scholarly journals RISK FACTORS FOR PATELLAR INSTABILITY USING A QUANTITATIVE ANALYSIS OF TROCHLEAR DYSPLASIA

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0034
Author(s):  
Jon Hedgecock ◽  
Christopher Cheng ◽  
Matthew Solomito ◽  
James Pace
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Roc Curve ◽  
Patellar Instability ◽  
Trochlear Dysplasia ◽  
Roc Curves ◽  
Patellar Height ◽  
Sulcus Angle ◽  
Demographic Risk ◽  
Demographic Risk Factors

Objectives: Multiple studies have described several anatomic and demographic risk factors of patellar instability (PI). Trochlear dysplasia (TD) has been shown to be a dominant risk factor for patellar instability but most prediction models have used the qualitative Dejour system to evaluate the influence of TD on PI. The lateral trochlear inclincation (LTI) angle is a described quantitative method to evaluate TD and a recent measurement technique has near perfect inter and intra rater reliability. Our hypothesis is that, in combination with other known radiographic and demographic risk factors of PI, that using a quantitative and numeric evaluation for TD, a highly reliable prediction model for PI can be created. Methods: 98 patients in a pediatric and adolescent sports medicine practice were identified with documented PI that had magnetic resonance imaging (MRI) studies available for review. A matched cohort of 100 patients with no history of PI but with MRI’s were identified as a control group. Anatomic risk factors evaluated included the LTI, sulcus angle, lateral condyle index (LCI), lateral patellar inclination angle (LPI), proximal and distal tibial tubercle-trochlear groove distance (pTTTG and dTTTG), Caton-Deschamps ratio (CD ratio), and patellotrochlear index (PTI). Demographic data included age and sex. Receiver operator characteristic (ROC) curves were constructed for each variable to identify which variables were the best predictors of PI (ROC value >0.7). Using the ROC curves with a Youden’s J statistic and setting specificity at 0.9, cutoff values for each variable were created. Each radiographic and demographic variable was analyzed for significance and those that were found to be significant were analyzed. Area under the curve (AUC) was determined for each variable. Two predictive models were created. One was developed from the ROC curve results while the other evaluated all measured variables. The models were designed to produce the best possible fit while trying to limit the total number of predictors. These models were tested on a second cohort of 45 patients with PI and 42 control patients. Results: ROC curve data is in Table 1. Of the two models, the superior model was the model that evaluated all variables, regardless of ROC cutoff value. The model takes on the form of a general logistic regression (Eq 1, Eq 2). Model accuracy on the validation set showed 84% accuracy with 78% sensitivity and 88% specificity. These values are based on a probability of >90%. Patellar height measures had significant AUC’s but were not prime drivers of the final model. Age was not significant in the ROC analysis. Conclusion: This study establishes a highly reliable and predictive model for PI that is driven by various direct (LTI, sulcus angle, LCI) or indirect (dTT-TG, LPI) quantitative measurements of TD. Patellar height did correlate with PI but was not a prime driver of the model which suggests that patella alta is a less common risk factor for PI.

scholarly journals ARE THERE SIDE-TO-SIDE DIFFERENCES IN KNEE MORPHOLOGY IN PATIENTS WITH BILATERAL PATELLAR INSTABILITY

2019 ◽  
Vol 7 (3_suppl) ◽  
pp. 2325967119S0011
Author(s):  
Shital Parikh ◽  
Neil Rajdev
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Patellar Instability ◽  
Trochlear Dysplasia ◽  
Patellar Height ◽  
Intraobserver Reliability ◽  
Study Cohort ◽  
Similar Treatment ◽  
Increased Risk ◽  
Symptomatic Knee

Introduction It is not known if there are side-to-side differences in knee morphology in patients with bilateral patellar instability (BPI). Such knowledge would help to answer the question whether similar treatment and prognosis could be expected for both knees in patients with BPI. The purpose of our study was to evaluate and compare anatomic / morphologic risk factors between knees in patients with BPI. Materials and Methods Of 294 patients who underwent surgical stabilization for patellar instability (2008-2017), 32 patients were identified who underwent staged or simultaneous bilateral surgery. This formed the study cohort. Demographic data, mechanism of initial injury and first knee side to be symptomatic were recorded. Radiographs and MRI of these 64 knees were evaluated for trochlear dysplasia (trochlear depth), patellar height (Caton-Deschamps index, Insall-Salvati ratio), patellar tilt, TT-TG distance, sulcus angle (cartilaginous and bony) and trochlear bump (cartilaginous and bony). The number and percentage of knees with pathologic values for measured risk factors were analyzed. For each risk factor, 15% side-to-side differences were considered significant. Statistical correlation was calculated between the time of presentation (first symptomatic knee) and magnitude of risk factors. All measurements were repeated after a 3-week interval and ICC was calculated to determine intraobserver reliability. Results The mean age of 32 patients was 14.6 years. 17/32 patients were females. 29 patients had staged surgery with mean interval of 21 months between surgeries; 3 patients had simultaneous surgery on each knee. Patients with BPI had multiple risk factors. 22/32 patients (69%) had the same Dejour type of trochlear dysplasia. For each measured risk factor, the number and percentage of patients with 15% or more side-to-side differences is shown (Table 1). There were significant side-to-side differences in patellar height ratios, TT-TG distance, and trochlear bump. The timing of presentation did not correlate with increased risk factors, i.e, the knee that presented earlier did not have increased risk factors compared to contralateral knee. ICC showed excellent intraobserver reliability. Conclusion There were significant side-to-side differences between knees in patients with BPI. Treatment and prognosis should be based on anatomic risk factors for each knee in patients with BPI. [Table: see text]

scholarly journals Why do MPFL reconstructions fail today?

2020 ◽  
Vol 8 (5_suppl4) ◽  
pp. 2325967120S0029
Author(s):  
Felix Zimmermann ◽  
Peter Balcarek
Keyword(s):  
Risk Factors ◽  
Revision Surgery ◽  
Patellar Instability ◽  
Trochlear Dysplasia ◽  
Valgus Deformity ◽  
Patellar Height ◽  
Tibial Tuberosity ◽  
Mpfl Reconstruction ◽  
Trochlear Groove ◽  
Type B

Aims and Objectives: The medial patellofemoral ligament (MPFL) is the most important passive stabilizer of the patella. In recurrent lateral patellar dislocations reconstruction of the MPFL with an autologous tendon transplant is a frequently performed surgical procedure that shows a low redislocation rate between 1%-7%. However, a complication rate of up to 26% and a reoperation rate of 4% has also been observed. The question, therefore, arises which parameter determines MPFL reconstruction failure. Thus, the purpose of this study was to identify reasons for MPFL reconstruction failure with regard to patients’ complaints leading to reoperation. Materials and Methods: Between July 2015 and May 2019 28 patients (M/F 9/19; mean age 27 ± 8 years) with postoperative complaints after MPFL reconstructive surgery had to undergo revision surgery. Preoperative failure analysis included clinical examination (ROM, ReDPAT, J-sign, and Patella-Glide Test) and radiological imaging with regard to anatomical risk factors of patellar instability and MPFL tunnel positioning. Anatomical predisposition was assessed according to Dejour’s classification of trochlear dysplasia, tibial tuberosity-trochlear groove distance, tibial tuberosity-posterior cruciate ligament distance, patellar height, varus/valgus malalignment and torsional profile. Results: Three major reasons for revision surgery were identified: (1) patellar redislocation, (2) limited range of motion (ROM), and (3) anterior knee pain (AKP). Sixteen of the 28 patients (57%) suffered from recurrent patellar dislocation. Severe trochlear dysplasia (type B/D according to Dejour) (44%), valgus deformity (19%), increased patellar height (19%), and misplaced femoral drill channels (31%) could be identified as risk factors for redislocation. An increased TT-TG (>20mm) or TT-PCL (>24mm) distance could not be observed in any patient in this group. Limited ROM with an average maximum flexion ability of about 92 ± 26° was observed in 10 of the 28 patients (36%), of which 9 patients additionally complained of AKP. Misplaced femoral drill channels (80%), severe trochlear dysplasia (type B/D according to Dejour) (20%) and postoperative decreased patellar height (20%) could be identified as risk factors for postoperative limited ROM. Other reasons for postoperative AKP were increased femoral antetorsion (n=1) and retropatellar cartilage damage (n=2) without any loss of ROM. Conclusion: Recurrent dislocation of the patella, limited ROM and AKP were identified as most common complications after MPFL reconstruction leading to revision surgery. Failures are mainly due to neglected bony risk factors of patellar instability (trochlear dysplasia, patella alta and valgus deformity) and to misplaced femoral drill channels. Appropriate patient selection and an accurate surgical technique appear mandatory for a good clinical outcome when patellar instability is treated solely with an MPFL reconstruction.

Clinical and Demographic Risk Factors for COVID-19 during Delivery Hospitalizations in New York City

2021 ◽  
Author(s):  
Desmond Sutton ◽  
Timothy Wen ◽  
Anna P. Staniczenko ◽  
Yongmei Huang ◽  
Maria Andrikopoulou ◽  
...  
Keyword(s):  
Risk Factors ◽  
New York ◽  
New York City ◽  
Logistic Regression ◽  
York City ◽  
Demographic Data ◽  
Outcome Data ◽  
Demographic Risk ◽  
Demographic Risk Factors ◽  
Zip Code

Objective This study was aimed to review 4 weeks of universal novel coronavirus disease 2019 (COVID-19) screening among delivery hospitalizations, at two hospitals in March and April 2020 in New York City, to compare outcomes between patients based on COVID-19 status and to determine whether demographic risk factors and symptoms predicted screening positive for COVID-19. Study Design This retrospective cohort study evaluated all patients admitted for delivery from March 22 to April 18, 2020, at two New York City hospitals. Obstetrical and neonatal outcomes were collected. The relationship between COVID-19 and demographic, clinical, and maternal and neonatal outcome data was evaluated. Demographic data included the number of COVID-19 cases ascertained by ZIP code of residence. Adjusted logistic regression models were performed to determine predictability of demographic risk factors for COVID-19. Results Of 454 women delivered, 79 (17%) had COVID-19. Of those, 27.9% (n = 22) had symptoms such as cough (13.9%), fever (10.1%), chest pain (5.1%), and myalgia (5.1%). While women with COVID-19 were more likely to live in the ZIP codes quartile with the most cases (47 vs. 41%) and less likely to live in the ZIP code quartile with the fewest cases (6 vs. 14%), these comparisons were not statistically significant (p = 0.18). Women with COVID-19 were less likely to have a vaginal delivery (55.2 vs. 51.9%, p = 0.04) and had a significantly longer postpartum length of stay with cesarean (2.00 vs. 2.67days, p < 0.01). COVID-19 was associated with higher risk for diagnoses of chorioamnionitis and pneumonia and fevers without a focal diagnosis. In adjusted analyses, including demographic factors, logistic regression demonstrated a c-statistic of 0.71 (95% confidence interval [CI]: 0.69, 0.80). Conclusion COVID-19 symptoms were present in a minority of COVID-19-positive women admitted for delivery. Significant differences in obstetrical outcomes were found. While demographic risk factors demonstrated acceptable discrimination, risk prediction does not capture a significant portion of COVID-19-positive patients. Key Points

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 Iron deficiency in Massachusetts communities: Socioeconomic and demographic risk factors among children.

1996 ◽  
Vol 86 (4) ◽  
pp. 544-550 ◽  
Author(s):  
J D Sargent ◽  
T A Stukel ◽  
M A Dalton ◽  
J L Freeman ◽  
M J Brown
Keyword(s):  
Risk Factors ◽  
Iron Deficiency ◽  
Demographic Risk ◽  
Demographic Risk Factors
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