Alterações radiográficas femoropatelares na insuficiência do ligamento cruzado anterior

Abstract

r e v b r a s o r t o p . 2 0 1 5;5 0(1):43-49 w w w . r b o . o r g . b r Artigo Original

Does patellar alignment or trochlear morphology predict worsening of patellofemoral disease within the first 5 years after anterior cruciate ligament reconstruction?

“…Second, we acknowledge substantial loss to follow-up, though note there were no differences in baseline demographics between those who did and did not participate at follow-up.Third, we did not have access to preoperative (or pre-injury) images or a control group (non-injured or ACL deficient), and therefore are unable to determine whether alignment or morphology differed as a result of ACL injury or reconstruction, or whether baseline values were pre-existing [14,40,41]. The literature suggests that alignment, but not morphology, may change as a result of ACL injury, and is at least partially restored following ACLR [14,[40][41][42]. It is also unknown whether graft type contributes to changes in alignment.…”

Patellofemoral joint geometry and osteoarthritis features 3–10 years after knee injury compared with uninjured knees

“…In the case of alignment, these findings could suggest that individuals who sustained injury either: (i) had, on average, alignment values that were like uninjured individuals before injury; (ii) did not undergo a substantial worsening of alignment because of the injury, or (iii) if they did have worse alignment that it was partially or fully reduced following treatment for their injury. For example, ACL injuries may lead to worse patellar alignment, but this may be at least partly corrected with ACLR 10,13–15 …”

“…For example, ACL injuries may lead to worse patellar alignment, but this may be at least partly corrected with ACLR. 10,[13][14][15] In the case of morphology, there is no evidence or obvious biological reason to suggest that the trochlear groove would become shallower as a result of knee injury. The fact that individuals in the injured group were more likely to have shallow morphology, therefore, suggests that shallow morphology existed before the injury, and ergo may be a risk factor for traumatic knee injury.…”

“…While extreme values of joint geometry—such as a patella that is laterally displaced far beyond mean values or an extremely shallow trochlear groove—can be seen in individuals without a history of joint injury, 12 the two can also co‐occur. For example, in ACL‐deficient knees, the patella may be more laterally tilted or displaced, or more inferiorly displaced, compared with uninjured contralateral knees 13,14 . ACLR may at least partially restore alignment, but a certain amount of “malalignment” may persist 14,15 .…”

“…For example, in ACL-deficient knees, the patella may be more laterally tilted or displaced, or more inferiorly displaced, compared with uninjured contralateral knees. 13,14 ACLR may at least partially restore alignment, but a certain amount of "malalignment" may persist. 14,15 Certain patterns of patellofemoral joint geometry may influence the amount of pressure or pressure distribution acting on patellofemoral joint cartilage during daily activities, representing a possible mechanism by which risk of OA is increased.…”