Magnetic Resonance Imaging Evaluation of Patellofemoral Joint

Background: Patellofemoral pain is the leading cause of knee pain in young adults. Magnetic resonance imaging plays an important role in early diagnosis of patellofemoral joint pathology. This study was carried out to evaluate the patellofemoral joint using magnetic imaging resonance and describe various predisposing factors for patellofemoral instability. Methods: The study was carried in Department of Radiology, BPKIHS over a period of six months from February 2020 to August 2020. All patients with clinical diagnosis of patellar instability were included and Magnetic resonance imaging was done using standard knee protocol and findings were noted on structured proforma. Analysis was done using statistical package for the social sciences version 20 applying simple descriptive statistical methods.Results: A total of 60 patients who underwent MRI knee were analyzed, out of which 28(46.7%) patients were male while 32(53.3%) patients were female. 44 patients (58.3%) had various predisposing factors for patellar instability. The commonest predisposing factor was patellar subluxation (73.3%) followed by abnormal trochlear groove angle (58.3%) and patellar translation (increased tibia tubercle trochlear groove distance) (53.3%). Various MRI findings in our study were bone contusion (28 cases,46.7%), joint effusion (36 cases,60%), medial patellofemoral ligament injury (11cases ,18.3%), erosion of patellar cartilage (5 cases,8.3%), femoral cartilage erosion (3 cases,5%),loose bodies (2 cases,3.3%), subchondral edema (3 cases,5%) and meniscus injury (18 cases,30%).Conclusions: Magnetic resonance imaging is not only useful in assessing lesions of the bone, cartilage and ligaments of patellofemoral joint but also enables detection of various predisposing factors for patellofemoral instability.Keywords: Magnetic resonance imaging; patellofemoral instability; patellofemoral joint

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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

The Journal of Knee Surgery ◽

10.1055/s-0039-1688563 ◽

2019 ◽

Vol 33 (08) ◽

pp. 768-776 ◽

Cited By ~ 3

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.

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Investigation of ligament, bone, synovial and plica pathologies accompanied by common extensor tendon in patients with lateral overuse syndrome of the elbow using magnetic resonance imaging

Acta Radiologica ◽

10.1177/0284185121990797 ◽

2021 ◽

pp. 028418512199079

Author(s):

Sinem Aydoğmuş ◽

Berna Dirim Mete ◽

Hüseyin Aydoğmuş ◽

Muhsin Engin Uluç ◽

Özgür Tosun ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Extensor Tendon ◽

Joint Effusion ◽

Ligament Injury ◽

Resonance Imaging ◽

Collateral Ligament ◽

Overuse Syndrome ◽

Signal Change ◽

The Common

Background Tendinosis in the common extensor tendon and accompanying ligament, bone, and plica abnormalities can be observed on magnetic resonance imaging (MRI). Purpose To determine whether there is a difference between accompanying abnormalities according to the degree of common extensor tendon injury Material and Methods Patients who underwent 1.5-T MRI tests with a prediagnosis of lateral overuse syndrome were retrospectively reviewed, and 56 patients who had an injury in the common extensor tendon (CET) were included. The degree of tendon and ligament injury, muscle signal change, bone marrow signal change, presence of joint effusion, and morphological features in the presence of plica were evaluated via MRI examinations of the elbow. Results Overall, 32, 16, and eight patients had mild, moderate, and severe CET damage, respectively. As the severity of CET damage increased, the presence of joint effusion, and the presence and degree of damage to the lateral ulnar collateral ligament (LUCL) and radial collateral ligament (RCL) increased. The radiohumeral (RH) plica area was significantly larger in the group with mild CET damage. There was no statistically significant correlation between the severity of CET damage and the end of RH plica with a blind-end, coverage of one-third or more of the radius, its signal, thickness, and presence of olecranon fold. Conclusion As the severity of CET injury increases, damage to the LUCL, RCL, and the presence of effusion in the joint increases. RH plica should be evaluated in terms of concomitant pathology in patients with mild CET injuries on MRI.

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Role of Magnetic Resonance Imaging in Study of the Patellofemoral Joint Morphological Abnormalities Predisposing to Patellar Instability

International Journal of Science and Healthcare Research ◽

10.52403/ijshr.20210438 ◽

2021 ◽

Vol 6 (2) ◽

pp. 208-215

Author(s):

H.P Parekh ◽

S Aravind Prasad Naik

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Mr Imaging ◽

Patellofemoral Joint ◽

Joint Instability ◽

Medial Patellofemoral Ligament ◽

Age Distribution ◽

Patellofemoral Instability ◽

Resonance Imaging

Objectives: The Patellofemoral joint (PFJ) is a complex joint structure with high functional and biomechanical requirements. The purpose of this study is to evaluate cause of patella-femoral joint instability with in-depth evaluation of influence of anatomical risk factors (AF), measurements and anatomical relationships of the patellofemoral joint and various pathologies causing medial patellofemoral ligament (MPFL) injury that contributes to the patellar maltracking using 1.5 Tesla magnetic resonance imaging. Materials and Methods: The present prospective study is carried out at department of radiology, shri M P Shah Medical College, Jamnagar. This is study of total 50 patients carried out in 12-month duration from July 2019 to June 2020, in which 50 patients aged between 8 - 68 years selected as study group presented with complaint symptoms of patellofemoral instability, knee pain and maltracking were examined and identified by an orthopaedic surgeon. Patients with the clinical suspicion of a PFJ maltracking were selected for subsequent MRI examination. Results: The age distribution in our study was in range of 8 years to 68 years with maximum population within 31 to 40 years range, 66 % were male and 34 % female. Their trochlear depth, sulcal angle, trochlear facet asymmetry, lateral inclination angle was found abnormal in 18 cases (36%), 8 (16%) showed patellar alta and 7 (14%) patella baja. Lateralization of patella (> 6 mm) was noted in 18 patients (36%), Medial patellofemoral ligament injuries were seen in 16 (32%) patients on MRI and kissing contusion 10 (20%) patients. A detailed understanding of the anatomy and pathology of the anterior knee compartment is essential for proper imaging interpretation and treatment management. Conclusion: Magnetic resonance (MR) imaging has been established as the method of choice, showing high accuracy in patellofemoral joint abnormalities. The present study aims to explore the role of MR imaging in diagnosing the various disorders located in anterior compartment of knee. Keywords: Joint instability, Patellofemoral joint, MPFL, MR imaging/diagnosis.

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Increased Magnetic Resonance Imaging Signal of the Lateral Patellar Facet Cartilage: A Functional Marker for Patellar Instability?

The American Journal of Sports Medicine ◽

10.1177/0363546517705634 ◽

2017 ◽

Vol 45 (10) ◽

pp. 2276-2283 ◽

Cited By ~ 6

Author(s):

Anna L. Falkowski ◽

Carlo Camathias ◽

Jon A. Jacobson ◽

Olaf Magerkurth

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Patellar Instability ◽

Trochlear Groove ◽

Resonance Imaging ◽

Patellar Cartilage ◽

Before And After ◽

Lateral Facet ◽

Interreader Agreement

Background: In the knee joint, predisposition for patellar instability can be assessed by an abnormal Insall-Salvati index, tibial tuberosity–trochlear groove (TTTG) distance, and abnormal shape of patella and trochlea. Given the complex anatomic features of the knee joint with varying positions of the patella during motion, the presence of a single or even a combination of these factors does not inevitably result in patellar instability. After trocheoplasty in patients with trochlear dysplasia, assessment of trochlear cartilage and subchondral bone is limited due to postoperative artifacts. Identification of presence of edema in the patellar cartilage may be helpful to identify patellar instability before and after surgery in these patients. Purpose: To determine whether increased signal intensity of the lateral patellar facet cartilage or measurements of abnormal patellofemoral articulation are associated with patellar instability before and after trochleoplasty. Study Design: Case series; Level of evidence, 4. Methods: Twenty-two patients with clinical diagnosis of patellar instability who underwent trochleoplasty, with magnetic resonance imaging (MRI) of the knee before and after surgery, were identified. The following observations and measurements were obtained in preoperative imaging: Insall-Salvati ratio, tibial tuberosity–trochlear groove (TTTG) distance, patellar shape (Wiberg), trochlear shape (Hepp), and edema in the lateral patellar facet cartilage. At 3 to 12 months after surgery, the presence or absence of edema in the cartilage of the lateral facet of the patella, the trochlear shape, and TTTG distance were reassessed. Wilcoxon matched-pairs signed rank test and Student t test were used. Interreader agreement was calculated as the Cohen κ or paired Student t test. Results: Increased cartilage signal was present in 20 patients before trochleoplasty and in 4 after trochleoplasty. Insall-Salvati ratio was greater than 1.20 in 20 patients. Patellar shape was greater than type 2 in 18 patients. Trochlear shape was greater than type 2 in 21 patients before and 7 after trochleoplasty. Mean TTTG distance was 14 mm before and 10 mm after surgery. When results before and after surgery were compared, a significant difference was found for cartilage signal, TTTG distance, and trochlear shape. Agreement for observations was moderate to substantial, and no significant differences were found for interreader agreement ( P > .05). Conclusion: Patellar cartilage at the lateral facet of the patella can be assessed after trochleoplasty despite postoperative artifacts in the trochlea. A decrease of patellar edema seems to be associated with improved femoropatellar articulation. Moreover, patellar edema may be used as a functional criterion of patellofemoral instability. This would provide additional information compared to morphologic criteria which just describe predisposing factors for femoropatellar instability.

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STUDY ON THE PATELLOFEMORAL JOINT USING MAGNETIC RESONANCE IMAGING: MORPHOLOGICAL VARIATION OF THE MEDIAL PATELLOFEMORAL LIGAMENT

Revista Brasileira de Ortopedia (English Edition) ◽

10.1016/s2255-4971(15)30087-2 ◽

2012 ◽

Vol 47 (2) ◽

pp. 204-209

Author(s):

Alfredo dos Santos Netto ◽

Marcelo Botelho Soares de Brito ◽

Fabrício Roberto Severino ◽

Leila Rodrigues Andrade Campos ◽

Marcelo Astolfi Caetano Nico ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Morphological Variation ◽

Patellofemoral Joint ◽

Medial Patellofemoral Ligament ◽

Resonance Imaging

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Inter- and intra-observer reliability of patellar height measurements in patients with and without patellar instability on plain radiographs and magnetic resonance imaging

Skeletal Radiology ◽

10.1007/s00256-021-03937-y ◽

2021 ◽

Author(s):

Stephen Picken ◽

Harry Summers ◽

Oday Al-Dadah

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Patellar Instability ◽

Patellar Height ◽

Resonance Imaging ◽

Plain Radiographs ◽

Observer Reliability

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Role of MRI in Screening of Non-Traumatic Pediatrics Hip Pain

QJM ◽

10.1093/qjmed/hcab106.025 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Abeer Abd El Maksoud Hafez ◽

Tarek Wahby Hameda ◽

Ghadier Ibrahim Attia

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Hip Joint ◽

Imaging Modality ◽

Bone Cyst ◽

Hip Pain ◽

Joint Effusion ◽

Resonance Imaging ◽

University Hospitals ◽

Great Ability

Abstract Background Magnetic resonance is the best imaging modality to assess hip joint in non-traumatic cases. It has a great ability to diagnose disorders of bone, cartilage, ligaments, muscles and soft tissue. MRI can also detect joint effusion and bone marrow edema. Aim of the Work: To assess the value of MRI as the imaging modality in children presenting with acute non-traumatic hip pain and its ability to assess the cause of the pain early without the use of another imaging modality. Patients and Methods A retrospective study was conducted on pediatric patients with non-traumatic hip pain, referred from the outpatient pediatric clinic, orthopedic clinic, Ain Shams University hospitals. The patients were investigated using magnetic resonance imaging (MRI) for detection the cause of non-traumatic hip pain. Results In this study we found that avascular necrosis is the commonest cause of non-traumatic hip pain followed by isolated hip effusion then synovitis. Other causes included perthes, septic arthritis, osteomyelitis, aneurysmal bone cyst, SCFE, PFFD and Osteomalacia. Magnetic resonance imaging doesn’t only demonstrate disorders of hip joint only; it also gives an accurate assessment of other extra-articular causes of referred hip pain. Conclusion Hip MRI is a practical, well accepted and accurate non-invasive imaging technique in children presenting with acute non-traumatic hip pain.

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Magnetic Resonance Imaging Analysis of Rotational Alignment in Patients With Patellar Dislocations

The American Journal of Sports Medicine ◽

10.1177/0363546512464691 ◽

2012 ◽

Vol 41 (1) ◽

pp. 51-57 ◽

Cited By ~ 65

Author(s):

Gerd Diederichs ◽

Torsten Köhlitz ◽

Evgenios Kornaropoulos ◽

Markus O. Heller ◽

Bernd Vollnberg ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Risk Factors ◽

Magnetic Resonance ◽

Patellar Dislocation ◽

Patellofemoral Instability ◽

Resonance Imaging ◽

Tibial Torsion ◽

Limb Alignment ◽

Femoral Antetorsion ◽

Rotational Limb Alignment

Background: The role of anatomic risk factors in patellofemoral instability is not yet fully understood, as they have been observed in patients either alone or in combination and in different degrees of severity. Purpose: To prospectively analyze rotational limb alignment in patients with patellofemoral instability and in controls using magnetic resonance imaging (MRI). Study Design: Cross-sectional study; Level of evidence, 3. Methods: Thirty patients (mean age, 22.9 y; range, 12-41 y) with a history of patellar dislocation and 30 age- and sex-matched controls (mean age, 25.2 y; range, 16-37 y) were investigated. The patients underwent MRI of the leg at 1.5 T using a peripheral angiography coil and a T2-weighted half-Fourier acquisition single-shot turbo spin echo (HASTE) sequence for measuring femoral antetorsion, tibial torsion, knee rotation, and mechanical axis deviation (MAD). The mean values of these parameters were compared between patients and controls. In addition, the patients underwent an assessment to determine the influence of rotational limb alignment on lateral trochlear inclination, trochlear facet asymmetry, trochlear depth, Insall-Salvati index, and tibial tuberosity–trochlear groove distance. Results: Patients had 1.56-fold higher mean femoral antetorsion (20.3° ± 10.4° vs 13.0° ± 8.4°; P < .01) and 1.6-fold higher knee rotation (9.4° ± 5.0° vs 5.7° ± 4.3°; P < .01) compared with controls. Moreover, patients had 2.9 times higher MAD (0.81 ± 0.75 mm vs −0.28 ± 0.87 mm; P < .01). Differences in tibial torsion were not significant. Also, there were no significant correlations between parameters of rotational alignment and standard anatomic risk factors. Conclusion: Our results suggest that some patients with nontraumatic patellar instability have greater internal femoral rotation, greater knee rotation, and a tendency for genu valgum compared with healthy controls. Rotational malalignment may be a primary risk factor in patellar dislocation that has so far been underestimated.

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