Patellar instability: the reliability of magnetic resonance imaging measurement parameters

Ye, Qin; Yu, Tao; Wu, Yinbo; Ding, Xiaonan; Gong, Xiangyang

doi:10.1186/s12891-019-2697-7

Cited by 25 publications

(8 citation statements)

References 29 publications

(48 reference statements)

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“…This could be explained by the age related deterioration of ligament elasticity and cartilaginous health. The mean±SD of age in our study was 37.4 ± 13.8 years similar to a recent study by Ye et al (13) , who reported a mean age of 33.8 ± 9.4 years. The number of males suffering from AKP was more than females (26 versus 22).…”

Section: Discussionsupporting

confidence: 91%

Evaluation of Anterior Knee Pain by Magnetic Resonance Imaging

Mohamed¹,

Enaba²,

Tantawy³

et al. 2021

The Egyptian Journal of Hospital Medicine

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Background: Anterior knee pain (AKP) is the commonest cause of knee complaints. It represented about 25% of all adult knee problems and its non-specific complaint has multiple causes and risk factors. Objective: This study aims to evaluate the role of magnetic resonance imaging (MRI) in diagnosing different diseases that cause pain in the front of the knee. Patients and methods: A cross sectional study of forty eight patients with history of anterior knee pain. All patients were referred from the outpatient clinic of orthopedic surgery, Zagazig University Hospitals. This work was performed at the MRI unit of Radiodiagnosis Department, Zagazig University Hospitals. Results: The mean age of the studied group was 37.35±13.78 years. Visual Analog Scale (VAS) was (4.62±1.16) with more than half (56.2%) of cases having right sided pain. Most presenting symptoms was isolated anterior knee pain (62.5%). The frequency distribution of all MRI findings in all patients showed that 58.3% of the studied group had patellar tilt, 33.3% had patellar chondromalacia or patellofemoral instability, and 20.8% of cases had patellofemoral osteoarthritis. Conclusion: MRI is proven to be the technique of choice in differentiation between various knee pathologies that cause AKP in different age groups due to its safety. Also, MRI has the ability to detect the different grades of some knee pathologies as trochlear dysplasia, chondromalacia patella or factors that may predispose to them.

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Section: Discussionsupporting

confidence: 91%

Evaluation of Anterior Knee Pain by Magnetic Resonance Imaging

Mohamed¹,

Enaba²,

Tantawy³

et al. 2021

The Egyptian Journal of Hospital Medicine

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“…Of the remaining 1,810, a further 1,743 were irrelevant based on their title and/or abstract. Full‐text screening of the remaining 67 eligible studies resulted in exclusion of 37 irrelevant studies [1–3, 5, 6, 8–11, 13, 14, 21, 23–25, 28, 29, 32, 33, 37, 38, 42, 44–46, 51, 55–57, 60, 61, 63, 66–70], five studies that did not report intra‐ or inter‐observer agreement [2, 35, 43, 52, 61], four studies that were conference proceedings [40, 49, 53, 59], two studies that assessed agreement for classification systems other than Dejour classification [34, 48], one study that included skeletally immature patients [15], two studies that expressed inter‐observer agreement only as a percentage [36, 64], three studies that were not in English or French [12, 39, 71] and three studies that could not be retrieved [7, 19, 47]. No additional studies were identified from reference lists, which left ten relevant studies for data extraction [4, 6, 22, 30, 31, 39, 41, 54, 58, 65].…”

Section: Resultsmentioning

confidence: 99%

Inconsistent repeatability of the Dejour classification of trochlear dysplasia due to the variability of imaging modalities: a systematic review

Pineda,

Müller,

Nover

et al. 2023

Knee surg. sports traumatol. arthrosc.

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Purpose The purpose of this systematic review was to critically assess the quality of papers that report on the intra-and inter-observer repeatability of the Dejour classification for trochlear dysplasia, and to identify the possible causes for poor repeatability. Methods Two authors independently conducted an electronic search (four databases) on 8 February 2023 for studies (English or French) that assessed trochlear dysplasia classifications on imaging of skeletally mature participants. Exclusion criteria were reviews of clinical studies, conference proceedings, or editorials. After title, abstract, and full-text screening, characteristics of eligible studies were tabulated (author, year, journal, study design, cohort characteristics, and intra-and/or interobserver agreement coefficients). The methodological quality of studies was assessed using the Joanna Briggs Institute (JBI) checklist for analytical cross-sectional studies. Authors analysed three components of the included studies: (1) classifications based on true lateral radiographs and slice imaging; (2) dysplasia graded into Type A vs B vs C vs D and 3) coefficients of intra-and/or inter-observer agreement. ResultsThe electronic search returned 3,178 references, and after removal of duplicates and irrelevant studies, ten were eligible for data extraction. A second search (31 July 2023) yielded one additional study. Eight studies did not include lateral radiographs, two studies did not explicitly state if radiographs were true lateral views, and one used true lateral radiographs in isolation. Classification of trochlear dysplasia into A vs B vs C vs D using different imaging modalities resulted in moderate to near-perfect intra-observer agreement, and slight to near-perfect inter-observer agreement. Studies distinguished between moderate and severe dysplasia using a variety of combinations: A vs B/C/D, A/B vs C/D and A/C vs B/D. Conclusion This systematic review revealed that the Dejour classification remains the most widely used to assess trochlear dysplasia and that the majority of studies that assessed the reliability of the Dejour classification, reported moderate to nearperfect inter-observer agreement; however, pooling of results for comparison among the included studies was inappropriate due to substantial variation in imaging protocols and non-standardised criteria to distinguish severe from moderate dysplasia. Level of evidence Level IV. Trial registryThe PROSPERO registration number is CRD42023386731.

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“…Regarding the evaluation and measurement by MRI, Ye et al. [ 15 ] found very poor interobserver reliability regarding the measurement of this congruence angle (ICCs 0.325–0.380), in contrast to the other measurements of the patellofemoral joint: Fulkerson angle [ 16 ], Laurin angle [ 17 ], patellar tilt angle (PTA), lateral patellar displacement (LPD), and bisect offset ratio (ICCs > 0.8). For the authors, these poor results could be explained by the changes in knee position during iconographic acquisition and/or the difficulty in identifying the patellar apex [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Radiographic measurement of the congruence angle according to Merchant: validity, reproducibility, and limits

Severyns

Mallet²,

Santoni³

et al. 2023

Knee Surg & Relat Res

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Purpose The objective of this study was to analyze the intra- and interobserver variability of this measurement according to a strict methodology and on a representative sample of the general population, as well as to identify the possible difficulties of measurement in case of patellar or trochlear dysplasia. Methods This observational study involved radiographic analysis by three independent observers of a total of 50 patients who had a loaded patellofemoral X-ray taken with the knee flexed to 45°. An initial reading was taken to measure the angle of the trochlear sulcus, the Merchant angle, and to classify the knees according to a possible trochlear dysplasia and/or patellar dysplasia according to Wiberg. A second measurement was then performed to analyze intraobserver agreement. Interobserver agreement was measured on all radiographic measurements (n = 100). Results The Merchant patellofemoral congruence angle showed good intraobserver concordance ranging from 0.925 (95% CI 0.868–0.957) to 0.942 (95% CI 0.898–0.967), as well as interobserver concordance ranging from 0.795 (95% CI 0.695–0.862) to 0.914 (95% CI 0.872–0.942). Poor results were found in terms of interobserver concordance on the measurement of the Merchant angle in case of stage 3 Wiberg patella ranging from 0.282 (95% CI −0.920 to 0.731) to 0.611 (95% CI 0.226–0.892). Conclusion Congruence angle is one of most commonly used measurements for patellar tracking. However, the convexity of the patellar surface makes it difficult to identify the patellar apex on its intraarticular facet, making the measurement of the Merchant congruence angle unreliable and not very reproducible in cases of stage 3 Wiberg patella. Registration N°IRB 2021/139

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Patellar instability: the reliability of magnetic resonance imaging measurement parameters

Cited by 25 publications

References 29 publications

Evaluation of Anterior Knee Pain by Magnetic Resonance Imaging

Evaluation of Anterior Knee Pain by Magnetic Resonance Imaging

Inconsistent repeatability of the Dejour classification of trochlear dysplasia due to the variability of imaging modalities: a systematic review

Radiographic measurement of the congruence angle according to Merchant: validity, reproducibility, and limits

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