Computed Tomography of the Normal Patellofemoral Joint

Martínez, S; Korobkin, M; Fb, Fondren; Lw, Hedlund; Goldner, J. Leonard

doi:10.1097/00004424-198305000-00006

Cited by 55 publications

(32 citation statements)

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“…The value ranged between 110°to 150°in the proximal part and between 110°and 135°in the distal part, confirming the studies of Martinez and Reikeras [23,30,34] who proved a decreasing sulcus angle from proximal to distal. Interestingly, our population demonstrated an almost normal value for the distal part of the trochlea.…”

Section: Discussionsupporting

confidence: 85%

CT changes after trochleoplasty for symptomatic trochlear dysplasia

Fucentese

Schöttle

Pfirrmann

et al. 2006

Knee Surg Sports Traumatol Arthrosc

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Trochlear dysplasia is an important risk factor for patellar instability. Because of a decreased trochlear depth in combination with a low lateral femoral condyle, the patella cannot engage properly in the trochlea. Trochleoplasty is a surgical procedure, which strives to correct such bony abnormalities. The aim of this study was to describe morphological features of trochlear dysplasia and the corrective changes after trochleoplasty on CT scan. The study group consists of 17 knees with trochlear dysplasia having undergone trochleoplasty for recurrent patellofemoral dislocation at a mean age of 22.4 years. The evaluation consisted in pre-and postoperative measurements on the proximal and distal trochlea on transverse CT scans in order to determine the morphological features. We measured the transverse position and depth of the trochlear groove, the transverse position of the patella, the ratio between the posterior patellar edge and the trochlear groove, the lateral patellar inclination angle, the sulcus angle, and the lateral trochlear slope. The trochlear groove lateralised a mean of 6.1 mm in the proximal aspect and 2.5 mm in the distal aspect of the trochlea, while the patella medialised a mean of 5 mm. Preoperatively the patella was lateral in relation to the trochlear groove in 13 cases, neutral in two cases, and medial in two cases. Postoperatively it was lateral in four cases, in neutral position in seven cases, and medialised in six cases, referenced to the trochlear groove. The trochlear depth increased from 0 to 5.9 mm postoperatively in the proximal aspect of the trochlea, and from 5.5 to 8.3 mm postoperatively in the distal trochlea. The lateral patellar inclination angle decreased from a mean of 21.9°to a mean of 7.8°. The sulcus angle decreased from a mean of 172.1°to a mean of 133°in the proximal trochlea and from a mean of 141.9°to a mean of 121.7°in the distal trochlea. The lateral trochlear slope changed from 2.8°to 22.7°in the proximal and from 14.9°to 26.9°in the distal part of the trochlea. In the CT scan patients with trochlear dysplasia demonstrated a poor depth, or even a flat or convex trochlea with a greater sulcus and lateral trochlear slope angle, a lateralised patella to the trochlear groove with poor congruency, and a greater lateral patellar inclination angle. Trochleoplasty can correct the pathological features of trochlear dysplasia by surgically creating more normal anatomy. The goal of this surgical procedure is to steepen and lateralise the trochlear groove for a better engagement of the patella.

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Section: Discussionsupporting

confidence: 85%

CT changes after trochleoplasty for symptomatic trochlear dysplasia

Fucentese

Schöttle

Pfirrmann

et al. 2006

Knee Surg Sports Traumatol Arthrosc

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“…Measurements such as sulcus angles, congruence angles, patella tilt, and lateral patellofemoral angles have been reported [9]. However, subluxated or dislocated patellae often reduce at knee flexion of greater than 30 ~ [4,8,10]. Since this is the only range of flexion in which plain film X-ray techniques can image the patella within the femoral trochlear groove, it has not proved to be a reliable diagnostic method.…”

Section: Discussionmentioning

confidence: 99%

“…Conventional radiographic techniques do not allow the patellofemoral mechanism to be evaluated in knee flexion of less than 30 ~ [2][3][4][5][6]. Knee flexion of less than 30 ~ is needed to view critical alignment characteristics [2,[4][5][6][7][8][9][10].…”

mentioning

confidence: 99%

CT determination of tibial tubercle lateralization in patients presenting with anterior knee pain

et al. 1995

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Anterior knee pain is commonly associated with patellofemoral malalignment. Both conventional radiographic measurements and CT measurements have been proposed to define and confirm the sometimes difficult clinical diagnosis of anterior knee pain secondary to patellofemoral malalignment. Using CT imaging with computerized technique to measure anatomic relationships, we evaluated patients (n = 50) with anterior knee pain for excessive lateralization of the tibial tubercle. The symptomatic knee of each patient was compared with their asymptomatic knee as well as with the knees of patients with other causes of anterior knee pain (n = 10) and with the knees of asymptomatic controls (n = 10). The symptomatic knee of patients with suspected patellofemoral malalignment demonstrated significantly greater lateralization of the tibial tubercle (12.2 +/- 0.5 mm) than did the asymptomatic knee (9.0 +/- 0.7 mm). The symptomatic knees of patients with patellofemoral malalignment also demonstrated significantly greater lateralization of the tibial tubercle than did the knees of patients with other causes of anterior knee pain (5.9 +/- 0.9 mm). When a control population was added to the analysis, the patients with symptomatic patellofemoral malalignment demonstrated significantly greater lateralization of the tibial tubercle than did the controls (6.4 +/- 0.4 mm). Using a critical value of 9 mm lateralization, the CT diagnosis of patellofemoral malalignment had a specificity of 95% and a sensitivity of 85%. We conclude that CT determination of tibial tubercle position assists the diagnosis of patellofemoral malalignment.

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“…Schutzer et al (1986) also found in healthy subjects a mild degree of lateral shifting and tilting from 0 to 5 of flexion, while a central or medialized patella at 10 of flexion. The study of Martinez et al (1983) did not corroborate these findings; 19 of 20 patients had the patella well centered in the trochlear groove in complete extension with the quadriceps relaxed. In the Lyon protocol, tilt is measured with and without quadriceps contraction providing dynamic information of the stability of the patella.…”

Section: Lateral Patellar Tilt (And Subluxation)mentioning

confidence: 84%

Radiologic Criteria in Patellar Dislocations

Saggin¹,

Dejour²

2014

Sports Injuries

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Imaging of patellofemoral instability allows the recognition of the disturbances of shape and congruence leading to dislocations. The key to adequate imaging is complete evaluation of the underlying factors leading to instability. This chapter discusses the radiographic signs of these factors involved in the genesis of instability, which are trochlear dysplasia, patella alta, abnormal tibial tuberosity-trochlear groove distance, and lateral patellar tilt. Additionally, the acute signs of patellar dislocation are reviewed.

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Computed Tomography of the Normal Patellofemoral Joint

Cited by 55 publications

References 0 publications

CT changes after trochleoplasty for symptomatic trochlear dysplasia

CT changes after trochleoplasty for symptomatic trochlear dysplasia

CT determination of tibial tubercle lateralization in patients presenting with anterior knee pain

Radiologic Criteria in Patellar Dislocations

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