Evidence of Abnormal Anteroposterior Patellar Tilt in Patients with Patellar Tendinitis with Use of a New Radiographic Measurement

Tyler, Timothy F.; Hershman, Elliott B.; Nicholas, Stephen; Berg, Jeffery H.; McHugh, Malachy P.

doi:10.1177/03635465020300031501

Cited by 20 publications

(16 citation statements)

References 31 publications

(53 reference statements)

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“…Previous studies evaluating this feature utilized different techniques, patient populations (i.e. patellar chondropathy) and methodologies, which may contribute to the inconsistencies in results (Kujala et al, 1986(Kujala et al, , 1987Johnson et al, 1996;Lian et al, 1996;Tyler et al, 2002). While variations in imaging and measurement techniques would affect both groups and have no bearing on between-group comparisons, differences in the patient selection and diagnostic criteria may have influenced the results of previous studies.…”

Section: Fat Pad Volume Is Larger In People With Ptmentioning

confidence: 99%

Infrapatellar fat pad size, but not patellar alignment, is associated with patellar tendinopathy

Culvenor

Cook

Warden

et al. 2011

Scandinavian Med Sci Sports

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Patellar tendinopathy (PT) is one of the most common overuse injuries of the knee. Recent reports indicate that increased body mass is frequently associated with tendinopathy, not only biomechanically but biochemically. Abnormalities of other structures within the knee extensor mechanism [patellofemoral joint (PFJ) alignment and patellar tendon length] that can directly influence the strain distribution of the patellar tendon are inconsistently implicated in PT. The aim of this study was to compare the infrapatellar fat pad volume, patellar tendon length and PFJ alignment in people with chronic PT and a group of age-, gender-, height-, and activity-matched controls with normal tendons. Axial magnetic resonance (MR) images, from 26 participants with PT and 28 control participants were obtained. Fat pad size, patellar tendon length and PFJ alignment were measured digitally from the MR images, using measurement software, and the results compared between the PT group and control group. People with PT had a significantly larger fat pad than healthy controls when controlled for height (P=0.04). Patellar tendon length was not significantly different between groups (P=0.16), nor were there between-group differences for the measures of PFJ alignment (P=0.07-0.76). Thus, the infrapatellar fat pad may play an important role in PT.

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Section: Fat Pad Volume Is Larger In People With Ptmentioning

confidence: 99%

Infrapatellar fat pad size, but not patellar alignment, is associated with patellar tendinopathy

Culvenor

Cook

Warden

et al. 2011

Scandinavian Med Sci Sports

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“…Ultrasonographic findings have been correlated with histologic changes associated with desmitis in humans and horses 5,6,16 . Commonly described histologic changes are primarily degenerative in nature and include mucoid degeneration, local collagen disruption, and the presence of granulation tissue 6,16–18 . Studies have shown that acute tendon injuries result in neutrophilic inflammation and fibroblastic cellular infiltrate whereas chronic tendon injuries result in fibroblastic infiltration without evidence of inflammation 5,19 .…”

Section: Introductionmentioning

confidence: 99%

Radiographic and Ultrasonographic Evaluation of the Patellar Ligament Following Tibial Plateau Leveling Osteotomy

Mattern

Berry²,

Peck

et al. 2006

Vet Radiology Ultrasound

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Objective evaluation of patellar ligament changes following tibial plateau leveling osteotomy (TPLO) for cranial cruciate ligament injury has not been published to date. In this study, the patellar ligament was evaluated using radiographs and high-resolution ultrasound in 31 stifles (29 dogs) preoperatively and at 1 month (n=31), 2 months (n=18), and 6 months (n=13) postTPLO. A ratio of the thickness of the proximal to distal patellar ligament was determined for all radiographs evaluated. Ultrasound evaluation included proximal, middle, and distal mid-sagittal thickness and transverse thickness, and transverse area measurements. Subjective grading (0 being normal through a scale of 3) of the ultrasound changes was also performed at each evaluation. Significant thickening of the distal patellar ligament was noted postoperatively as evidenced by thickness and area measurements and a decreased radiographic ratio (P < 0.01). Preoperative patellar ligament thickness and area were similar at the proximal, middle and distal sites. Ultrasound-derived thickness and area measurements of the distal patellar ligament were increased at 1 and 2 months (P < 0.01). The radiographic ratio was significantly decreased at 1, 2 and 6 months (P < 0.01). Subjectively, all patellar ligaments scored a 0 preoperatively and 16/31 received a score of 2 or 3 during follow-up evaluation. Additionally, these dogs had ultrasonographic and radiographic changes consistent with distal patellar ligament thickening. Body weight (kg) and postoperative TPLO angle had a significant influence on 1-month postoperative distal patellar ligament area using a stepwise logistic model (P < 0.05). Patellar ligament desmitis is a common postoperative sequela to the TPLO procedure, however its clinical significance (i.e., correlation with a residual lameness) was not evaluated in this study.

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“…However, several studies have shown abnormal sagittal plane kinematics in pathological knees [3,5,8,21] and knees replaced by total knee arthroplasty [6,7,9,10]. Tyler et al [8] demonstrated that patients with patellar tendinitis have abnormal patellar tilt in the sagittal plane. Luyckx et al [3] reported that patella alta was associated with higher maximal patellofemoral contact force and contact pressure than normal patellar positions and thereby gives rise to anterior knee pain.…”

Section: Discussionmentioning

confidence: 99%

“…However, previous reports have only evaluated patellar flexion [6][7][8] or tendon angle [9,10] during mid-flexion (∼100°) using lateral radiographic images. Combined measurements of patellar flexion and translation relative to both the femur and tibia during deep flexion could enhance the opportunity to identify patellar pathological conditions.…”

Section: Introductionmentioning

confidence: 99%

“…However, the methods used are either technically demanding or time-consuming. In contrast, a lateral radiographic view can be easily taken in the clinical setting and reveal considerable information about the patella [8]. Therefore, we have developed a 2D patella alignment measurement technique, which implemented a scaling tool of image measurements to physical dimensions, for quick and easy characterisation of patellar kinematics under dynamic conditions.…”

Section: Introductionmentioning

confidence: 99%

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Physiological sagittal plane patellar kinematics during dynamic deep knee flexion

Hamai

Dunbar

Morooka

et al. 2013

International Orthopaedics (SICOT)

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Purpose Lateral radiographic views can be easily taken and have reveal considerable information about the patella. The purpose of this study was to obtain sagittal plane patellar kinematics data through the entire range of knee flexion under weight-bearing conditions. Methods Patellar flexion angles relative to the femur and tibia and anterior-posterior and proximal-distal translations of the patella relative to the femur and tibia were measured from 0 to 165°knee flexion in nine healthy knees using dynamic radiographic images. Results The patella flexed relative to the femur and tibia by two thirds times and one third times the knee flexion angle, respectively. The patella translated in an arc relative to the femur and tibia as the knee flexed. In early flexion, the superior and centroid points translated anteriorly and then the patella translated posteriorly relative to the femur. All three points of the patella translated posteriorly relative to the tibia during a full range of flexion. An average of four and three millimetres proximal patellar translation relative to the tibia was demonstrated from 0 to 20°and 140 to 160°knee flexion, respectively.Conclusions Physiological sagittal plane patellar kinematics, including patellar flexion angles and translations relative to the femur and tibia, showed generally similar patterns for each subject. Measurements of dynamic radiographic images under weight-bearing activities may enhance the opportunity to identify patellar pathological conditions.

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Evidence of Abnormal Anteroposterior Patellar Tilt in Patients with Patellar Tendinitis with Use of a New Radiographic Measurement

Cited by 20 publications

References 31 publications

Infrapatellar fat pad size, but not patellar alignment, is associated with patellar tendinopathy

Infrapatellar fat pad size, but not patellar alignment, is associated with patellar tendinopathy

Radiographic and Ultrasonographic Evaluation of the Patellar Ligament Following Tibial Plateau Leveling Osteotomy

Physiological sagittal plane patellar kinematics during dynamic deep knee flexion

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