1053 Comparing MRI Parameters in Quantifying Patellofemoral Instability

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
S Nagi ◽  
C Hing
Keyword(s):  
Soft Tissue ◽  
Tilt Angle ◽  
Patellofemoral Joint ◽  
Patellofemoral Instability ◽  
Trochlear Groove ◽  
Magnetic Resonance Imaging Measurement ◽  
Patellar Tilt ◽  
Significant Difference ◽  
Soft Tissue Changes ◽  
Patellar Tilt Angle

Abstract Aim Patellofemoral instability is where various stabilising factors of the patellofemoral joint undergo pathomorphological changes. It has an incidence rate of 5.8 per 100,000 in UK and has been associated with osteoarthritis[1]. Variations in the factors that stabilise the patellofemoral joint can be observed on MRI including measurements of the trochlea in relation to the patella, the femur and soft tissue changes. This study aims to compare different measures used to detect and quantify patellofemoral instability on MRIs and to look for any significant difference in their use both in isolation and together. Method 109 MRI reports of 78 patients diagnosed with patellofemoral instability were reviewed and all quantitative and qualitative parameters reported were inputted in a data table. Quantitative elements known as the Dejour protocol included the trochlear sulcus angle, patellar tilt angle, tibial tuberosity-trochlear groove distance and the Insall-Salvati ratio. Qualitative factors involved facet changes, patellar position, and any damage to soft tissue. Results It was found that the Insall-Salvati ratio greater than 1.2 and the patellar tilt angle of greater than 11 degrees irregular ranges had the greatest incidence in the MRI reports found 77.1% and 87.6% respectively in MRIs that reported them. Conclusions There is a discrepancy between quantitative parameters in their correlation with patellofemoral instability for the MRI reports observed. [1]: Ye Q, Yu T, Wu Y, Ding X, Gong X. Patellar instability: the reliability of magnetic resonance imaging measurement parameters. BMC Musculoskeletal Disorders. 2019;20(1).

scholarly journals Relationship of Patellofemoral Angles and Tibiofemoral Rotational Angles With Jumper’s Knee in Professional Dancers: An MRI Analysis

2021 ◽  
Vol 9 (3) ◽  
pp. 232596712098522
Author(s):  
Neslihan Aksu ◽  
Vefa Atansay ◽  
Işık Karalök ◽  
Taner Aksu ◽  
Ayhan Nedim Kara ◽  
...  
Keyword(s):  
Patellar Tendon ◽  
Tilt Angle ◽  
Patella Alta ◽  
Jumper’S Knee ◽  
Patellar Tilt ◽  
Sulcus Angle ◽  
Significant Difference ◽  
Mri Scans ◽  
Professional Dancers ◽  
Patellar Tilt Angle

Background: Jumper’s knee is a type of tendinopathy affecting the distal insertion of the quadriceps tendon (25% of cases) or the patellar tendon. It has been shown that frontal-plane measurements, such as genu valgum, genu varum, an increased quadriceps angle, a protuberant tibial tuberosity, patella alta, and short hamstring muscles, may be related to jumper’s knee. Purpose: To investigate the effects of tibiofemoral rotational angles and patellofemoral (PF) angles on the development of jumper’s knee in professional folk dancers. Study Design: Case-control study; Level of evidence, 3. Methods: We examined 26 dancers (16 male, 10 female) with knee pain using magnetic resonance imaging (MRI), for a total of 32 knees. Of the knees, 21 with quadriceps tendinopathy (QT) and 7 with patellar tendinopathy (PT) were detected. Using MRI scans, we measured PF angles (PF sulcus angle, lateral PF angle, patellar tilt angle, lateral trochlear inclination angle, lateral patellar tilt angle, and PF congruence angle) and tibiofemoral rotational angles (condylar twist angle, posterior condylar angle, femoral Insall angle, tibial Insall angle, posterior tibiofemoral angle, and angle between the Whiteside line and posterior femoral condylar line) and noted specifics such as patella alta, patella baja, and the Wiberg classification of the patellar shape between the patients with versus without QT and between patients with versus without PT to understand if there was any relationship with tendinopathy. Results: No statistically significant difference was observed in age, sex, patella alta, or the Wiberg classification between the QT groups (with vs without) and between the PT groups (with vs without) ( P > .05). Having QT was found to be significantly associated with the PF sulcus angle ( P = .009), and having PT was found to be significantly associated with the femoral Insall angle ( P = .029). Conclusion: Jumper’s knee was found to be associated with anatomic variations of the PF sulcus angle and rotation of the patellar tendon in relation to the femur (femoral Insall angle) on axial MRI scans in professional dancers. Unlike those of other athletes, dancers’ knees are exposed more to external rotation forces because of turnout, and this can be the cause of jumper’s knee.

Evidence of Abnormal Anteroposterior Patellar Tilt in Patients with Patellar Tendinitis with Use of a New Radiographic Measurement

2002 ◽  
Vol 30 (3) ◽  
pp. 396-401 ◽  
Author(s):  
Timothy F. Tyler ◽  
Elliott B. Hershman ◽  
Stephen J. Nicholas ◽  
Jeffery H. Berg ◽  
Malachy P. McHugh
Keyword(s):  
Tilt Angle ◽  
Sagittal Plane ◽  
High Reliability ◽  
Normal Population ◽  
Normal Subjects ◽  
Patellofemoral Pain ◽  
Radiographic Measurement ◽  
Patellar Tilt ◽  
Radiographic Measurements ◽  
Patellar Tilt Angle

Background A number of clinical conditions of the patellofemoral joint have been correlated with abnormal patellofemoral radiographic measurements. Hypothesis An abnormal anteroposterior patellar-tilt angle may be a contributing factor to pathologic conditions of the knee. Study Design Prospective nonrandomized clinical trial. Methods The anteroposterior patellar-tilt angle was measured in cadaveric knees to determine the best knee position. The radiographs of normal subjects and patients with patellar tendinitis or patellofemoral pain syndrome were examined for differences in patellar-tilt angle. Results Cadaveric measurements demonstrated highest intertester and intratester reliability at 30° of knee flexion and neutral femoral rotation. Intratester measurements on normal subjects exhibited high reliability, with a mean anteroposterior tilt angle of 30.8° ± 6.7°. In the patellofemoral pain group the mean anteroposterior tilt angle was 29.1° ± 8.5°; however, for patients with patellar tendinitis, it was 25.6° ± 7.0°, significantly lower than in the normal population. Furthermore, there was no difference between the angles of involved and uninvolved knees of patients with unilateral patellar tendinitis. Conclusion The anteroposterior patellar-tilt angle is a clinically reliable measurement of patellar tilt in the sagittal plane that can be used to study patellofemoral tilt in a variety of clinical situations. The results of this study demonstrate that patients with patellar tendinitis have abnormal patellar tilt in the sagittal plane.

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.

scholarly journals Changes in soft tissue facial profile of class II skeletal malocclusion patients with retrognathic mandible treated with twin block appliance

2019 ◽  
Vol 31 (1) ◽  
pp. 32
Author(s):  
Ng Hui Lin ◽  
Eky Setiawan Soeria Soemantri ◽  
Gita Gayatri
Keyword(s):  
Soft Tissue ◽  
Class Ii ◽  
Facial Soft Tissue ◽  
Profile Angle ◽  
Facial Profile ◽  
Twin Block ◽  
Skeletal Malocclusion ◽  
Soft Tissue Profile ◽  
Significant Difference ◽  
Soft Tissue Changes

Introduction: The soft tissue aspect in orthodontics treatment has gained attention in the last few years. The soft tissue profile is said to reflect the underlying skeletal profile, which causes a convex profile in patients with class II skeletal malocclusion. This research was aimed to determine the changes in the soft tissue facial profile of class II skeletal malocclusion patients with retrognathic mandible after twin block treatment. Methods: The type of research used in this study was retrospective descriptive research with paired t-test. The population was children aged 10-13 years old with class II skeletal malocclusion that were treated with twin block appliance in the Faculty of Dentistry Universitas Padjadjaran, Indonesia. The results of soft tissue changes before and after twin block treatment were compared. Results: There was an insignificant increase in soft tissue profile angle and Holdaway’s soft tissue angle after twin block treatment (p > 0.05). Whereas, Holdaway’s H-angle was decreasing and Merrifield’s Z-angle was increasing after twin block treatment, with statistically significant difference (p < 0.05). Conclusion: There was a decrease of H-angle, indicates a reduction in facial convexity and improvement of the facial profile after twin block treatment, but no difference in soft tissue profile angle and Holdaway’s soft tissue angle after twin block treatment. Keywords: Facial soft tissue profile, class II skeletal malocclusion, retrognathic mandible, twin block appliance

Anatomical Medial Patellofemoral Ligament Reconstruction for Recurrent Patella Dislocation: Two-Strand Grafts versus Four-Strand Grafts

2019 ◽  
Author(s):  
Jinghui Niu ◽  
Wei Lin ◽  
Qi Qi ◽  
Jiangfeng Lu ◽  
Yike Dai ◽  
...  
Keyword(s):  
Tilt Angle ◽  
Medial Patellofemoral Ligament ◽  
Lysholm Score ◽  
Mpfl Reconstruction ◽  
Patella Dislocation ◽  
Reconstruction Method ◽  
Patellar Tilt ◽  
Kujala Score ◽  
Patellar Tilt Angle

AbstractThe purpose of this study was to describe two anatomical medial patellofemoral ligament (MPFL) reconstruction methods: reconstruction with two-strand grafts and reconstruction with four-strand grafts and to evaluate the clinical and radiological results. From January 2010 to January 2013, patients who sustained recurrent patella dislocation and met inclusion criteria were included in the study and divided into two groups randomly to undergo MPFL reconstruction either by two-strand grafts (T group) or four-strand grafts (F group). Patients were followed up 1 month, 1 year, 2 years, and 3 years postoperatively. The apprehension test was applied to test patella stability. The Kujala score, Lysholm score, and Crosby–Insall grading were used to evaluate the function of the affected knee. The patellar congruence and patellar tilt angle were used to measure the morphology of the patellofemoral joint. In addition, patients' subjective assessments and complications were recorded. Thirty-eight patients in T group and 38 patients in F group were followed for at least 36 months. The apprehension test was positive in all patients preoperatively but was negative at follow-up. The Kujala score, Lysholm score, patellar congruence angle, and the patellar tilt angle of patients in both groups improved significantly at 36-month follow-up when compared with those assessed preoperatively. However, patients in the F group achieved better clinical results in terms of Kujala score, patellar congruence angle, patellar tilt angle, and Crosby–Insall grading when compared with those in the T group 3 years after the operation. Most patients (92% of patients in the T group and 97% of patients in the F group) were satisfied with the surgery. The anatomical MPFL reconstruction with two-strand grafts or four-strand grafts were both safe techniques for recurrent patella dislocation with satisfactory clinical outcomes. The anatomical fixation with four-strand grafts achieved better clinical and radiographic results in the follow-up, which may be a better reconstruction method.

scholarly journals Automatic Segmentation and Measurement on Knee Computerized Tomography Images for Patellar Dislocation Diagnosis

2020 ◽  
Vol 2020 ◽  
pp. 1-13
Author(s):  
Limin Sun ◽  
Qi Kong ◽  
Yan Huang ◽  
Jiushan Yang ◽  
Shaoshan Wang ◽  
...  
Keyword(s):  
Computerized Tomography ◽  
Tilt Angle ◽  
Patellar Dislocation ◽  
Automatic Segmentation ◽  
Automatic Measurement ◽  
Ct Images ◽  
Lateral Shift ◽  
Patellar Tilt ◽  
Cad System ◽  
Patellar Tilt Angle

Traditionally, for diagnosing patellar dislocation, clinicians make manual geometric measurements on computerized tomography (CT) images taken in the knee area, which is often complex and error-prone. Therefore, we develop a prototype CAD system for automatic measurement and diagnosis. We firstly segment the patella and the femur regions on the CT images and then measure two geometric quantities, patellar tilt angle (PTA), and patellar lateral shift (PLS) automatically on the segmentation results, which are finally used to assist in diagnoses. The proposed quantities are proved valid and the proposed algorithms are proved effective by experiments.

Investigation for Lesional Onset Site and Patellofemoral Joint Anatomy in Juvenile Femoral Trochlear Osteochondritis Dissecans : A Case Control Study

2021 ◽  
Author(s):  
Mitsuhiro Kimura ◽  
Junsuke Nakase ◽  
Yoshinori Ohashi ◽  
Kazuki Asai ◽  
Rikuto Yoshimizu ◽  
...  
Keyword(s):  
Osteochondritis Dissecans ◽  
Patellofemoral Joint ◽  
Femoral Condyle ◽  
Lateral View ◽  
Tibial Tubercle ◽  
Trochlear Groove ◽  
Return To Sports ◽  
Patellar Tilt ◽  
The Mean

Abstract Background: Femoral trochlear osteochondritis dissecans is an uncommon disease, and its cause remains unknown. We investigated the site of osteochondritis dissecans lesions and the patellofemoral joint anatomy of femoral trochlear osteochondritis dissecans in 15 knees, and assessed the clinical outcomes of the surgical treatments. Methods: We conducted a retrospective study of 15 knees in 14 patients who underwent surgery. The mean age was 13.2 ± 1.0 years at the time of surgery. All patients played athletic sports and experienced no traumatic events. We determined the site of osteochondritis dissecans lesions using the modified Cahill and Berg classification on magnetic resonance imaging scans. We also evaluated the patellofemoral structures with sulcus angle, facet ratio, patellar tilt, patellar height, and tibial tubercle-trochlear groove distance. Results: We performed osteochondral autograft transplantation surgery in nine knees, internal fixation in four knees, and drilling in two knees. The mean follow-up period was 34.5 ± 14.0 months, and the period of return to sports was 6.1 ± 1 months. At the final follow-up, the mean Tegner activity scale was 7.2 ± 1.4 (preoperative score was 7.7 ± 1.0), and the Lysholm knee score was 98.5 (range, 89-100). The area of most preponderance was in the medial portion of the lateral femoral condyle in the frontal view, and in the segment superior two-thirds of the anterior region in the lateral view. There were no anatomical abnormalities in the patellofemoral structures. Conclusions: Femoral trochlear osteochondritis dissecans lesions occurred in virtually identical sites, and there were no anatomical abnormalities. This disease seemed to be related to the repetitive and persistent loading from the patella at slight knee flexion. In almost all cases, satisfactory postoperative results were obtained for osteochondritis dissecans regardless of the stage or surgical method.

scholarly journals Comparison of the Radiologic, Morphometric, and Clinical Outcomes between Kinematically and Mechanically Aligned Total Knee Arthroplasty: A Propensity Matching Study

2021 ◽  
Author(s):  
Tae Woo Kim ◽  
Jae Ik Lee ◽  
Han Gyeol Choi ◽  
Hyun Jin Yoo ◽  
Kyu Tae Kim ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Clinical Outcomes ◽  
Knee Arthroplasty ◽  
Tilt Angle ◽  
Patellar Tilt ◽  
Functional Scores ◽  
Propensity Matching ◽  
Total Knee ◽  
Preoperative Status ◽  
Patellar Tilt Angle

AbstractThe purpose of this study was to compare radiologic, morphometric, and clinical outcomes between kinematically aligned (KA) and mechanically aligned (MA) total knee arthroplasty (TKA) in Korean patients. Overall, 168 patients who underwent primary TKA were retrospectively reviewed, and propensity matching (age, sex, and body mass index) was performed as 1:3 ration (KA TKAs [n = 42]: MA TKAs [n = 126]). Joint-line orientation angle (JLOA), coronal and axial alignments of implants, hip–knee–ankle (HKA) angle, and patellar tilt angle were assessed using full-length standing radiograph, axial computed tomography (CT) scan, and plain radiographs. Morphometric assessment was performed by analyzing the intraoperative measurement of the femoral cut surface and femoral components fitting in five zones. Clinical outcomes more than 2 years of follow-up were evaluated with the Knee Society (KS) knee and functional scores, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, and the Short-Form Health Survey (SF-36). In radiologic results, JLOA was more parallel to the floor in KA TKAs (KA: medial tilt 0.9 ± 1.5 degrees; MA: lateral tilt 1.7 ± 1.5 degrees, p < 0.05), and patellar tilt angle was closer to preoperative status after KA TKA (KA: 2.0 ± 1.6 degrees; MA;0.3 ± 1.2 degrees, p < 0.05). HKA angle and rotational mismatch were similar between two groups. In morphometric analysis, entire overhang of anterior femoral cutting surface was reduced in KA TKA compared with MA TKA (KA: 11.7 ± 6.2 mm; MA: 14.4 ± 5.9 mm, p < 0.05). However, both of MA and KA TKAs showed underhang in mediolateral dimension without difference. There were no significant differences in clinical scores between two groups. KA TKA showed more parallel JLOA to floor, closer patellar tilt to preoperative status, and better anterior flange fitting that can reproduce more natural knee kinematics compared with MA TKA. Although clinical outcomes assessed by conventional evaluating tools were similar between two groups, further evaluation focusing on the patellofemoral symptoms or unawareness of TKA is necessary to clarify the clinical benefit of KA TKA.

Patellar Height Is Not Altered When the Knee Axis Correction Is Less than 15 Degrees and Has Good Short-Term Clinical Outcome

2019 ◽  
Vol 33 (06) ◽  
pp. 536-546
Author(s):  
Cheng Jingbo ◽  
Feng Mingli ◽  
Cao Guanglei ◽  
Li Zheng ◽  
An Shuai ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Patellofemoral Joint ◽  
Lateral Displacement ◽  
Patellar Height ◽  
Patient Specific ◽  
Trochlear Groove ◽  
Tibial Osteotomy ◽  
Short Term ◽  
Significant Difference ◽  
Axis Correction

AbstractThe objectives of our study were to evaluate (1) patellar height changes when the knee axis correction was < 15 degrees and (2) the clinical effect after open wedge high tibial osteotomy (OWHTO). Sixty-nine patients (69 knees) undergoing OWHTO between January 2016 and June 2017 were enrolled in this prospective study. All patients underwent OWHTO using a three-dimensional (3D)-printed patient-specific instrument. We used X-ray and lower-limb computed tomography scan to measure the osteotomy angle, patellar height, and other patellofemoral joint indices. We used the hospital for special surgery knee (HSS), Western Ontario and McMaster Universities Arthritis Index (WOMAC), and Kujala's scores to evaluate the clinical outcome. All knee axis corrections were less than 15 degrees. The change in posterior tibial slope (PTS) did not show a statistically significant difference. We observed that the patellar height was not altered when we used femur referenced measurement method. The change in modified Miura–Kawamura index (MKI) and Femoral patellar height index (FPHI) did not show a statistically significant difference. The differences in Blackburne–Peel index (BPI) and Caton–Deschamps index (CDI) were statistically significant, decreasing from 0.91 ± 0.12 and 1.06 ± 0.11 preoperatively to 0.79 ± 0.13 and 0.95 ± 0.11 postoperatively, respectively. In the axial plane, we did not observe a change in lateral patellar shift (LPS), but we found that lateral patellar tilt (LPT) showed a significant decrease from 8.67 ± 2.60 degrees preoperatively to 6.13 ± 2.30 postoperatively, respectively. The tuberositas tibae–trochlear groove (TT–TG) distance showed a significant decrease after OWHTO from 14.30 ± 4.10 mm preoperatively to 11.52 ± 3.63 mm postoperatively. The clinical score showed a significant increase after OWHTO, and all patients were satisfied with the outcome. After OWHTO, the patellar height was not altered when the knee axis correction was < 15 degrees. It was also found that there was still lateral displacement of the patella. Internal rotation of the distal tibia is an important cause of LPT reduction. After OWHTO, all patients achieved satisfactory clinical outcomes. At 1-year short-term follow-up, patients did not report discomfort in the patellofemoral joint. The Level of Evidence for this study was IV.

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