A magnetic resonance imaging study of abnormalities of the patella and patellar tendon that predispose children to acute patellofemoral dislocation

Yılmaz, Barış; Çiçek, Esin Derin; Şirin, Evrim; Özdemir, Güzelali; Karakuş, Özgün; Muratli, Hasan Hilmi

doi:10.1016/j.clinimag.2016.11.010

Cited by 16 publications

(32 citation statements)

References 32 publications

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“…The incidence of type C patella according to Wiberg in the patellar dislocation group was significantly higher than that in the control group. Yılmaz et al [19] compared 20 children with acute patellofemoral dislocation with an age-matched healthy control group and found that the mean length and width of the patella in the two groups were significantly different. From the abovementioned studies, patellar morphology was believed to be correlated with patellar stability; however, the effects of patellar instability on patellar development had not been directly observed.…”

Section: Discussionmentioning

confidence: 99%

Patella morphological alteration after patella instability in growing rabbits

Niu

et al. 2017

J Orthop Surg Res

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BackgroundThe shape of the patella has been considered to be a predisposing factor resulting in patellar instability, but the effects of abnormal patella position during its development are unclear. The present study evaluated patellar morphological changes after patella instability and evaluated the influence of patellar instability on the patella shape.MethodsTwenty rabbits that were 2 months old were included in the study. The left knee of each rabbit, defined as the experimental group (N = 20 knees/group), underwent a medial soft tissue restraint release. The right knee of each rabbit, defined as the control group (N = 20 knees/group), did not undergo any surgical procedures. A CT scan was performed on each knee before surgery and 6 months post-surgery to measure the transverse diameter, thickness, Wiberg index, and Wiberg angle for analysis of the patellar morphological changes. Cross-specimen examination was conducted to evaluate the differences between the experimental group and the control group.ResultsThe four indices remained the same between the two groups before surgery. However, 6 months after surgery, the mean transverse diameter of the patellae in the experimental group was significantly longer than that in the control group (P < 0.001), while the mean thickness in the experimental group was not significantly greater than that in the control group (P = 0.314), resulting in a flattened shape. The Wiberg indices were not significantly different between the two groups. However, the mean Wiberg angle was higher in the experimental group than in the control group (P < 0.001), which resulted in a flattened articular surface of the patella.ConclusionThe sectional shape and articular surface of the patella became more flattened after patella instability in this study, which indicates that patella dysplasia could be caused by patella instability. Clinically, early intervention for adolescent patients with patella instability is important.

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Section: Discussionmentioning

confidence: 99%

Patella morphological alteration after patella instability in growing rabbits

Niu

et al. 2017

J Orthop Surg Res

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“…[9][10][11][12][13][14][15][16][17][18][19] These included six publications that compared between cartilaginous and bony sulcus angles, 9,11,13,15,17,18 and eight publications that compared between sulcus angles for patients with and without patellofemoral instability. 9,10,12-14, 16,18,19 Collectively, these included a total of Table 1 Details of the studies included in the review 1,204 patients, of which 693 had patellofemoral instability, while 511 did not have patellofemoral instability. The details of the study design and patient population of all the studies are reported in ►Table 1.…”

Section: Resultsmentioning

confidence: 99%

“…A total of eight publications compared between patients with and without patellofemoral instability. 9,10,[12][13][14]16,18,19 These included six publications that compared cartilaginous sulcus angle 9,10,12,13,18,19 and five publications that compared bony sulcus angle. 9,13,14,16,18 All eight publications reported the sulcus angle to be greater in patients with patellofemoral instability as compared with those without patellofemoral instability (►Figs.…”

Section: Comparison Between Patients With and Without Patellofemoral mentioning

confidence: 99%

“…5). 9,10,[12][13][14]16,18,19 Both the cartilaginous and bony sulcus angles could therefore be used to differentiate between patients with and without trochlear dysplasia.…”

Section: Comparison Between Patients With and Without Patellofemoral mentioning

confidence: 99%

“…2 Two different methods of sulcus angle measurements have been widely used for CT and MRI. [9][10][11][12][13][14][15][16][17][18][19] These are commonly known as the cartilaginous sulcus angle and bony sulcus angle which use cartilaginous and bony landmarks, respectively. [9][10][11][12][13][14][15][16][17][18][19] However, there is a lack of conclusive data in the current literature as to whether these parameters, originally designed for radiographs, can be applied in their entirety to CT and MRI.…”

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confidence: 99%

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The Difference between Cartilaginous and Bony Sulcus Angles for Patients with or without Patellofemoral Instability: A Systematic Review and Meta-Analysis

et al. 2019

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The cartilaginous sulcus angle and bony sulcus angle have been widely used to evaluate trochlea dysplasia. The current review aims to evaluate (1) whether there is a difference in measurement for cartilaginous and bony sulcus angles, (2) whether both the cartilaginous and bony sulcus angles could be used to differentiate between patients with or without trochlear dysplasia, and (3) whether the same cut-off of 145 degrees, originally used for radiographs, can be applied for the cartilaginous and bony sulcus angles measured on CT and MRI. The review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRSIMA) guidelines. A total of 11 publications with 1204 patients were included. All publications reported the sulcus angle to be greater in patients with patellofemoral instability. All publications reported the cartilaginous sulcus angle to be greater than the bony sulcus angle (MD 7.27 degrees; 95% CI: 5.67 – 8.87). The mean cartilaginous sulcus angle for the control group was 141.83 degrees (95% CI: 139.90 – 143.76) while the mean cartilaginous sulcus angle for patients with patellofemoral instability was 156.24 degrees (95% CI: 153.71 – 158.77). The mean bony sulcus angle for the control group was noted to be 133.69 degrees (95% CI: 131.23 – 136.15) while the mean bony sulcus angle for patients with patellofemoral instability was 148.42 (95% CI: 144.02 – 152.82). Both the cartilaginous and bony sulcus angles measured on CT and MRI could therefore be used to differentiate between patients with and without trochlear dysplasia. However, the cartilaginous sulcus angles are significantly higher than that of bony sulcus angles. Different cut off values should therefore be used.

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Trochlea dysplasia, increased TT-TG distance and patella alta are risk factors for developing first-time and recurrent patella dislocation: a systematic review

Danielsen

Poulsen

Eysturoy

et al. 2023

Knee Surg Sports Traumatol Arthrosc

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PurposeThe aim of the study was to perform a systematic review and best knowledge synthesis of the present literature concerning biomechanical risk factors for developing first‐time and recurrent patella dislocation. MethodsThe study was performed as a systematic review following PRISMA guidelines. PubMed and EMBASE were systematically searched. Studies investigating participants with risk factors for first‐time as well as recurrent patella dislocation were included. The records were screened, and data extracted independently by two researchers supervised by a third independent assessor. The study was registered in PROSPERO. ResultsA total of 6233 records were screened, and 50 studies met the inclusion criteria. The biomechanical risk factors: trochlear dysplasia, increased tibial tuberosity–trochlear groove distance (TT‐TG), and patella alta were found to be statistically significantly associated with patella dislocation in several publications and were thus recognized as risk factors for patella dislocation. The soft‐tissue stabilizers: longer and thinner MPFL ligament, increased number of type 2C and decreased number of type 1 muscle fibers, and joint laxity were found to be statistically significantly associated with patella dislocation in a few publications, but due to limited evidence, no conclusion was made on this matter. ConclusionThere is strong evidence in the literature that abnormalities of bony stabilizers, trochlear dysplasia, increased TT–TG distance, and patella alta are risk factors for patella dislocation. There is less evidence that soft‐tissue stabilizers are risk factors. The study emphasizes the importance of a thorough investigation of bony stabilizers in clinical decision‐making. Level of evidenceLevel IV.

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A magnetic resonance imaging study of abnormalities of the patella and patellar tendon that predispose children to acute patellofemoral dislocation

Cited by 16 publications

References 32 publications

Patella morphological alteration after patella instability in growing rabbits

Patella morphological alteration after patella instability in growing rabbits

The Difference between Cartilaginous and Bony Sulcus Angles for Patients with or without Patellofemoral Instability: A Systematic Review and Meta-Analysis

Trochlea dysplasia, increased TT-TG distance and patella alta are risk factors for developing first-time and recurrent patella dislocation: a systematic review

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