A comparison of sagittal MRI and lateral radiography in determining the Insall–Salvati ratio and diagnosing patella alta in the pediatric knee

Kurowecki, Darya; Shergill, Ravi; Cunningham, Kelly M.; Peterson, Devin; Takrouri, Heba S.; Habib, Neuman O; Ainsworth, K

doi:10.1007/s00247-021-05207-4

Cited by 8 publications

(19 citation statements)

References 11 publications

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“…According to different types of the patella (according to Wiberg), we found statistical significance of the Insall–Salvati index and the Caton–Deschamps index. The values of Insall–Salvati ratio in our study correspond with those of previous reports [ 34 ]. The same applies for the Caton–Deschamps index in our study [ 35 ].…”

Section: Discussionsupporting

confidence: 93%

Morphometric Parameters and MRI Morphological Changes of the Knee and Patella in Physically Active Adolescents

et al. 2023

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Background and Objectives: The immature skeleton in a pediatric population exposed to frequent physical activity might be extremely prone to injuries, with possible consequences later in adulthood. The main aim of this study is to present specific morphometric parameters and magnetic resonance imaging (MRI) morphological changes of the knee and patella in a physically active pediatric population. Additionally, we wanted to investigate the morphological risk factors for patellar instability. Materials and Methods: The study included the MRI findings of 193 physically active pediatric patients with knee pain. The participants underwent sports activities for 5 to 8 h per week. Two divisions were performed: by age and by patellar type. We evaluated three age groups: group 1 (age 11–14), group 2 (age 15–17), and group 3 (age 18–21 years). In addition, participants were divided by the patellar type (according to Wiberg) into three groups. The following morphometric parameters were calculated: lateral trochlear inclination (LTI), the tibial tubercle–trochlear groove distance (TT-TG), trochlear facet asymmetry (TFA), Insall–Salvati index, modified Insall–Salvati index, Caton–Deschamps index, articular overlap, morphology ratio and contact surface ratio. Results: We found a statistically significant association between patellar type groups in LTI (p < 0.001), TFA (p < 0.001), Insal–Salvati (p = 0.001) index, and Caton–Deschamps index (p = 0.018). According to age groups, we found statistical significance in the Caton–Deschamps index (p = 0.039). The most frequent knee injury parameter, according to Wiberg, in physically active pediatric patients was patella type 2 in boys and type 3 in girls. Conclusions: The MRI morphometric parameters observed in our study might be factors of prediction of knee injury in physically active children. In addition, it might be very useful in sports programs to improve the biomechanics of the knee in order to reduce the injury rate in sports-active children.

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Section: Discussionsupporting

confidence: 93%

Morphometric Parameters and MRI Morphological Changes of the Knee and Patella in Physically Active Adolescents

et al. 2023

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“…MRI visualizes cartilaginous structures, so there are previous studies related to MRI and radiographs in the pediatric knee ( 14 , 20 ). Kurowecki et al showed Insall–Salvati ratio derived from MRI and radiographs in children showed strong association and Park et al suggested to apply the IS in patients older than 13 years with complete ossification and the KS in patients with incomplete ossification.…”

Section: Discussionmentioning

confidence: 99%

“…Park et al assessed which of the three methods, among IS, BP, and KS, was most appropriate for measuring patellar height in pediatric patients; however, they did not consider modIS and CD methods (14). Recently, Kurowecki et al reported that IS and patella alta, as determined on MRI, were comparable to those determined on radiography in pediatric patients (20). However, these two studies on pediatric patients did not consider other methods to measure patellar height and had limitations of modest sample sizes (14,20).…”

Section: Introductionmentioning

confidence: 99%

“…Recently, Kurowecki et al reported that IS and patella alta, as determined on MRI, were comparable to those determined on radiography in pediatric patients (20). However, these two studies on pediatric patients did not consider other methods to measure patellar height and had limitations of modest sample sizes (14,20). Moreover, while many previous studies have evaluated the reliability and variability of various patellar height measurement methods (7,(21)(22)(23), data on pediatric patients are scarce.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of age group and sex differences in the measurement of patellar height of pediatric knee in a Korean population

Kwak

Park²,

Huser³

et al. 2023

Front. Pediatr.

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IntroductionVarious methods based on bony landmarks are used to determine patellar height. This study analyzed five methods for patellar height measurement on lateral knee radiographs, namely, the Insall–Salvati, Koshino–Sugimoto, Blackburne–Peel, modified Insall–Salvati, and Caton–Deschamps methods.MethodsOverall, 425 pediatric participants (221 males, 204 females; age range 5–18 years) were included and were divided equally into three age groups (A, 5–10 years; B, 11–13 years; and C, 13–18 years). For the comparison of the applicability of each method, the applicable probabilities for each age group and sex-based differences were analyzed using logistic regression techniques. Intra-rater reliability and inter-rater variability were analyzed by two trained raters.ResultsThe Koshino–Sugimoto method was applicable to all patients. The 80% applicable age of female patients was lower than that of male patients for the Blackburne–Peel (male = 11.9, female = 11) and Caton–Deschamps (male = 11.9, female = 11.1) methods. However, in the Insall–Salvati (male = 12, female = 12.1) and modified Insall–Salvati (male = 12.6, female = 13.1) methods, the 80% applicable age in male patients was lower than that in female patients. The Koshino–Sugimoto method showed the highest variability in group B, while the Insall–Salvati showed the highest variability in group C. In terms of intra-observer reliability, the Caton–Deschamps method showed the same reliability as the Insall–Salvati method, in group C.ConclusionsOur results demonstrated differences in the reliability, variability, and applicability of patellar height measurement methods according to age group. The applicability of patellar height measurement methods also differed according to sex. Therefore, based on age group and sex, different methods should be used for patellar height measurement in pediatric patients.

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“…ISR is the ratio of patellar tendon length to patella length and determines the position of the patella in lateral knee radiography with the knee in 30° flexion (6). The use of ISR in other imaging modalities, including computed tomography (CT), magnetic resonance imaging (MRI), and ultrasonography (US) in determining patellar position in children and adults has been reported in the literature (7)(8)(9)(10).…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Accuracy of MRI Evaluation of Patellar Position According to the Physeal Line in Pediatric Patients

Taşolar

Sağlam

2023

Medical Records

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Background: Abnormal positioning of patella, of which superior position is defined as patella alta (PA) whereas inferior position is defined as patella baja (PB). Most of the measurements of patellar position evaluations are time consuming. In this study, we aimed to examine the diagnostic accuracy of visual evaluation of the patellar position according to the physeal line and to determine the inter- and intraobserver agreement of this evaluation in MRI examinations. Method: Knee MRI examinations performed between 2019-2021 with different knee symptoms and prediagnoses were retrospectively analyzed in this study. As reference test, insall-Salvati Ratio was calculated by the following formula: Tendon length/Patellar Length. Two different visual evaluation methods were used; physis line to patella (PLP) and physis line to patellar joint cartilage (PLC). Results: Three hundred and sixty consecutive children aged 60-215 months were included in the study. There was excellent agreement of both intra- and interobserver on PLP and PLC for two observers (κ > 0.800, for all). When we evaluate intra- and interobserver agreements according to groups, almost perfect agreement were detected (κ > 0.750, for all). Diagnostic accuracy for both two observers on the visual evaluation of PLP were almost perfect (Sensitivity 95.5%, specificity 87.2% for observer 1, and Sensitivity 94.7%, specificity 87.2% for observer 2), and on the PLC evaluation were also good (Sensitivity 89.3%, specificity 82.9% for observer 1, and Sensitivity 88.1%, specificity 85.5% for observer 2). Conclusion: Even though direct radiography is used in the diagnosis of PA and PB, it has been shown that MRI can also be used in pediatric patients in daily practice. Instead of the time-consuming measurements used in MRI, it may be kept in mind to use these methods in our study for practical and accurate diagnosis.

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A comparison of sagittal MRI and lateral radiography in determining the Insall–Salvati ratio and diagnosing patella alta in the pediatric knee

Cited by 8 publications

References 11 publications

Morphometric Parameters and MRI Morphological Changes of the Knee and Patella in Physically Active Adolescents

Morphometric Parameters and MRI Morphological Changes of the Knee and Patella in Physically Active Adolescents

Evaluation of age group and sex differences in the measurement of patellar height of pediatric knee in a Korean population

Diagnostic Accuracy of MRI Evaluation of Patellar Position According to the Physeal Line in Pediatric Patients

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