Patients with bilateral patellar instability have multiple and symmetric risk factors in each knee

Abstract

Purpose Bilateral involvement is common in patients with patellar instability. The management of bilateral patellar instability is associated with increased complication rate. The higher complication rate in this cohort may be related to the presence of underlying anatomic risk factors. The purpose of the study was to evaluate the presence and side-to-side differences in risk factors between knees in bilateral patellar instability. Methods In a retrospective study (2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017), demographic information, characteristics of patellar dislocation and anatomic risk factors on MRI (trochlear dysplasia, patellar height, tibial tubercle lateralization, patellar tilt, sulcus angle, bump height) were evaluated in both knees of all patients (n = 32, 15 males and 17 females) with bilateral patellar instability. The risk factors were analyzed based on established cut off values and were compared between gender, laterality and more symptomatic (index) knee. Knee symmetry and absolute differences between risk factors for both knees were analyzed. ResultsThe mean age of 32 patients was 14.6 ± 2.3 years. Of the 4 major anatomic risk factors, the most common were trochlear dysplasia in 59/64 (92.1%) knees and patella alta in 51/64 (79.7%) knees. Tibial tubercle lateralization was the least common risk factor being present in 8/64 (12.5%) knees. Of 64 knees, 55 (85.9%) had 2 or more risk factors and 30 (46.8%) had 3 or all 4 risk factors present. There were no significant differences in risk factors based on gender, laterality or index knee. There was symmetry between paired knees for 31/32 (96.8%) patients for trochlear depth, 29/32 (90.6%) for patellar tilt, 27/32 (84.3%) for TT-TG distance and 25/32 (78.1%) for patellar height. There were no significant differences in absolute measurements between knees for any of the risk factors. Conclusion Patients with bilateral instability had multiple risk factors, with trochlear dysplasia being the most common and increased TT-TG distance being the least common. Majority of patients had 2 or more risk factors and about half had 3 or 4 risk factors in each knee. There was symmetry between paired knees for each risk factor without any significant differences between the index knee compared to the contralateral knee. Level of evidence Level III.

Distal femoral torsion is correlated with higher‐grade trochlear dysplasia and shorter anterior condyles in patients with patellar dislocation and increased femoral torsion

“…Recurrent patellar dislocation is a common and debilitating condition with multifactorial aetiologies associated with various pathoanatomical factors, which usually affects young active children and adolescents [6,20,26]. Of all the anatomical variants, increased femoral torsion is a potential risk factor for recurrent patellar dislocation, which may exert a persistent lateralizing force vector on the patella and lead to increased tension of the reconstructed medial patellofemoral ligament (MPFL), thus causing anterior knee pain, patellar maltracking, early cartilage degeneration, graft failure and patellar redislocation [8,10,19,21,24,28,30].…”