Femoropatellar radiographic alterations in cases of anterior cruciate ligament failure

Abstract

ObjectiveTo make a comparative analysis on three femoropatellar radiographic parameters, between knees with chronic failure of the anterior cruciate ligament (ACL) and normal knees.MethodsThirty volunteer patients with a diagnosis of unilateral isolated chronic ACL injury for more than one year and a normal contralateral knee were selected. Digital radiographs were produced for all the patients, on both knees in absolute lateral view at 30° of flexion, with and without load-bearing on one leg, and in axial view of the patella at 30°. The Caton–Deschamps patellar height index, Merchant patellar congruence angle and Laurin lateral patellar tilt angle were measured on the radiographs obtained from the normal knees and knees with ACL injuries, and comparative analysis was performed between these two groups.ResultsThe patellar height was statistically significantly lower (p < 0.001) in the knees with ACL failure than in the normal knees, both on radiographs without loading and on those with single-foot loading. The Merchant patellar congruence angle was significantly smaller (p < 0.001) in the normal knees and the lateral patellar tilt angle was smaller (p < 0.001) in the knees with ACL failure.ConclusionChronic ACL failure gave rise to a statistically significant change in the femoropatellar radiographic values studied (p < 0.001). Knees with injuries to this ligament presented lower patellar height values, greater tilt and lateral displacement of the patella, in relation to the femoral trochlea, in comparison with the normal contralateral knees.

Carta ao editor: Alterações Radiográficas Femoropatelares na insuficiência do Ligamento Cruzado Anterior. Rev Bras Ortop 2015;50(1):43–49

“…We were interested in reading 'Femoropatellar radiographic alterations in cases of anterior cruciate ligament failure' by de Vasconcelos D. P. et al, 1 published in the esteemed Revista Brasileira de Ortopedia journal on the year 2015. doi:10.1016/j.rboe.2015.01.005. The objective of the study was to assess the femoropatellar radiographic alterations in 30 patients with anterior cruciate ligament (ACL) failure using three parameters.…”

“…The authors selected 30 volunteer patients with unilateral isolated ACL tear of > 1duration for the study and compared them with normal contralateral knees. 1 The patellar height was studied using the Caton-Deshchamps ratio, whereas the patellar tilt and translation were assessed by lateral inclination angle and congruence angle, respectively. Although the inclusion criteria states that knees with single ACL tear were included, no mention was made of the medial patellofemoral ligament integrity throughout the text.…”

“…Interessamos-nos na leitura de “Alterações Radiográficas Femoropatelares na insuficiência do Ligamento Cruzado Anterior” por de Vasconcelos D. P. et al, 1 publicado no prestigiado periódico “Revista Brasileira de Ortopedia” no ano de 2015. doi:10.1016/j.rboe.2015.01.005. O objetivo do estudo foi avaliar as alterações radiográficas femoropatelares em 30 pacientes com falha do ligamento cruzado anterior (LCA) usando três parâmetros.…”

Carta resposta referente ao artigo “Alterações radiográficas femoropatelares na insuficiência do ligamento cruzado anterior”. Rev Bras Ortop 2015;50(1):43–49

“…We agree that the presence of previous injury to the medial patellofemoral ligament (MPFL), or previous episode of lateral patellar dislocation, could alter the radiographic indices studied. Thus, as highlighted in Table 1 of our original article, 4 we emphasize that the presence of any previous injuries or changes of any origin, including traumatic, in either knee, except for the isolated ACL injury in one knee, would be an exclusion criterion. For this, we performed clinical history and physical examination of the lower limbs searching for any changes, in addition to the unilateral isolated signs of ACL failure.…”

“…Concordamos que a presença de lesão prévia do ligamento patelofemoral medial (LPFM), ou episódio prévio de luxação lateral da patela, poderiam alterar os índices radiográficos estudados. Desta forma, conforme destacado na Tabela 1 do nosso artigo original, 4 enfatizamos que a presença de quaisquer lesões ou alterações prévias de qualquer origem, inclusive traumática, em qualquer um dos joelhos, à exceção da lesão isolada do LCA em um dos joelhos, seria critério de exclusão. Para isto, realizamos história clínica e exame físico dos membros inferiores em busca de quaisquer alterações, além dos sinais de insuficiência isolada unilateral do LCA.…”