Sulcus depth, congruence angle, Wiberg index, TT-TG distance, and CDI are strong predictors of recurrent patellar dislocation

Chen, Jiebo; Ye, Zipeng; Wu, Chenliang; Zhang, Xueying; Zhao, Jinzhong; Xie, Guoming

doi:10.1007/s00167-022-07245-3

Cited by 9 publications

(3 citation statements)

References 50 publications

(69 reference statements)

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“…As such, it is crucial that future studies clearly define the axial plane used to measure LTI so that results can be directly compared across studies. The reduced trochlear width and depth, 5 patella alta, 6 lateralized patella, 15 and increased TT-TG 6,47 all agree with findings of past reports. Direct reporting of the medial and lateral trochlear length could not be found; however, our results agree with the increased patellar trochlear ratio previously reported.…”

Section: Discussionsupporting

confidence: 92%

“…2,31 The decreased medial PW, accompanied by no changes in the lateral PW, indicates that a hypotrophic medial patella 14,31 and not a hypertrophic lateral patella 26 fosters the increased Wiberg index. This decreased medial and not lateral PW is reflected in the decreased overall PW, 6,34 decreased medial facet length, and increased facet ratio with no change in lateral facet length. 34 The increased sulcus angle 1,20,23,25,28 with an unchanged LTI 1 previously reported in patients after a primary LPD supports the current finding that a decreased medial, not lateral, edge distinguishes patients with recurrent dislocation from controls.…”

Section: Discussionmentioning

confidence: 92%

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The Importance of Medial Patellar Shape as a Risk Factor for Recurrent Patellar Dislocation in Adults

Sheehan,

Shah,

Boden

2024

Am J Sports Med

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Background: Research on the cause of lateral patellar dislocation (LPD) has focused on trochlear morphologic parameters, joint alignment, and patellofemoral soft tissue forces. A paucity of information is available regarding how patellar morphologic parameters influence the risk for LPD. Purpose/Hypothesis: The purpose was to assess whether patellar morphology is a risk factor for recurrent LPD. It was hypothesized that (1) patients with recurrent LPD would have decreased patellar width and volume and (2) patellar morphologic parameters would accurately discriminate patients with recurrent LPD from controls. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: A total of 21 adults with recurrent LPD (age, 29.7 ± 11.1 years; height, 170.8 ± 9.9 cm; weight, 76.1 ± 17.5 kg; 57% female) were compared with 21 sex- and height-matched controls (age, 27.2 ± 6.7 years; height, 172.0 ± 10.6 cm; weight, 71.1 ± 12.8 kg; 57% female). Three-dimensional axial fat-saturated magnetic resonance imaging scans were used to measure patellar medial, lateral, and total width; patellar volume; patellar medial and lateral facet length; the Wiberg index; and previously validated knee joint alignment and femoral shape measurements (eg, tibial tuberosity to trochlear groove distance, trochlear dysplasia). Results: The LPD group demonstrated reduced medial patellar width (Δ = −3.6 mm; P < .001) and medial facet length (Δ = −3.7 mm; P < .001) but no change in lateral width or facet length. This resulted in decreased total patellar width (Δ = −3.2 mm; P = .009), decreased patellar volume (Δ = −0.3 cm3; P = .025), and an increased Wiberg index (Δ = 0.05; P < .001). No significant differences were found for all other patellar shape measures between cohorts. Medial patellar width was the strongest single discriminator (83.3% accuracy) for recurrent LPD. Combining medial patellar width, patellofemoral tilt, and trochlear groove length increased the discrimination to 92.9%. Conclusion: The medial patellar width was significantly smaller in patients with recurrent LPD and was the single most accurate discriminator for recurrent LPD, even compared with traditional trochlear shape and joint alignment measures (eg, trochlear dysplasia, patella alta). Therefore, medial patellar morphology should be assessed in patients with LPD as a risk factor for recurrence and a potential means to improve treatment.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 92%

The Importance of Medial Patellar Shape as a Risk Factor for Recurrent Patellar Dislocation in Adults

Sheehan,

Shah,

Boden

2024

Am J Sports Med

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“…The results from the normal group were compared with those from the case group to identify the optimal indicators for RPD across different age ranges within these protocols. Measurements (accuracy per pixel: 0.1 mm and 0.1°) [5,6,18,22] were subsequently conducted using standardised protocols, which are detailed below.…”

Section: Methodsmentioning

confidence: 99%

Impact of sex and age on the lateralisation of the tibial tubercle in normal paediatric and adolescent populations

Chen,

Sha,

Zhang

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeNumerous methods have been proposed to characterise tubercle lateralisation. However, their normal values and related changes remain unclear. Accordingly, it was aimed to determine the potential sex and age effects and determined the optimal individualised method of diagnosing lateralisation of the tibial tubercle in patients with recurrent patellar dislocation (RPD).MethodsMeasurements included the tibial tubercle–trochlear groove (TT‐TG) distance, tibial tubercle‐posterior cruciate ligament (TT‐PCL) distance and tibial tubercle lateralisation (TTL); and the proximal tibial width (PTW), trochlear width (TW) and trochlear dysplasia index (TDI), for adjustment. A two‐way analysis of variance was used to determine the effect of age, sex and their interaction within the normal group. When the age effect was statistically significant, a nonlinear regression was created. Areas under the receiver‐operating characteristic curve (AUCs) were calculated to assess diagnostic accuracy.ResultsA total of 277 normal participants (mean [SD] age, 13.5 [2.6] years; 125 [45.1%] female) and 227 patients with RPD (mean [SD] age, 13.5 [2.6] years; 161 [58.1%] female) were analysed. It was found that in the normal group, in patients aged 7–10, TT‐PCL distance (p = 0.006), TTL (p = 0.007) and TT‐PCL/PTW (p < 0.001) were significantly larger in females than in males. A significant sex effect was also detected on TT‐TG/TW (p = 0.014). TT‐TG distance, TT‐PCL distance, TTL and TT‐PCL/PTW (in male patients) approached an established normal adult value of 12.3 mm, 20.9 mm, 0.64 and 0.28, respectively, with increasing age (p < 0.001). The AUC was greater for TT‐TG/TDI and TT‐TG/TW (p ≤ 0.01) and TT‐TG/TDI outperformed TT‐TG/TW in patients aged 15–18 (p = 0.004).ConclusionsTubercle lateralisation increased with age and was affected by sex, with the exception of TT‐TG distance and TT‐TG/TDI. TT‐TG/TDI is the optimal method of diagnosing a lateralized tibial tubercle in patients with RPD. These findings assist with the evaluation of tubercle lateralisation in that they provide a proper protocol for paediatric and adolescent populations with RPD; and thus, will help determine whether medial tubercle transfer should be included among the tailored surgical procedures considered for the treatment of patients with RPD.Level of EvidenceLevel III.

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Development of patellofemoral osteoarthritis with knee joint malalignment and lateral patellar dislocation after hindlimb suspension in growing rats

Ozawa,

Ikeda,

Kanehara

et al. 2024

Journal Orthopaedic Research

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Knee malalignment is a risk factor for patellar instability and patellofemoral osteoarthritis (PFOA), but etiologies remain unknown. We investigated the potential effects of decreased weight loading during growth on knee alignments and patellofemoral (PF) joint pathology. Hindlimb suspension (HS) was performed in 4‐week‐old female rats for 2, 4, and 8 weeks (HS groups). Age‐matched rats were used as controls. Three‐dimensional reconstructed images of the knee were obtained using X‐ray computed tomography. Tibial tubercle–trochlear groove (TT–TG) distance, patellar tilt angle, and bisect offset were measured as indices of knee alignment. Histological analysis was also performed to evaluate the changes in cartilage and synovium in the PF joints. At Week 8, TT–TG distance, patella tilt angle, and bisect offset were significantly larger in the HS group than in the control group, respectively, indicating tibial external rotation, outward patellar tilt, and external displacement of the patella. Lateral patellar dislocation was frequently found in the HS group at Week 8 (five of eight knee joints, p < 0.05). Degenerative changes in the cartilage of the trochlear groove were observed at Week 8, and synovial changes such as hypertrophy and synovitis were observed at Weeks 4 and 8. Correlation analyses revealed significant relationships between the Mankin score and bisect offset, and between the OARSI synovitis score and all knee alignments indices. These results suggest that decreased weight loading on the lower extremities in growing rats resulted in knee malalignments characterized by external rotation of tibia and high incidence of lateral patellar dislocation with concomitant PFOA.

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Sulcus depth, congruence angle, Wiberg index, TT-TG distance, and CDI are strong predictors of recurrent patellar dislocation

Cited by 9 publications

References 50 publications

The Importance of Medial Patellar Shape as a Risk Factor for Recurrent Patellar Dislocation in Adults

The Importance of Medial Patellar Shape as a Risk Factor for Recurrent Patellar Dislocation in Adults

Impact of sex and age on the lateralisation of the tibial tubercle in normal paediatric and adolescent populations

Development of patellofemoral osteoarthritis with knee joint malalignment and lateral patellar dislocation after hindlimb suspension in growing rats

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