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.

Relationship between Anatomical Risk Factors, Articular Cartilage Lesions, and Patient Outcomes Following Medial Patellofemoral Ligament Reconstruction

Cartilage ◽  
2019 ◽  
pp. 194760351989472 ◽  
Author(s):  
Charles L. Holliday ◽  
Laurie A. Hiemstra ◽  
Sarah Kerslake ◽  
John A. Grant
Keyword(s):  
Risk Factors ◽  
Odds Ratio ◽  
Patellar Instability ◽  
Ligament Reconstruction ◽  
Medial Patellofemoral Ligament ◽  
Trochlear Dysplasia ◽  
Cartilage Lesion ◽  
Low Grade ◽  
Medial Patellofemoral Ligament Reconstruction ◽  
Cartilage Lesions

Objective The purpose of this study was (1) to determine which risk factors for patellar instability were associated with the presence of patellofemoral cartilage lesions and (2) to determine how cartilage lesion presence, size, and grade affect postoperative disease-specific quality of life. Design Preoperative, intraoperative, and postoperative demographic, anthropometric (body mass index, Beighton score, hip rotation), radiographic (crossover sign, trochlear bump), cartilage lesion morphology (presence, size, location, grade), and outcomes data (Banff Patella Instability Instrument 2.0 [BPII 2.0]) were prospectively collected from patients undergoing isolated medial patellofemoral ligament reconstruction. For all knees ( n = 264), single and multivariable logistic regression was used to determine if any patellar instability risk factors affected the odds of having a cartilage lesion. In patients with unilateral symptoms ( n = 121), single variable linear regression was used to determine if the presence, size, or ICRS (International Cartilage Regeneration & Joint Preservation Society) grade of cartilage lesions could predict the 12 or 24+ month postoperative BPII 2.0 score. Results A total of 84.5% of knees had patellofemoral cartilage lesions (88.3% involved the distal-medial patella). Trochlear dysplasia (high grade: odds ratio = 15.7, P < 0.001; low grade: odds ratio = 2.9, P = 0.015) was associated with the presence of a cartilage lesion. The presence, size, and grade of cartilage lesions were not associated with 12 or 24+ month postoperative BPII 2.0 scores. Conclusions Trochlear dysplasia was a risk factor for the development of patellofemoral cartilage lesions in this patient population. Cartilage lesions most commonly involve the distal-medial patella. There was no significant relationship between patellofemoral cartilage lesion presence, size, or grade and postoperative BPII 2.0 scores in short-term follow-up.

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.

Morphology and Anatomic Patellar Instability Risk Factors in First-Time Traumatic Lateral Patellar Dislocations: A Prospective Magnetic Resonance Imaging Study in Skeletally Immature Children

2016 ◽  
Vol 45 (1) ◽  
pp. 50-58 ◽  
Author(s):  
Marie Askenberger ◽  
Per-Mats Janarv ◽  
Throstur Finnbogason ◽  
Elizabeth A. Arendt
Keyword(s):  
Magnetic Resonance Imaging ◽  
Risk Factors ◽  
Magnetic Resonance ◽  
Patellar Instability ◽  
Trochlear Dysplasia ◽  
Control Group ◽  
Skeletally Immature ◽  
Resonance Imaging ◽  
Patellar Tilt ◽  
First Time

Background: The incidence of primary lateral patellar dislocation (LPD) in children aged 9 to 14 years is 0.6 to 1.2 per 1000. Causation is assumed to be multifactorial, including anatomic variants of the patellofemoral (PF) joint that result in a higher risk of LPD. No publication has compared the morphology of the PF joint and anatomic patellar instability risk factors (APIFs) in a primary LPD population versus controls, defining children by skeletal maturity. Purpose: To characterize the PF morphology and APIFs (trochlear dysplasia, abnormal lateral patellar tilt, elevated tibial tubercle–trochlear groove [TT-TG] distance, patella alta) through magnetic resonance imaging (MRI) measurements in skeletally immature children with and without a primary LPD and to identify (potential) distinctive differences between these 2 groups. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A prospective series of 103 skeletally immature children aged 9 to 14 years with an MRI-confirmed primary LPD were matched with a control group of 69 children. The PF morphology and APIFs were assessed during a 2.5-year period with standardized MRI using sagittal and axial views. Results: In the LPD group, 79% had 2 to 4 APIFs compared with 7% in the control group. All major measurements of trochlear dysplasia were significantly different between the 2 groups. The mean central condylar height was significantly higher in the LPD group compared with the control group, resulting in a lower trochlear depth (2.3 vs 4.5 mm, respectively) and higher sulcus angle (156.7° vs 141.1°, respectively). The LPD group had significantly higher values of patellar height, Caton-Deschamps index (1.33 vs 1.15, respectively), lateral patellar tilt (21.1° vs 8.5°, respectively), and TT-TG distance (13.9 vs 9.8 mm, respectively) compared with the control group. The main divergent APIF was trochlear dysplasia (defined as trochlear depth <3 mm), seen in 74% of the LPD group compared with 4% of the control group. Elevated TT-TG distance as a single APIF was never present in the LPD group; patellar tilt was only seen in the LPD group. The most common APIF in the control group was patella alta (36%). Conclusion: There was a significant difference in mean values of all established APIFs between the children with a first-time LPD and the controls. Trochlear dysplasia was the main APIF, and together with lateral patellar tilt (≥20°), they had the strongest association with LPD.

scholarly journals Effect of Trochlear Dysplasia on Commonly Used Radiographic Parameters to Assess Patellar Instability

2020 ◽  
Vol 8 (7) ◽  
pp. 232596712093876
Author(s):  
J. Lee Pace ◽  
Chris Cheng ◽  
Sheeba M. Joseph ◽  
Matthew J. Solomito
Keyword(s):  
Risk Factors ◽  
Patellar Instability ◽  
Trochlear Dysplasia ◽  
Inverse Correlation ◽  
Trochlear Groove ◽  
Modified Technique ◽  
Significant Inverse Correlation ◽  
Patellar Tilt ◽  
Level Of Evidence ◽  
The Relationship

Background: Trochlear dysplasia (TD) is an important anatomic risk factor for patellar instability (PI). Several imaging-based risk factors for PI have been established, but it is unclear what effect TD has on these measurements, and the Dejour method of categorizing TD has been shown to be unreliable. The lateral trochlear inclination (LTI) is a quantifiable measurement of proximal trochlear morphology. Recently, a modified technique for measuring LTI referencing the posterior condylar angle has demonstrated near-perfect reliability and may serve as a new standard for quantifying TD. Purpose/Hypothesis: The purpose of this study was to evaluate how TD, expressed in terms of LTI, affects historically used measures of PI, including the sulcus angle (SA), tibial tuberosity to trochlear groove (TT-TG) distance, lateral patellar inclination (LPI), and Caton-Deschamps (CD) ratio. We hypothesized that lower LTI (ie, more dysplastic trochlea) will correlate with higher SA and TT-TG distances, increased patellar tilt, and more patella alta. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Patients aged 9 to 18 years treated for PI between January 2014 and August 2017 were queried. On magnetic resonance imaging (MRI), LTI, SA, LPI, and the TT-TG measured at the most proximal (pTT-TG) and distal (dTT-TG) aspects of the fully formed trochlear groove were measured on axial images. CD ratio was measured using sagittal MRI as well as lateral radiographs. All measurements were performed by 2 independent observers. Patients were included if there was a diagnosis of PI that was confirmed with a chart review and if there were appropriate imaging studies to analyze. Results: A total of 65 patients met inclusion criteria for this study. Average pTT-TG distance (15.7 ± 4.5 mm) was not significantly different from dTT-TG distance (15.7 ± 4.2 mm) ( P = .94). LTI had a weak but significant inverse correlation with pTT-TG ( r = –0.40; β = –0.15 mm; P < .001) and SA ( r = –0.43; β = –0.478°; P < .001). There was a moderate and significant inverse correlation of LTI with dTT-TG ( r = –0.593; β = –0.21 mm; P < .001) and with LPI ( r = –0.69; β = –0.54°; P < .001). There was a weak but significant correlation between LTI and the MRI-based CD ratio ( r = 0.279; β = 0.149; P = .005). Radiograph-based CD ratio did not show a significant correlation with LTI ( r = –0.189; P = .135). Conclusion: Smaller (ie, more dysplastic) LTI values correlated significantly with larger TT-TG, SA, LPI, and MRI-based CD ratio measurements. The relationship between SA and LTI is intuitive, but the relationship between LTI and the other analyzed variables suggests that they are dependent variables to TD and may not be consistent independent risk factors for PI. Together, these suggest that TD alters the radiographic interpretation of TT-TG and patellar tilt. The correlation between TD and patellar height is unclear and warrants further investigation.

scholarly journals MPFL reconstruction and tibial tuberosity transposition in patients with patellar instability: May it troubleshots also trochlear dysplasia?

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
A. Castelli ◽  
E. Jannelli ◽  
E. Ferranti Calderoni ◽  
G. Galanzino ◽  
A. Ivone ◽  
...  
Keyword(s):  
Patellar Instability ◽  
Trochlear Dysplasia ◽  
Functional Results ◽  
Activity Level ◽  
Tibial Tuberosity ◽  
Mpfl Reconstruction ◽  
Trochlear Groove ◽  
Patellar Tilt ◽  
Sulcus Angle

Abstract Purpose This study aimed to highlight short- and medium-term outcomes of combined medial patello-femoral ligament (MPFL) reconstruction and anterior tibial tuberosity (ATT) transposition surgery in patients with recurrent patellar instability and different degrees of trochlear dysplasia. Methods Between January 2014 and May 2019, 25 patients with patellar instability underwent a surgical procedure combining the lowering/transposition of the ATT and the MPFL reconstruction. Each patient were preoperative assessed by Kujala score, International Knee Documentation Committee (IKDC), Tegner activity level scale. The assessment of instability predisposing factors was carried out with patellar height, tibial tuberosity-trochlear groove (TT-TG) distance, trochlear dysplasia, sulcus angle, patellar tilt and MPFL injuries. Functional outcomes were evaluated with Kujala, IKDC and Tegner scores at 3, 6 and 12 months after surgery. Results The average age of the patients was 20 years (range 13–43 years). Pre- operative Caton–Deschamps index was pathological in 10 (40%). Sulcus angle was elevated in 13 patients (52%) and TT-TG distance was irregular in 17 patients (68%). Trochlear dysplasia was present in 13 patients (9 type A, 3 type B, 1 type C according to Dejour’s Classification). No re-dislocation occurred during the follow-up. There was a significant increase in the Kujala, IKDC and Lysholm scores after 3, 6 and 12 months, and the results were compared for the different follow-up times and patient’s trochlear dysplasia degree. Conclusion This prospective observational longitudinal study identified good clinical outcomes in patients who underwent MPFL reconstruction and ATT transposition for patellar instability. Finally, the different risk factors for patellar instability examined, particularly the presence of trochlear dysplasia, did not significantly influence the final functional results, which range from good to excellent without re-dislocation episodes.

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.

Deepening trochleoplasty and medial patellofemoral ligament reconstruction normalize patellotrochlear congruence in severe trochlear dysplasia

2019 ◽  
Vol 101-B (3) ◽  
pp. 325-330 ◽  
Author(s):  
P. Balcarek ◽  
F. Zimmermann
Keyword(s):  
Contact Area ◽  
Medial Patellofemoral Ligament ◽  
Trochlear Dysplasia ◽  
Mpfl Reconstruction ◽  
Control Group ◽  
Study Group ◽  
Trochlear Groove ◽  
Contact Ratio ◽  
Patellar Tilt ◽  
Patellofemoral Alignment

Aims The aim of this study was to evaluate cartilaginous patellotrochlear congruence and patellofemoral alignment parameters after deepening trochleoplasty in severe trochlear dysplasia. Patients and Methods The study group comprised 20 patients (two male, 18 female; mean age 24 years (16 to 39)) who underwent deepening trochleoplasty and medial patellofemoral ligament (MPFL) reconstruction for the treatment of recurrent lateral patellar dislocation due to severe trochlear dysplasia (Dejour type B to D). Pre- and postoperative MRI investigations of the study group were compared with MRI data of 20 age- and gender-matched control patients (two male, 18 female; mean age 27 years (18 to 44)) regarding the patellotrochlear contact ratio, patellotrochlear contact area, posterior patellar edge-trochlear groove ratio, and patellar tilt. Results Preoperatively, all parameters in the study group indicated significant patellar malalignment, including a reduced patellotrochlear contact ratio (mean 0.38 (0.13 to 0.59) vs mean 0.67 (0.48 to 0.88); p < 0.001), reduced contact area (mean 128 mm2 (87 to 190) vs mean 183 mm2 (155 to 227); p < 0.001), increased patellar lateralization (mean 0.82 (0.55 to 1.0) vs mean 0.99 (0.93 to 1.1); p < 0.001) and increased patellar tilt (mean 25.8° (8.1° to 43.0°) vs mean 9.1° (0.5° to 16.8°); p < 0.001). Postoperatively, all parameters in the study group improved significantly and reached normal values compared with the control group. The patellotrochlear contact ratio increased to a mean of 0.63 (0.38 to 0.85) (p < 0.001), the contact area increased to a mean of 187 mm2 (101 to 255) (p < 0.001), the posterior patellar edge-trochlear groove ratio improved to a mean of 0.96 (0.83 to 0.91) (p < 0.001), and the patellar tilt decreased to a mean of 13.9° (8.1° to 22.1°) (p < 0.001) postoperatively. Conclusion Deepening trochleoplasty and MPFL reconstruction normalized the patellotrochlear congruence and patellofemoral alignment parameters. Modifying the dysplastic trochlea involves approximating the trochlear morphology to the shape of the patella rather than inducing a patella and trochlea mismatch. Cite this article: Bone Joint J 2019;101-B:325–330.

scholarly journals The Presence of Patellar Apprehension in Higher Degrees of Flexion Identifies Patients with Patella Alta and or Severe Trochlear Dysplasia

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0034
Author(s):  
Matthew Colatruglio ◽  
David Flanigan ◽  
Sarah Harangody Robert Magnussen
Keyword(s):  
Sports Medicine ◽  
Knee Flexion ◽  
Patellar Instability ◽  
Trochlear Dysplasia ◽  
Patella Alta ◽  
Tibial Tubercle ◽  
Trochlear Groove ◽  
Sulcus Angle ◽  
Plain Films ◽  
Recurrent Patellar Instability

Objectives: 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 a tibial tubercle osteotomy or trochleoplasty. The indications to include 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. We hypothesis that the persistence of patellar apprehension at greater than 60 degrees of knee flexion is associated with patella alta, increased TT-TG distance, and trochlear dysplasia. Methods: Seventy-six 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 repeated assessed as the knee was flexed in 10 degrees intervals as measured with a goniometer. The degree of flexion at which patellar apprehension disappeared was recorded. Plain films and MRI were obtained in all patients. Patellar height was assessed with the Caton-Deschamps (CD) index and trochlear morphology was assessed through measurement of the sulcus angle and depth on MRI and classification with the Dejour classification system. Imaging measurements of patients in which apprehension resolved by 60 degrees of knee flexion were compared with measures for those with apprehension that persisted deeper into flexion. Results: Apprehension resolved by 60 degrees of flexion in 55 patients and persisted into deeper flexion in 21 patients. The patients with delayed resolution of apprehension demonstrated a higher CD Index, elevated TT-TG distance, increased higher sulcus angle, decreased trochlear depth, and a higher incidence of Dejour B, C, or D dysplasia (all p < 0.05, Table 1). Of the 21 patients with delayed resolution of apprehension, 18 had either Dejour B, C, or D dysplasia or a Caton-Deschamps Index of at least 1.3. Delayed resolution of apprehension was present in 11 of the 16 patients with Dejour B, C, or D dysplasia. Conclusion: The presence of patellar apprehension in higher degrees of knee flexion is associated with patella alta, increased TT-TG distance, and more severe trochlear dysplasia. Further work is needed to evaluate utility of this exam finding to inform surgical decision-making in this population.

Effect of Medialization of the Trochlear Groove and Lateralization of the Tibial Tubercle on TT-TG Distance: A Cross-sectional Study of Dysplastic and Nondysplastic Knees

2021 ◽  
pp. 036354652098781
Author(s):  
Mathias Paiva ◽  
Lars Blønd ◽  
Per Hölmich ◽  
Kristoffer Weisskirchner Barfod
Keyword(s):  
Trochlear Dysplasia ◽  
Cross Sectional Study ◽  
Magnetic Resonance Images ◽  
Tibial Tubercle ◽  
Control Group ◽  
Trochlear Groove ◽  
Sectional Study ◽  
Cross Sectional ◽  
Mean Values ◽  
The Mean

Background: Tibial tubercle–trochlear groove (TT-TG) distance is often used as a measure of lateralization of the TT and is important for surgical planning. Purpose: To investigate if increased TT-TG distance measured on axial magnetic resonance images is due to lateralization of the TT or medialization of the TG. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 84 knees (28 normal [NK], 28 with trochlear dysplasia [TD], and 28 with patellar dislocation without TD [PD]) were examined. The medial border of the posterior cruciate ligament (PCL) was chosen as the central anatomic landmark. The distance from the TT to PCL (TT-PCL) was measured to examine the lateralization of the TT. The distance from the TG to the PCL (TG-PCL) was measured to examine the medialization of the TG. Between-group differences were investigated by use of 1-way analysis of variance. Results: The mean values for TT-TG distance were 8.7 ± 3.6 mm for NK, 12.1 ± 6.0 mm for PD, and 16.7 ± 4.3 mm in the TD group ( P < .01). The mean values for TT-PCL distance were 18.5 ± 3.6 mm for NK, 18.5 ± 4.5 mm for PD, and 21.2 ± 4.2 mm in the TD group ( P = .03). The mean values for TG-PCL distance were 9.6 ± 3.0 mm for NK, 7.1 ± 3.4 mm for PD, and 5.1 ± 3.3 mm in the dysplastic group ( P < .01). Conclusion: The present results indicate that increased TT-TG distance is due to medialization of the TG and not lateralization of the TT. Knees with TD had increased TT-TG distance compared with the knees of the control group and the knees with PD. The TT-PCL distance did not differ significantly between groups, whereas the TG-PCL distance declined with increased TT-TG.

scholarly journals Evaluation of the Effect of the Sulcus Angle and Lateral to Medial Facet Ratio of the Patellar Groove on Patella Tracking in Aging Subjects with Stable Knee Joint

2018 ◽  
Vol 2018 ◽  
pp. 1-5
Author(s):  
Jianghui Qin ◽  
Dongyang Chen ◽  
Zhihong Xu ◽  
Dongquan Shi ◽  
Jin Dai ◽  
...  
Keyword(s):  
Lower Limb ◽  
Lateral Displacement ◽  
Three Dimensional ◽  
Trochlear Groove ◽  
Patellar Tilt ◽  
Sulcus Angle ◽  
Lateral Tilt ◽  
Computed Tomography Images ◽  
Three Dimensional Models ◽  
Patella Tracking

Purpose.To determine whether the sulcus angle and the lateral to medial facet ratio correlate with patella lateral displacement and tilt in patients without patella instability.Methods.Computed tomography images of the lower limb of 64 patients without known arthropathy were collected. Three-dimensional models of the lower limb with a unified coordinate system were rebuilt by using Mimics software. The sulcus angle, lateral to medial facet ratio, lateral trochlear inclination of the patellar groove, tibial tuberosity-trochlear groove (TT-TG) distance, bisect offset index, and lateral tilt of the patella were measured. Pearson’s correlation test was used to determine the relationship between the aforementioned parameters.Results.Data from 51 patients were analyzed. The sulcus angle was negatively correlated with lateral tilt inclination (p<0.001,r=0.8406) and positively correlated with the bisect offset index (p=0.003,r=0.634) and patellar tilt (p=0.03,r=0.551); the lateral to medial facet ratio was positively correlated with TT-TG distance (p=0.003,r=0.643) and bisect offset index (p=0.026,r=0.559).Conclusion.The sulcus angle and lateral to medial facet ratio of the patellar groove can influence patella tracking in patients with stable knee joints.

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