Evaluation of Anatomical Variations with Morphological Measurements and Their Relationship to Meniscal Injury and Ligament Damage

Abstract

Introduction: The purpose of this study was to reveal the anatomical risk factors for anterior and posterior cruciate ligament (ACL and PCL) injuries and menisci injury. We aim to investigate whether there are significant relationship between tibial tubercle-trochlear groove distance distance (TT-TG), patella angle, trochlear sulcus angle (TSA), trochlear groove depth (TGD), medial and lateral trochlea length (MT and LT), MT/LT ratio, lateral patellar tilt angle (LPTA), patella-patellar tendon angle (P-PTA), quadriceps-patellar tendon angle (QPA), Insall-Salvati index (ISI), medial and lateral trochlear inclination (MTI and LTI) measurements and important common pathologies such as ACL, PCL, medial and lateral meniscal injuries (MM and LM), peripatellar fat pad edema, chondromalacia and effusion. Thus, the mechanisms of injury will be better understood by revealing important anatomical variations for meniscus and ligament damage. Material and Methods: Three hundred eighty patients with knee magnetic resonance imaging examination included in this study. Our patients who underwent knee MRI were divided into groups according to the presence of MM tear, LM tear, ACL tear, PCL tear, peripatellar fat pad edema, chondromalacia and effusion. TT-TG distance, patella angle, TSA, TGD, MT, LT, MT/LT ratio, LPTA, P-PTA, QPA, ISI, MTI and LTI were measured. Results: In patients with ACL tear; age, LT, ML/LT ratio and QPA measurements were found to be significantly higher. There was no significant difference between the participants' LPTA value and the presence of ACL tear, MM and LM injury. MT and ML/LT ratio were found to be significantly lower in the group with MM tear (p<0.001). The TT-TG distance was found to be significantly lower in the group with LM tear. Conclusion: Increased age, LT, ML/LT ratio and QPA are predispose risk for ACL tear. Decreased MT and ML/LT ratio are among the risk factors for MM tear. The anatomical variations are associated with ligamant and meniscal injury.

Correlating quadriceps patellar tendon angle and lateral patellar tilt angle in patients with irregular alignment: a cross-sectional study with retrospective data

“…They reported that larger QPA is increasing the frequency of total anterior cruciate ligaman tear. However larger QPA did not increase the menisci tear ( 21 ). The meniscus distributes the pressure transmitted to the main joint to the knee joint surface and absorbs shock in case of excessive loading.…”

“…QPA is a newly discovered angle showing the axis of the vectorial sum of the forces on the patella. As the QPA changes, the force transmitted to the patella also changes ( 21 ). Recently, there are only few studies evaluated the QPA ( 4 , 21 ).…”

“…As the QPA changes, the force transmitted to the patella also changes ( 21 ). Recently, there are only few studies evaluated the QPA ( 4 , 21 ). For this reason, it has not been fully clarified which measurements are associated with QPA and abnormal QPA values may predispose to which pathologies.…”

“…The second study, Yücel et al ( 21 ) investigated the association between QPA and meniscal injury. They reported that larger QPA is increasing the frequency of total anterior cruciate ligaman tear.…”

“…As the angle between the tendon of quadriceps and patella increases, the resultant force which stabilizing the knee anteriorly is decreases. Thus, decreased vectorial sum of the forces may cause loading on anterior cruciate ligaman ( 21 ).…”