°, 47.3% had a patellar tilt of > 20°, and 36.4% had a TT-TG of ≥ 16 mm. Increased patellar height was observed in 34.5, 65.5, and 34.5% of the patients as per CDI, BPI, and ISI, respectively. Nineteen (34.5%) patients suffered from recurrent dislocation. Compared with patients without recurrent dislocation, those with recurrent dislocation had a significantly lower LTI (p = 0.0467). All other parameters were not significantly different between the groups. Risk factor analysis showed higher odds ratios (OR > 2), although not statistically significant, for MPFL rupture (OR 2.05 [95% confidence interval 0.38–11.03], LTI (6.6 [0.6–68.1]), TT-TG (2.9 [0.9–9.2]), and patellar height according to ISI (2.3 [0.7–7.5]) and CDI (2.3 [0.7–7.5])). Patients without recurrent dislocation had a Kujala score of 93.7 ± 12.1 (42–100) points and an IKDC score of 90.6 ± 11.7 (55.2–100) points. Conclusion Anatomical, MRI-based parameters should be considered before indicating medial reefing. A ruptured MPFL, an LTI < 11°, a TT-TG ≥ 16 mm, a patellar tilt > 20 mm, and an increased patellar height according to ISI and CDI were found to be associated, although not significantly, with a higher risk (OR > 2) of recurrent patellar dislocation after medial reefing. Thorough preoperative analysis is crucial to reduce the risk of recurrent dislocation in young patient cohorts. Level of evidence Level IV

scholarly journals Association of patellofemoral morphology and alignment with the radiographic severity of patellofemoral osteoarthritis

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Yike Dai ◽  
Heyong Yin ◽  
Chongyang Xu ◽  
Hongrui Zhang ◽  
Ai Guo ◽  
...  
Keyword(s):  
Tibial Tubercle ◽  
Type I ◽  
Trochlear Groove ◽  
Patellofemoral Osteoarthritis ◽  
Patellar Tilt ◽  
Sulcus Angle ◽  
Patella Height ◽  
Radiographic Severity ◽  
Type Iii ◽  
Radiographic Grade

Abstract Background Risk factors for the severity of patellofemoral osteoarthritis (PFOA) are poorly understood. This research aims to evaluate the association between patellofemoral joint (PFJ) morphology and alignment with the radiographic severity of PFOA. Methods A retrospective analysis of CT scan and lateral radiograph data were acquired in patients with PFOA. The radiographic grade of PFOA and tibiofemoral osteoarthritis (TFOA), lateral and medial trochlear inclination angle, sulcus angle, and the Wiberg classification of patella morphology, the congruence angle, patellar tilt angle, and lateral patellar angles, and tibial tubercle trochlear groove distance (TT-TG) and patella height (i.e., Caton-Deschamps index) were assessed using CT scans and sagittal radiographs of the knee. All the PFJ morphology and alignment data were divided into quarters, and the relationships between each of these measures and the severity of PFOA were investigated. Results By studying 150 patients with PFOA, we found a U-shaped relationship between the Caton-Deschamps index and the severity of PFOA (P < 0.001). A lower value of sulcus angle and lateral patellar angle, a higher value of congruence angle, and type III patella were associated with more severity of lateral PFOA. Compared with the highest quarter of each measure, the adjusted odds ratios (OR) of the severity of PFOA in the lowest quarter of sulcus angle, lateral patellar angle, and congruence angle; and type I patella was 8.80 (p = 0.043), 16.51 (P < 0.001), 0.04 (P < 0.001), and 0.18 (p = 0.048) respectively. Conclusions Extreme value of patella height, a higher value of lateral patellar displacement and lateral patellar tilt, lower value of sulcus angle, and type III patella were associated with more severity of PFOA.

Femoral Trochlear Geometry in Patients with Trochlear Dysplasia Using MRI Oblique Trochlear View

2019 ◽  
Author(s):  
Luiz Felipe Ambra ◽  
Pedro Henrique Schmidt Alves Ferreira Galvão ◽  
Enzo Salviatto Mameri ◽  
Jack Farr ◽  
Andreas H. Gomoll
Keyword(s):  
Trochlear Dysplasia ◽  
Cruciate Ligament ◽  
Patellofemoral Instability ◽  
Trochlear Groove ◽  
Sulcus Angle ◽  
Sagittal Image ◽  
Level 3 ◽  
Magnetic Resonance Imaging Mri ◽  
Anterior Cruciate ◽  
Retrospective Comparative Study

AbstractThe objective of this study was to evaluate trochlear morphology in patients with trochlear dysplasia using a new oblique trochlear magnetic resonance imaging (MRI) view (OTV) in comparison with standard axial MRI sequences. MRI exam of 73 patients with patellofemoral instability (PFI) and the same number of controls were retrospectively reviewed. The oblique trochlear sequence was acquired by inclining the axial plane parallel to the intercondylar roof of the sagittal image, showing the anterior cruciate ligament (ACL) in its entire length. Trochlear morphology was assessed on axial and oblique trochlear sequences at three levels: level 1 at 25%, level 2 at 50%, and level 3 at 75% of the length of the trochlear groove. Trochlear sulcus angle and sulcus depth were measured at these three levels and compared between the new trochlear and standard axial sequences. Trochlear sulcus angle and sulcus depth were statistically different between axial and oblique trochlear views at all three levels (p < 0,05). Additionally, OTV displayed more uniform sulcus angle and depth along the trochlea. The oblique trochlear view on the MRI can more accurately evaluate trochlear morphology and also better characterize trochlear dysplasia in patients with PFI. This is Level III, retrospective comparative study.

Bisect offset ratio and cartilaginous sulcus angle are good combined predictors of recurrent patellar dislocation in children and adolescents

2021 ◽  
pp. jisakos-2020-000461
Author(s):  
Sheanna Maine ◽  
Christina Ngo-Nguyen ◽  
Martina Barzan ◽  
Chris Stockton ◽  
Luca Modenese ◽  
...  
Keyword(s):  
Patellar Dislocation ◽  
Trochlear Dysplasia ◽  
Pediatric Population ◽  
Tibial Tubercle ◽  
Trochlear Groove ◽  
Recurrent Patellar Dislocation ◽  
Patellar Tilt ◽  
Level Of Evidence ◽  
Femoral Torsion ◽  
Sulcus Angle

ObjectivesRecurrent patellar dislocation (RPD) is found most commonly in the juvenile population. While risk factors have been well-established in adults, there remains a paucity in radiographical data to define normal and pathoanatomical juvenile cohorts. The objectives of this paper were to elucidate the differences in the patellofemoral joint between RPD and typically developed (TD) juvenile populations, using MRI measurements, and determine the best independent and combined predictors of RPD.MethodsA prospective, cross-sectional study was conducted with 25 RPD and 24 TD participants aged between 8 and 19 years. MR images were obtained to assess common measures of lower limb alignment, patellofemoral alignment, and trochlear dysplasia.ResultsSignificant differences were evident for acetabular inclination, tibial-femoral torsion, tibial tubercle-to-trochlear groove (TT-TG) distance, lateral patellar tilt (LPT), cartilaginous sulcus angle (CSA) and bisect offset ratio (BOR). CSA and BOR were included in the final predictive model, which correctly classified 89.4% of RPD cases.ConclusionRadiographical parameters that stratify risk of RPD in adults are also able to predict RPD in the pediatric population (TT-TG, LPT, CSA and BOR). Together, CSA and BOR accurately identified 89.4% of RPD. These measures should be included in the evaluation of pediatric patients who present with patellar dislocation.Level of evidenceLevel II.

Association between Patellofemoral Anatomy and Chondral Lesions of the Knee in Patellofemoral Instability

2021 ◽  
Author(s):  
Olivia O'Malley ◽  
Aliya Choudhury ◽  
Alexandra Biggs ◽  
Alina J. Humdani ◽  
Oliver Brown ◽  
...  
Keyword(s):  
Tilt Angle ◽  
Patellar Dislocation ◽  
Lateral Meniscus ◽  
Patellofemoral Instability ◽  
Patellar Height ◽  
Tibial Tubercle ◽  
Trochlear Groove ◽  
Sulcus Angle ◽  
Chondral Lesions ◽  
Chondral Injury

AbstractChondral injury is a serious consequence of patellar dislocation and patellofemoral instability (PFI). There is limited data on the relationship between radiological features such as sulcus angle and patellar height to the presence, location, and severity of chondral lesions. The purpose of this study was to determine the association of anatomical variants in patellofemoral instability with injuries sustained due to patellar dislocation. A cohort of 101 patients who had four or more episodes of dislocation or instability undergoing isolated arthroscopy or arthroscopies at the time of corrective realignment surgery were identified. The prevalence of chondral, ligamentous, and meniscal injuries was determined and correlated to the sulcus angle, tibial tubercle trochlear groove distance, and patellar height on magnetic resonance imaging (MRI) scans. A total of 101 patients was identified. At arthroscopy, the patella demonstrated the highest incidence of chondral injury (68%) followed by the trochlear groove (40%). Lateral meniscal injuries were noted in 6% of patients, medial meniscal injuries in 2%, and anterior cruciate ligament (ACL) injury in 3%. Chondral injuries were graded using the Outerbridge criteria and there was a correlation between more severe chondral injuries and a greater tilt angle (p = 0.05). The occurrence of injury to the lateral meniscus was associated with a higher Insall–Salvati ratio (p = 0.05). More severe chondral injuries are seen in patients with a greater tilt angle.

Sign in / Sign up

Export Citation Format

Share Document