Standardization of patellofemoral morphology in the pediatric knee

Mundy, Andrew; Ravindra, Amy; Yang, Jingzhen; Adler, Brent H.; Klingele, Kevin E.

doi:10.1007/s00247-015-3459-9

Cited by 20 publications

(29 citation statements)

References 26 publications

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“…Measurements are changing due to age, and skeletal maturity. 118 This said, adult thresholds for trochlear depth £ 3mm, Sulcus angle >145°, and CDI ³1,2 are consistent between adults and our population of children according to our ROC curves.…”

Section: Why Do Some Patients Sustain An Lpd?supporting

confidence: 82%

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Morphology and Anatomic Patellar Instability Risk Factors in First-Time Traumatic Lateral Patellar Dislocations: A Prospective Magnetic Resonance Imaging Study in Skeletally Immature Children

et al. 2016

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Section: Why Do Some Patients Sustain An Lpd?supporting

confidence: 82%

“…121 Recently published MRI studies have shown the development of patellofemoral morphology with advancing age; and as described above the cartilage got progressively thinner during skeletal maturation. 85,45,118…”

Section: Anatomymentioning

confidence: 99%

Morphology and Anatomic Patellar Instability Risk Factors in First-Time Traumatic Lateral Patellar Dislocations: A Prospective Magnetic Resonance Imaging Study in Skeletally Immature Children

et al. 2016

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“…Bone bruising was defined by location and divided into patella, lateral femoral condyle, combined lesion, no lesion, or other which included bruising in other locations of the knee. MRIs were also used to determine skeletal maturity; patients with open physes were classified as skeletally immature while patients with closing or closed physes were classified as skeletally mature [2,4,25]. A fellowship-trained musculoskeletal radiologist interpreted the injury patterns on all MRI.…”

Section: Mri Interpretationmentioning

confidence: 99%

Anatomic patellar instability risk factors in primary lateral patellar dislocations do not predict injury patterns: an MRI-based study

Tompkins

Rohr

Agel

et al. 2017

Knee Surg Sports Traumatol Arthrosc

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for this injury due to clinician-perceived need for cartilage debridement. MPFL injury severity was complete rupture (N = 69, 44%), partial (N = 67, 43%), and none (N = 19, 13%). MPFL injury location was isolated femoral (N = 16, 10%), isolated patella (N = 26, 17%), isolated mid-substance (0%), multiple locations (N = 95, 61%), and none (N = 20, 13%). Chondral injury location was patella (N = 67, 43%), lateral femoral condyle (N = 11, 7%), multiple locations (N = 53, 34%), and none (N = 26, 17%). A majority (61%) of patellar chondral lesions were at its inferomedial aspect; all medial patellar retinacular partial injuries involved the inferomedial aspect of the patella, consistent with the insertion of the medial patellotibial ligament (MPTL). Skeletally immature patients had a greater risk of isolated patellar MPFL and chondral injury. No clear relationship was found between/across the location and/or severity of bone bruising, MPFL, or chondral injury. Clinical relevance Underlying anatomic patellar instability risk factors defined by MRI, do not predict injury patterns. MPFL and chondral injury, as well as bone bruising, are common following LPD. The medial patellotibial ligament is torn in patellar-based medial retinacular injuries, based on MRI injury location. Skeletal immaturity plays a role in the location of the injury pattern with isolated patellar-based MPFL/chondral injury being more common in the skeletally immature patient. Sex does not appear to be a factor in injury patterns after primary LPD. Knowledge of these injury trends will help focus the clinician in injury evaluation when managing primary patellar dislocations. Level of evidence Case series, Level IV. AbstractPurpose The primary goal was to describe the injury patterns in a population of primary (first time) lateral patellar dislocators (LPD) to lend clarity to commonly held notions about injury patterns in this population. Methods A prospective study identifying patients presenting with LPD between 2008 and 2012. Inclusion criteria were a history and physical exam consistent with primary LPD, and an MRI consistent with the diagnosis without other significant ligamentous injury. On MRI, location of cartilage, medial patellofemoral ligament (MPFL) injury, and bone bruising were noted. Severity was categorized as partial or complete for MPFL and cartilage lesions. Anatomic patellar instability risk factors (patella alta, trochlear dysplasia, increased TT-TG, and lateral patella tilt) were recorded and compared to the injury patterns. Results This study involved 157 patients; 107 patients were skeletally mature. Of the 157 patients, 26 had surgery

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“…Mundy et al . [ 18 ] have shown high inter and intraobserver reliability in the utilization of such measurements in the immature knee. In addition, such measurements develop with maturation, gradually reaching adult norms by age 10 [ 15 , 18 ].…”

Section: Discussionmentioning

confidence: 99%

“…Radiographic thresholds that can aid in operative planning have been established based on anatomic differences [ 9 , 14 , 16 , 17 ]. It is largely unknown if these thresholds are applicable to skeletally immature patients, as there are only a limited number of studies reporting radiographic norms in pediatric patients with patellar instability [ 15 , 18 ] The purpose of the current study is to report morphological differences between skeletally immature patients with and without acute, lateral patellar instability.…”

Section: Introductionmentioning

confidence: 99%

Radiographic Assessment of Anatomic Risk Factors Associated with Acute, Lateral Patellar Dislocation in the Immature Knee

Trinh

Mundy

Beran

et al. 2016

Sports

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Acute patellar dislocation remains a common injury in both adult and pediatric patients. Non-operative management has been advocated for patients without a history of recurrent instability. Although pathologic thresholds for consideration of operative management have previously been reported in adults, it is largely unknown in children. A retrospective review of all skeletally immature patients diagnosed with acute lateral patellar dislocation who had MRI imaging were included for analysis. An age-based control group was also identified. Six radiographic measurements were compared: lateral trochlear inclination (LTI), trochlear facet asymmetry (TFA), trochlear depth (TD), tibial tuberosity–trochlear groove (TT–TG), sulcus angle (SA) and patellar height ratio. A total of 178 patients were included for analysis (study: n = 108, control: n = 70). The mean age of patients in the study and control groups was 13.7 and 12.1 years respectively (p ≤ 0.001). Study group patients had significant differences in all radiographic measurements including a decreased LTI (p < 0.001), increased TFA (p < 0.001) and SA (p < 0.001). The mean trochlear depth was 3.4 mm and 5.6 mm for patients in the study and control groups respectively (p < 0.001). Study group patients had an increased patellar height ratio (p < 0.001) and TT–TG distance (p < 0.001). Morphologic abnormalities may predispose skeletally immature patients to an increased risk of acute lateral patellar instability.

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Standardization of patellofemoral morphology in the pediatric knee

Abstract: Our data verify the development of patellofemoral morphology with advancing age. We found that six of the most commonly used patellofemoral measurements in adults can be accurately reproduced regardless of age.

Cited by 20 publications

References 26 publications

Morphology and Anatomic Patellar Instability Risk Factors in First-Time Traumatic Lateral Patellar Dislocations: A Prospective Magnetic Resonance Imaging Study in Skeletally Immature Children

Morphology and Anatomic Patellar Instability Risk Factors in First-Time Traumatic Lateral Patellar Dislocations: A Prospective Magnetic Resonance Imaging Study in Skeletally Immature Children

Anatomic patellar instability risk factors in primary lateral patellar dislocations do not predict injury patterns: an MRI-based study

Radiographic Assessment of Anatomic Risk Factors Associated with Acute, Lateral Patellar Dislocation in the Immature Knee

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