Anatomical patella instability risk factors on MRI show sensitivity without specificity in patients with patellofemoral instability: a systematic review

Ridley, Taylor J.; Hinckel, Betina B.; Kruckeberg, Bradley M.; Agel, Julie; Arendt, Elizabeth A.

doi:10.1136/jisakos-2015-000015

Cited by 26 publications

(23 citation statements)

References 57 publications

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“…6,18,23,28 Generally, it has been held that females are more at risk than males, although this is not consistent across studies. 36-39 The data from this study, with nearly equal numbers between the sexes, did not find sex to be a risk factor.…”

Section: Discussioncontrasting

confidence: 55%

“…These include anatomic factors (trochlear dysplasia, patella alta, elevated tibial tubercle–trochlear groove [TT-TG] distance, increased lateral patellar tilt), skeletal maturity status, demographic factors (age, sex), injury pattern, and mechanism of injury. 1,2,21,29,32,34,37,38,40,42 Previous studies done by our institutions evaluated anatomic risk factors and injury patterns as defined by magnetic resonance (MR) imaging measurements in a population of patients with primary LPD. 1,2,5,45 The purpose of the current study is threefold:…”

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confidence: 99%

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Risk of Redislocation After Primary Patellar Dislocation: A Clinical Prediction Model Based on Magnetic Resonance Imaging Variables

et al. 2018

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Background: First-time lateral patellar dislocations have historically been treated with a nonoperative approach; a clinical tool to predict patients who are most likely to redislocate may have clinical utility. Purpose: (1) To determine if there are discriminating factors present between patients who redislocated their patellas and those who did not after a first-time lateral patellar dislocation and (2) to use this information to develop a model that can predict the recurrence risk of lateral patellar dislocation in this population. Study Design: Case-control study; Level of evidence, 3. Methods: The study population included those with first-time lateral patellar dislocation, magnetic resonance imaging within 6 weeks, and 2-year minimum follow-up. Cohort A was from a prospective study with 2-year follow-up. Cohort B was a prospectively identified cohort with retrospective chart review. Follow-up was obtained clinically or via mail for patients without 2-year clinical follow-up. Results: Sixty-one patients (42%) out of 145 with primary lateral patellar dislocation had recurrent dislocation within 2 years. Stepwise logistic regression analysis demonstrated that skeletal immaturity (odds ratio, 4.05; 95% CI, 1.86-8.82; P = .0004), sulcus angle (odds ratio, 4.87; 95% CI, 2.01-11.80; P = .0005), and Insall-Salvati ratio (odds ratio, 3.0; 95% CI, 1.34-6.70; P = .0074) were significant predictors of redislocation. Receiver operator characteristic curves defined the cut points to be sulcus angle ≥154° and Insall-Salvati ratio ≥1.3. The probability of redislocation based on the presence of factors was 5.8% with no factors present and 22.7% with any 1 factor present, increasing to 78.5% if all 3 factors were present. Conclusion: This model demonstrates a high risk of lateral patellar redislocation when a patient presents with skeletal immaturity as well as magnetic resonance measurements of sulcus angle ≥154° and patellar height as measured by Insall-Salvati ratio ≥1.3. A patient will have a low risk of lateral patellar redislocation with the inverse findings.

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Section: Discussioncontrasting

confidence: 55%

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confidence: 99%

Risk of Redislocation After Primary Patellar Dislocation: A Clinical Prediction Model Based on Magnetic Resonance Imaging Variables

et al. 2018

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“…A recent systematic review with meta-analysis of MRI measurements reveals a wide variation in imaging measurements used for clinical decision-making, in both control and PF instability groups 89. This study showed that appropriate abnormality thresholds exist for MRI-based anatomic patellar instability factors within patients classified as having PF instability, thus indicating sensitivity.…”

Section: Current Approach To Lpdmentioning

confidence: 65%

The management of lateral patellar dislocation: state of the art

Arendt

Donell

Sillanpää³

et al. 2017

Journal of ISAKOS

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“…There is a spectrum of the presentation, and may include patellofemoral pain (PFP), potential patellar instability (PPI) and objective patellar instability (OPI). While anatomical risk factors have been identified,1–8 little is known on how biomechanical factors influence these diverse presentations 9–13…”

Section: Introductionmentioning

confidence: 99%

“…A variety of predisposing risk factors has been shown to contribute to the various patellofemoral disorders. These include bony or soft tissue anatomy (trochlea dysplasia, patella alta, increased quadriceps vector and/or increased lateral tilt) and soft tissue imbalance (ligamentous laxity of the medial patellar stabilisers and tightness of the lateral retinaculum) 8 14–16. The patellofemoral medial stabilisers include the medial patellofemoral ligament (MPFL), the medial quadriceps tendon femoral ligament, the medial patellotibial ligament and the medial patellomeniscal ligament 17.…”

Section: Introductionmentioning

confidence: 99%

Patients with different patellofemoral disorders display a distinct ligament stiffness pattern under instrumented stress testing

et al. 2020

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ObjectiveInvestigate the patellar force-displacement profile (ligament stiffness) of patellofemoral disorders.MethodsFifty-two knees from 34 consecutive patients (mean 31.6 years and 53% male) were analysed including 24 knees with patellofemoral pain (PFP), 19 with potential patellofemoral instability (PPI) and 9 with objective patellofemoral instability (OPI). Physical examination, patient-reported outcome measures (Kujala and Lysholm Scores), standard radiography and MRI or CT were performed in all patients. Instrumented stress testing (Porto Patella testing device) concomitantly with imaging (MRI or CT) was performed to calculate ligament stiffness.ResultsThe force-displacement curves in patients with PPI and OPI displayed a similar pattern, which was different from that of the PFP group. Patients with PPI showed higher ligament stiffness (a higher force was required to displace the patella) than the patients in the OPI group. Patients with OPI had a statistically significant shallower trochlear groove and increased lateral tilt. More than half of the PPI and OPI population presented with at least one classic risk factor (patella alta, trochlear dysplasia, increased quadriceps vector, lateral tilt). In the PPI group, at least two risk factors were found in 37% of patients, whereas at least 33% of patients in the OPI group had three risk factors present. None of the patients presented with all four anatomical risk factors.ConclusionPatients presenting with patellofemoral instability (PPI and OPI) display similar ligament stiffness patterns (force-displacement curve). Patients with PFP and PPI showed higher ligament stiffness as compared with patients with OPI.Level of evidenceLevel V, case series.

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Anatomical patella instability risk factors on MRI show sensitivity without specificity in patients with patellofemoral instability: a systematic review

Cited by 26 publications

References 57 publications

Risk of Redislocation After Primary Patellar Dislocation: A Clinical Prediction Model Based on Magnetic Resonance Imaging Variables

Risk of Redislocation After Primary Patellar Dislocation: A Clinical Prediction Model Based on Magnetic Resonance Imaging Variables

The management of lateral patellar dislocation: state of the art

Patients with different patellofemoral disorders display a distinct ligament stiffness pattern under instrumented stress testing

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