scholarly journals Relation of the chondromalatia patellae to proximal tibial anatomical parameters, assessed with MRI

2020 ◽  
Vol 54 (2) ◽  
pp. 159-167
Author(s):  
Mohammadreza Tabary ◽  
Azadehsadat Esfahani ◽  
Mehdi Nouraie ◽  
Mohammad Reza Babaei ◽  
Ali Reza Khoshdel ◽  
...  
Keyword(s):  
Tilt Angle ◽  
Odds Ratio ◽  
Tibial Slope ◽  
Patellar Height ◽  
Mri Findings ◽  
Patellar Tilt ◽  
Chondromalacia Patellae ◽  
Knee Mri ◽  
Adjacent Structures ◽  
Patellar Tilt Angle

AbstractBackgroundMagnetic resonance imaging (MRI) is a non-invasive highly sensitive tool for diagnosing chondromalacia patellae in the early stages. Many studies have evaluated patellar and trochlear morphology with different radiologic indices. We aimed to assess the discriminative power of tibial, patellar, and femoral indices in MRI for chondromalacia patellae.Patients and methods100 cases of chondromalacia, as well as 100 age-matched controls among the patients who underwent knee MRI between February 2017 and March 2019, were included. The standard protocol of knee MRI was applied and the diagnosis of chondromalacia was made on MRI findings. Chondromalacia subjects were also classified as grade 1 to 4 according to the Modified Outerbridge’s MRI grading system. We measured 25 MRI parameters in the knee and adjacent structures to determine the relation between chondromalacia patellae and anatomical MRI parameters.ResultsTibial slope, trochlear depth, lateral trochlear inclination, and lateral patellar tilt angle had significant correlation with chondromalacia. Any increase in lateral trochlear inclination and lateral patellar tilt angle could increase the probability of the disease (Odds ratio [OR] 1.15, 1.13; 95% CI: 1.03–1.30; 1.02–1.26, respectively), while any increase in medial tibial slope and trochlear depth could decrease the probability of chondromalacia (OR 0.85, 0.06; 95% CI: 0.73–0.98, 0.02–0.17, respectively). We also designed a model for the severity of disease by using the patellar height index (relative odds ratio: 75.9).ConclusionsThe result of this study showed the novelty role of tibial anatomy in developing chondromalacia and its mechanism. We also concluded that patellar height might be an important factor in defining disease severity.

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.

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.

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.

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 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.

Correlation Between Trochlear Groove Depth and Patellar Position During Open and Closed Kinetic Chain Exercises in Subjects With Anterior Knee Pain

2012 ◽  
Vol 28 (3) ◽  
pp. 335-342 ◽  
Author(s):  
Lílian Ramiro Felicio ◽  
Marcelo Camargo Saad ◽  
Rogério Ferreira Liporaci ◽  
Augusto do Prado Baffa ◽  
Antônio Carlos dos Santos ◽  
...  
Keyword(s):  
Knee Pain ◽  
Tilt Angle ◽  
Anterior Knee Pain ◽  
Kinetic Chain ◽  
Pain Group ◽  
Patellar Tilt ◽  
Sulcus Angle ◽  
Closed Kinetic Chain ◽  
Anterior Knee ◽  
Patellar Tilt Angle

The purpose of this study was to correlate the trochlear shape and patellar tilt angle and lateral patellar displacement at rest and maximal voluntary isometric contraction (MVIC) exercises during open (OKC) and closed kinetic chain (CKC) in subjects with and without anterior knee pain. Subjects were all women, 20 who were clinically healthy and 19 diagnosed with anterior knee pain. All subjects were evaluated and subjected to magnetic resonance exams during OKC and CKC exercise with the knee placed at 15, 30, and 45 degrees of flexion. The parameters evaluated were sulcus angle, patellar tilt angle and patellar displacement using bisect offset. Pearson’srcoefficient was used, withp< .05. Our results revealed in knee pain group during CKC and OKC at 15 degrees that the increase in the sulcus angle is associated with a tilt increase and patellar lateral displacement. Comparing sulcus angle, patellar tilt angle and bisect offset values between MVIC in OKC and CKC in the knee pain group, it was observed that patellar tilt angle increased in OKC only with the knee flexed at 30 degrees. Based on our results, we conclude that reduced trochlear depth is correlated with increased lateral patellar tilt and displacement during OKC and CKC at 15 degrees of flexion in people with anterior knee pain. By contrast, 30 degrees of knee flexion in CKC is more recommended in rehabilitation protocols because the patella was more stable than in other positions.

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