Computed Tomography Imaging Analysis of the MPFL Femoral Footprint Morphology and the Saddle Sulcus: Evaluation of 1094 Knees

Chen, Jiebo; Xiong, Yijia; Han, Kang; Xu, Caiqi; Cai, Jiangyu; Wu, Chenliang; Ye, Zipeng; Zhao, Jinzhong; Xie, Guoming

doi:10.1177/23259671211073608

Cited by 9 publications

(12 citation statements)

References 70 publications

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“…Intraobserver and interobserver reliability were assessed using the interclass correlation coefficient (ICC). An ICC of ≥ 0.75 was defined as good [9].…”

Section: Methodsmentioning

confidence: 99%

Sulcus depth, congruence angle, Wiberg index, TT-TG distance, and CDI are strong predictors of recurrent patellar dislocation

Chen

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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PurposeTo characterize patellofemoral morphology, determine radiological cutoff values based on computed tomography (CT) images, and clarify predominant anatomic risk factors in young patients with recurrent patellar dislocation (RPD). MethodsA total of 212 knees (age 23.0 ± 5.3 years, female: male = 110:102) with CT‐confirmed RPD were enrolled for analysis. The control group was matched by age and sex (2:1). Patellofemoral and trochlear morphology, patellofemoral alignment, and other parameters were assessed by CT. Standardized methods were used for measurements. Receiver operating characteristic (ROC) curves and the areas under the ROC curve (AUCs) were used to assess accuracy in diagnosing RPD. The index of union (IU) was employed to identify a cutoff value for risk. A binary logistic regression model (Forward, LR) was constructed, and standardized coefficients were calculated to compare the relative strength of different predictors. Factors included in the model were employed to calculate distributions in the studied population. ResultsThe majority of measurements showed a significant difference between the RPD and control groups when comparing mean values. The AUC value was favorable for sulcus depth and significantly better than that for other trochlear morphology parameters (P < 0.0001). Cutoff values were 0.58 for the Wiberg index, 153.3° for the sulcus angle, 3.6 mm for the sulcus depth, 1.94 for the trochlear width ratio, 16.2° for the lateral trochlear inclination, 17.2° for the patellar lateral tilt, 25.5° for the congruence angle, 1.2 for the patellar height [Caton–Deschamps index (CDI)], 6.1° for the knee rotation, and 16.4 mm for the tibial tubercle–trochlear groove (TT‐TG) distance. A binary logistic regression model (χ2 = 20.826, P = 0.008) including the Wiberg index, sulcus depth, congruence angle, patellar height (CDI), and TT‐TG distance was constructed for RPD (P ≤ 0.015), which showed excellent diagnostic performance, as indicated by an AUC of 0.989 (95% CI, 0.979 to 0.998). Sulcus depth showed the strongest relationship with RPD, followed by the congruence angle and Wiberg index, as indicated by the standardized coefficients − 1.43, 1.02, and 0.97, respectively. Eighty‐seven percent of the RPD population had sulcus depth ≤ 3.6 mm. ConclusionsThis study provides a systematic reference of cutoff values based on CT data. The combination of five anatomic risk factors (sulcus depth, congruence angle, Wiberg index, TT‐TG distance, and CDI) may be an excellent predictor of RPD as initial risk assessment. Sulcus depth, as the most frequently observed anatomic risk factor, showed the best diagnostic performance among trochlear morphological parameters and the strongest relationship with RPD, followed by the congruence angle and Wiberg index. In clinical practice, the sulcus depth, congruence angle, Wiberg index, TT‐TG distance, and CDI with the proposed cutoff values can be used in combination to evaluate RPD. When assessing trochlear morphology, sulcus depth is recommended as the best radi...

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“…Intraobserver and interobserver reliability were assessed using the interclass correlation coefficient (ICC). An ICC of ≥ 0.75 was defined as good [9].…”

Section: Methodsmentioning

confidence: 99%

Sulcus depth, congruence angle, Wiberg index, TT-TG distance, and CDI are strong predictors of recurrent patellar dislocation

Chen

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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“…The third aim of the study was to compare our CLASS method with 4 previously accepted methods [17][18][19][20] (Fig. 1).…”

Section: Discussionmentioning

confidence: 99%

“…One of the most widely accepted methods to localize the MPFL insertion was described by Schöttle et al 19 . Their framework for describing the location of the MPFL insertion was supported by other authors, who developed various alternative ways of identifying the MPFL femoral anatomical point [16][17][18]20 .…”

Section: Discussionmentioning

confidence: 99%

“…Using the 2D reconstructed lateral image with the medial epicondyle, adductor tubercle, and CLASS MPFL insertion identified, each previously described method for MPFL localization [17][18][19][20] was performed and the insertion point was marked on the image. The definition of each of these methods is provided in Figure 1 and Table I.…”

Section: Comparison Of Mpfl Class Footprint With Footprints Determine...mentioning

confidence: 99%

“…Based on these findings, different methods have been proposed to reliably identify the femoral insertion point of the MPFL (Fig. 1, Table I) [17][18][19][20] . While each technique has its proponents, there is controversy regarding which best identifies an individual's ideal anatomical location of the MPFL femoral tunnel.…”

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confidence: 99%

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Patient-Individualized Identification of Medial Patellofemoral Ligament Attachment Site to Femur Using “CLASS” MRI Sequences

Uso,

Thürig,

Heimann

et al. 2023

JBJS Open Access

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Background: Malposition of the femoral tunnel during medial patellofemoral ligament (MPFL) reconstruction may increase the risk of recurrence of patellar dislocation due to isometric changes during flexion and extension. Different methods have been described to identify the MPFL isometric point using fluoroscopy. However, femoral tunnel malposition was found to be the cause of 38.1% of revisions due to patellar redislocation. This high rate of malposition has raised the question of individual anatomical variability. Methods: Magnetic resonance imaging (MRI) was performed on 80 native knees using the CLASS (MRI-generated Compressed Lateral and anteroposterior Anatomical Systematic Sequence) algorithm to identify the femoral MPFL insertion. The insertions were identified on the MRI views by 2 senior orthopaedic surgeons in order to assess the reliability and reproducibility of the method. The distribution of the MPFL insertion locations was then described in a 2-plane coordinate system and compared with MPFL insertion locations identified with other methods in previously published studies. Results: The CLASS MPFL footprint was located 0.83 mm anterior to the posterior cortex (line 1) and 3.66 mm proximal to the Blumensaat line (line 2). Analysis demonstrated 0.90 and 0.89 reproducibility and 0.89 and 0.80 reliability of the CLASS method to identify the anatomical femoral MPFL insertion point. The distribution did not correlate with previously published data obtained with other methods. The definitions of the MPFL insertion point in the studies by Schöttle et al. and Fujino et al. most closely approximated the CLASS location in relation to the posterior femoral cortex, but there were significant differences between the CLASS method and all 4 previously published methods in relation to the proximal-distal location. When we averaged the distances from line 1 and line 2, the method that came closest to the CLASS method was that of Stephen et al., followed by the method of Schöttle et al. Conclusions: The CLASS algorithm is a reliable and reproducible method to identify the MPFL femoral insertion from MRI views. Measurement using the CLASS algorithm shows substantial individual anatomical variation that may not be adequately captured with existing measurement methods. While further research must target translation of this method to clinical use, we believe that this method has the potential to create a safe template for sagittal fluoroscopic identification of the femoral tunnel during MPFL surgical reconstruction. Level of Evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

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An MRI study demonstrating consistent anatomic relation of central longitudinal artery and associated periosteal vessels with the medial femoral epicondyle and adductor tubercle—A visual landmark method for femoral tunnel placement in medial patellofemoral ligament reconstruction

Mandalia,

Anaspure,

Aboelmagd

et al. 2024

Clinical Anatomy

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The two most common techniques to determine femoral tunnel placement during medial patellofemoral ligament (MPFL) reconstruction are radiographic and by palpation. Their intra/interobserver reliability is widely debated. Both techniques rely on identifying bony landmarks such as the medial epicondyle (ME) and adductor tubercle (AT) during surgery. During MPFL reconstructive surgery, the central longitudinal vessels (CLVs) are seen consistently. The aim of this study was to investigate the anatomic relationship of CLV to ME and AT and to determine if CLV might be used as a landmark during MPFL reconstruction. A retrospective review of MRI scans in skeletally mature patients was undertake. There were two groups, a PFI group that consisted of patients with a diagnosis of patellofemoral instabiliy (PFI) and a non‐PFI group that underwent MRI scan for an alternative diagnosis. MRIs were measured for the CLV‐ME‐AT anatomy and relationship. Following exclusions, 50 patients were identified in each group. The CLV passed anterior to the AT and ME in all patients. ME morphology did not differ greatly between the groups except in the tubercle height, where there was statistically significant but not a clinically important difference (larger in the non‐PFI group, 2.95 vs. 2.52 mm, p = 0.002). The CLV to ME tip distance was consistent between the groups (PFI group 3.8 mm and non‐PFI group 3.9 mm). The CLV‐ME‐AT relationship remained consistent irrespective of patients' presenting pathology. The CLV consistently courses anterior to ME and AT. The CLV could be used as a vascular landmark assisting femoral tunnel placement during MPFL reconstruction.

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Computed Tomography Imaging Analysis of the MPFL Femoral Footprint Morphology and the Saddle Sulcus: Evaluation of 1094 Knees

Cited by 9 publications

References 70 publications

Sulcus depth, congruence angle, Wiberg index, TT-TG distance, and CDI are strong predictors of recurrent patellar dislocation

Sulcus depth, congruence angle, Wiberg index, TT-TG distance, and CDI are strong predictors of recurrent patellar dislocation

Patient-Individualized Identification of Medial Patellofemoral Ligament Attachment Site to Femur Using “CLASS” MRI Sequences

An MRI study demonstrating consistent anatomic relation of central longitudinal artery and associated periosteal vessels with the medial femoral epicondyle and adductor tubercle—A visual landmark method for femoral tunnel placement in medial patellofemoral ligament reconstruction

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