A Computed Tomography Study of the Association Between Increased Patellar Tilt Angle and Femoral Anteversion in 30 Patients with Recurrent Patellar Dislocation

Kang, Huijun; Dong, Conglei; Tian, Gengshuang; Wang, Fei

doi:10.12659/msm.914747

Cited by 12 publications

(10 citation statements)

References 23 publications

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“…Tibial tubercle osteotomy (TTO) is a frequent surgical technique applied for correcting abnormal patellar tracking caused by a lateral force vector, described in literature as the main cause of the lateralization of the tibial tubercle and other rotational deformities [10,11]. The surgical indication for TTO has been established by a computed tomography study of Dejour et al, in 1994, at a tibial tubercle-trochlear groove (TT-TG) distance of 20 mm or more and it has been considered a standard surgery indication since then [12].…”

Section: Introductionmentioning

confidence: 99%

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: Introductionmentioning

confidence: 99%

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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“…Inclusion criteria: patients aged 18 to 45 years (2) more than 2 dislocations after the first dislocation; painful patellar instability symptoms or subluxation; positive patellar apprehension test; [14] excessive patellar tilt angle on computed tomography (CT) and MPFL tear on magnetic resonance imaging. Exclusion criteria: age < 18 years or more than 45 years; bony structural abnormalities: Insall-Salvati index ≥ 1.2, [15] tibial tuberosity-trochlear groove distance of ≥ 20 mm, [16] Severe Trochlear Dysplasia (Dejour type B, C, or D), [17] Femoral anteversion angle ≥ 25°, [18] and previous surgery on the affected knee, all performed by a surgically experienced chief surgeon. All knee function scores and imaging measurements, assessments and follow-up, and documentation were performed by a single blinded observer.…”

Section: Methodsmentioning

confidence: 99%

3D-printed individualized navigation template versus the fluoroscopic guide to defining the femoral tunnel for medial patellofemoral ligament reconstruction: A retrospective study

et al. 2023

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During medial patellofemoral ligament (MPFL) reconstruction, fluoroscopic determination of the femoral tunnel point is the most common method. However, there is a decrease in tunnel position accuracy due to rotation of the femur during fluoroscopy, as well as the damage to the operator from multiple fluoroscopies, whereas the 3D-printed individualized navigation template is not affected by this factor. This study focuses on the accuracy and early clinical efficacy of 2 different ways to determine the femoral tunnel (Schöttle point) for double-bundle isometric MPFL reconstruction. This is a retrospective study, conducted between 2016 and 2019, in which 60 patients with recurrent patellar dislocation were divided into 2 groups: 30 with MPFL reconstruction at the Schöttle point determined by 3D-printed individualized navigation template (group A) and 30 with MPFL reconstruction at the Schöttle point determined by fluoroscopic guidance (group B). The changes in patella congruence angle and patella tilt angle before and after surgery were assessed using computed tomography scans of the knee, knee function was assessed using the Kujala knee score and the international knee documentation committee (IKDC) score, and the 2 approaches were compared for the intraoperative establishment of the femoral tunnel position at a distance from Schöttle point. At a minimum of 3 years follow-up, patella tilt angle and patella congruence angle returned to normal levels and were statistically different from the preoperative range, with no significant differences between the 2 groups at the same period, and Kujala and IKDC scores of knee function were significantly improved in both groups after surgery. The mean Kujala and IKDC scores were statistically different between groups A and B at 3 and 6 months postoperatively. No statistically significant differences were seen between the 2 groups at the final follow-up. Both femoral tunnel localization approaches for double-bundle isometric MPFL reconstruction resulted in good knee function. At no < 3 years of follow-up, the use of a 3D-printed individualized navigation template did result in more accurate isometric points and higher knee function scores in the early postoperative period.

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“…The axial slice with the widest patella was determined, and the line connecting the medial and lateral edges of the patella was the widest patellar axis. The posterior condylar line was defined as the line passing through the most posterior points of the medial and lateral femoral condyles on the axial slice showing the posterior condyles with the Roman arch [ 31 ]. Positive value represented lateral patellar tilt.…”

Section: Methodsmentioning

confidence: 99%

Quality of life following medial patellofemoral ligament reconstruction combined with medial tibial tubercle transfer in patients with recurrent patellar dislocation: a retrospective comparative study

et al. 2022

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Background Because the patients undergoing medial patellofemoral ligament reconstruction (MPFLr) combined with medial tibial tubercle transfer (TTT) procedure are usually young and active, the quality of life (QoL) is also an important prognostic factor for patients with recurrent patellar dislocation. Assessing QoL can provide more useful and accurate evidence for the effects of this procedure. This study aimed to evaluate QoL following MPFLr combined with TTT, compared with isolated MPFLr (iMPFLr). Methods Fifty-one patients who underwent iMPFLr + TTT and 48 patients who underwent iMPFLr were included. Clinical evaluation included QoL (EQ-5D-5L and EQ-5D VAS), functional outcomes (Kujala, Lysholm and Tegner activity scores), physical examinations (patellar apprehension test and range of motion) and redislocation rates. Radiological evaluation included patellar tilt angle and bisect offset. These preoperative and postoperative results were compared between groups at baseline and the final follow-up. The paired and independent t tests were used for the data following a normal distribution. Otherwise, the Wilcoxon and Mann–Whitney U tests were used to analyze the differences. Categorical variables were compared by chi-square or Fisher’s exact test. Results All of the QoL (EQ-5D-5L and EQ-5D VAS), clinical results and radiological outcomes significantly improved in both groups at the final follow-up, with no significant differences between groups. There was no significant difference in five dimensions of EQ-5D at the final follow-up, although percentages of people with problems of mobility and pain/discomfort were higher in the MPFLr + TTT group. Female patients had lower EQ-5D index and EQ-5D VAS compared with male patients in both groups at the final follow-up, but there was only a significant difference in the EQ-5D VAS. Conclusions Both MPFLr + TTT and iMPFLr groups obtained similar and satisfactory improvements in the QoL, clinical results and radiological outcomes, indicating that MPFLr combined with TTT is a safe and effective procedure, which can significantly improve the QoL for patients with recurrent patellar dislocation in cases of pathologically lateralized TT. However, female patients obtained lower QoL than males.

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A Computed Tomography Study of the Association Between Increased Patellar Tilt Angle and Femoral Anteversion in 30 Patients with Recurrent Patellar Dislocation

Cited by 12 publications

References 23 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

3D-printed individualized navigation template versus the fluoroscopic guide to defining the femoral tunnel for medial patellofemoral ligament reconstruction: A retrospective study

Quality of life following medial patellofemoral ligament reconstruction combined with medial tibial tubercle transfer in patients with recurrent patellar dislocation: a retrospective comparative study

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