Predicting Risk of Recurrent Patellar Dislocation

Parikh, Shital N.; Lykissas, Marios G.; Gkiatas, Ioannis

doi:10.1007/s12178-018-9480-5

Cited by 95 publications

(67 citation statements)

References 39 publications

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“…Moreover, increased lateralization of the tibial tuberosity can be evaluated throughout the measurement of the TT-TG distance. TT-TG value is independent of the patient's height and weight [21].…”

Section: Discussionmentioning

confidence: 94%

Correlations between intra and extraarticular factors measured by computed tomography in patients with recurrent patellar dislocation

Iacobescu

Cursaru

Anghelescu

et al. 2020

Romanian Journal of Orthopaedic Surgery and Traumatology

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Introduction: Lateral patellar dislocation (LPD) is a common injury of the knee, most frequent in young patients. It has a multifactorial etiology with several underlying risk factors. In most cases, patellar dislocation occurs on the lateral side, with the rupture of the medial patellofemoral ligament (MPFL), appearing in more than 80% of the cases. The tibial tuberosity-trochlear groove (TT-TG) distance of 20 mm or more in patients with lateral patellar dislocation is a gold standard for the surgical indication of tibial tubercle osteotomy (TTO).Hypothesis: Our investigation aimed to establish whether there is a correlation between the TT-TG distance and other bony landmarks, like trochlear groove medialization, tibial tuberosity lateralization, and knee rotation angle, in the surgical algorithm for the patient with patellar dislocation.Methods: We conducted a prospective study, analyzing and comparing data from two groups, 33 patients with a diagnosis of patellar dislocation, and a control group of 30 patients, with meniscal injury, but healthy contralateral limb. Using computed tomography, we measured the TT-TG distance, femoral anteversion, tibial torsion, knee rotation angle, tuberosity lateralization, and trochlear groove medialization of all the patients in our study. The measurements were conducted by two independent orthopedic surgeons in a randomized manner. Using an unpaired t test, we compared and analyzed each parameters value from the study and the control group.Results: Comparing the two groups, we observed a significant difference for TT-TG distance, knee rotation angle and tibial tuberosity lateralization with higher values in the study group compared to the control group (CI 95% 6.44-9.72, CI 95% 8.64-10.39, CI 95% 3.77-5.46, respectively), with a p value < 0.0001 in all cases. Also, the TT-TG distance positively correlated with knee rotation angle (r=.97, p=0.01) and tibial tuberosity lateralization (r=.86, p=0.0001) in the study group.Conclusions: The TT-TG distance measurement usually defines the lateralization of the tibial tuberosity; yet, in some cases, it can be caused by the trochlear groove medialization, or high rotation between the femur and tibia. Our study revealed that knee rotation and tuberosity lateralization were factors implicated in patellar dislocation and they should be taken into account when making the decision of tibial tubercle osteotomy.

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Section: Discussionmentioning

confidence: 94%

Correlations between intra and extraarticular factors measured by computed tomography in patients with recurrent patellar dislocation

Iacobescu

Cursaru

Anghelescu

et al. 2020

Romanian Journal of Orthopaedic Surgery and Traumatology

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“…TD has consistently been associated with PI, and several studies 4,12,20,21,26,27,31 have identified it as either the primary or one of the strongest associated risk factors for instability or recurrent instability. Dejour et al 14 observed that in a population of patients undergoing surgical stabilization for PI, 85% had 2 radiographic signs of TD and 96% had 1 sign of TD, versus only 6% of the control group with any radiographic signs of TD.…”

Section: Discussionmentioning

confidence: 99%

“…1,17,35 PI is multifactorial, with several identified risk factors such as age, activity level, trochlear dysplasia (TD), patella alta, patellar tilt, and coronal and rotational plane malalignment. 4,12,21,24,31,36,41 Of these risk factors, TD has been consistently identified as having the strongest association with recurrent PI. 6,12,14,21,26,27 Recently, some studies 9,25,40 have shown that TD alters the patellofemoral joint such that other radiographic parameters used to characterize PI, in particular the tibial tuberosity to trochlear groove (TT-TG) measurement, are changed relative to the amount of TD present.…”

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confidence: 99%

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confidence: 99%

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

Pace

Cheng

Joseph

et al. 2020

Orthopaedic Journal of Sports Medicine

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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.

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“…review by Parikh et al 15 It is imperative to continue to search for the optimal treatment of a first-time dislocation patient, understanding that each patient will have a unique pattern of injury and risk factors that will deserve patient-specific treatment.…”

Section: Editorial Commentarymentioning

confidence: 99%

Editorial Commentary: What Is the Optimal Management of First and Recurrent Patellar Instability? Patellofemoral Instability Management Continues to Evolve

Farr

2018

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Patellar instability patients may present for evaluation after their first instability episode or after recurrent episodes. Current management differs for these 2 groups. The accepted "common denominator" of patellar instability is the medial patellofemoral ligament, or medial patellar restraints, to be more all-encompassing. These patients often have multiple contributing comorbidities (e.g., trochlear dysplasia, patellar alta, excessive lateral position of tibial tubercle). Historically, the recommended treatment for a first-time patellar dislocation was nonoperative because medial soft tissue repairs had not been proven more effective. Indications for primary repair of the medial patellar restraints are a single discrete tear identified on magnetic resonance imaging. In the case of recurrent patellar instability, medial patellofemoral ligament reconstruction, rather than repair/reef, has been the recommended approach. The keys to reconstruction remain: honor the anatomy and avoid overconstraint of the patella. For first time dislocation patients with trochlear dysplasia, patellar alta, and age <25 years, recurrent instability is common.

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Predicting Risk of Recurrent Patellar Dislocation

Cited by 95 publications

References 39 publications

Correlations between intra and extraarticular factors measured by computed tomography in patients with recurrent patellar dislocation

Correlations between intra and extraarticular factors measured by computed tomography in patients with recurrent patellar dislocation

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

Editorial Commentary: What Is the Optimal Management of First and Recurrent Patellar Instability? Patellofemoral Instability Management Continues to Evolve

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