Patients with lateral tracking patella have better pain relief following CT-guided tuberosity transfer than patients with unstable patella

Diks, M.J.F.; Wymenga, A. B.; Anderson, Peter

doi:10.1007/s00167-003-0415-2

Cited by 43 publications

(44 citation statements)

References 18 publications

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“…Many anatomical factors such as trochlear dysplasia, increased patellar height, patellar tilt/translation and tibial torsion predispose to patellofemoral instability [4,11,13]. Many of these measurements vary due to alterations in leg positioning and degree of knee flexion.…”

Section: Discussionmentioning

confidence: 99%

Patellar instability: CT and MRI measurements and their correlation with internal derangement findings

Thakkar

Grande

Wadhwa

et al. 2015

Knee Surg Sports Traumatol Arthrosc

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Section: Discussionmentioning

confidence: 99%

Patellar instability: CT and MRI measurements and their correlation with internal derangement findings

Thakkar

Grande

Wadhwa

et al. 2015

Knee Surg Sports Traumatol Arthrosc

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“…Only one study [20] addresses the interobserver reliability of using MRI to measure this distance, but does not address intraobserver reliability. Although the landmarks chosen to measure the TT-TG using CT are more uniform [1,7,8,13,20,29], the studies using MRI to measure the lateral offset are far more variable in their choice of landmarks [2,3,20,30], creating a source of variability. Given the small difference between what is considered a normal lateral offset and what is considered pathologic distance, the reliability of the measurement must be determined before using this measurement to plan a surgical procedure.…”

Section: Discussionmentioning

confidence: 99%

Does Landmark Selection Affect the Reliability of Tibial Tubercle-Trochlear Groove Measurements Using MRI?

Wilcox

Snow²,

Aoki

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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Background A lateralized tibial tubercle is one potential cause of patellar instability. The tibial tubercle-trochlear groove (TT-TG) distance using CT is a reliable measure and considered the gold standard. Using MRI for this purpose has increased, although the reliability of doing so is not well studied. Questions/purposes We sought to (1) determine variability in the insertion of the patellar tendon relative to the tibial tubercle and whether this affects the measurement on MRI of the traditional TT-TG distance versus the functional patellar tendon-trochlear groove (PT-TG) distance, (2) determine the reliability of measuring the osseous TT-TG distance, (3) determine the reliability of measuring the soft tissue PT-TG distance, and (4) compare the reliabilities of using osseous (TT-TG) versus soft tissue (PT-TG) landmarks. Methods Four observers measured the TT-TG and the PT-TG distances of 50 MR images of knees obtained for any reason. Each observer repeated these measurements 30 days later. The interobserver and intraobserver reliabilities, measurements per observer that varied from the group mean by greater than 2 mm, and the limit of agreement were calculated. Results The TT-TG and PT-TG differed by as little as 0.11 mm and by as much as 4.18 mm with an average difference of 1.37 mm. The interobserver and intraobserver reliabilities were greater than 90% for the PT-TG and TT-TG distances. The PT-TG distance was less variable in that this measurement showed interobserver and intraobserver reliabilities of 0.977 and 0.972 respectively, versus 0.913 and 0.961 for the TT-TG measurement. Additionally, the PT-TG measurements resulted in a lower average difference to the mean for each observer, less number of knees per observer where the difference to the mean was greater than 2 mm, and improved limit of agreement. Conclusions The TT-TG and the PT-TG distances were not identical and differed by as much as 4.18 mm; as such they are not interchangeable when measuring this distance.

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“…Trochlear dysplasia is commonly associated with recurrent patellar dislocation with atraumatic onset [6,9,11,12,25,32]. A positive crossing sign, a decreased trochlear depth, and an anterior translation on a straight lateral X-ray [11] are radiological signs of trochlear dysplasia.…”

Section: Introductionmentioning

confidence: 99%

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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Patients with lateral tracking patella have better pain relief following CT-guided tuberosity transfer than patients with unstable patella

Cited by 43 publications

References 18 publications

Patellar instability: CT and MRI measurements and their correlation with internal derangement findings

Patellar instability: CT and MRI measurements and their correlation with internal derangement findings

Does Landmark Selection Affect the Reliability of Tibial Tubercle-Trochlear Groove Measurements Using MRI?

CT changes after trochleoplasty for symptomatic trochlear dysplasia

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