The Modified Insall-Salvati Ratio for Assessment of Patellar Height

Grelsamer, Ronald P.; Meadows, Steve

doi:10.1097/00003086-199209000-00022

Cited by 266 publications

(247 citation statements)

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“…As patellar malalignment has been shown to be associated with knee pain and patellofemoral OA progression [32], baseline MRI examinations of all subjects were also assessed for the following abnormal imaging findings by a board-certified radiologist with 4 years of experience in musculoskeletal radiology (L.F.): a patellar bisect offset of more than 65%, a patellar tilt of more than 9° [33], a patella alta expressed by a modified Insall-Salvati ratio of more than two [34], and a sulcus angle of more than 145° [35,36].…”

Section: Magnetic Resonance Imaging and Analysismentioning

confidence: 99%

Hyperintense signal alteration in the suprapatellar fat pad on MRI is associated with degeneration of the patellofemoral joint over 48 months: data from the Osteoarthritis Initiative

et al. 2017

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Hyperintense signal alteration in the suprapatellar fat pad on MRI is associated with degeneration of the patellofemoral joint over 48 months: data from the Osteoarthritis Initiative. Results Baseline SPFP signal alterations were found in 51% of the subjects (n = 217), of whom 11% (n = 23) additionally had a mass effect. Progression of cartilage lesions was significantly higher in subjects with signal alteration versus without (adjusted mean increases, 95% CI; patella: 0.29, −0.07 to 0.64 vs −0.04, −0.40 to 0.31; p < 0.001; trochlea: 0.47, 0.16 to 0.77 vs 0.31, 0.01 to 0.61; p = 0.007). BML progression was also more likely in subjects with signal alteration (OR 1.75, 95% CI 1.09 to 2.82; p = 0.021). Mass effect was not associated with joint degeneration and SPFP findings were not associated with clinical worsening (p > 0.18 for all). Conclusion Patellofemoral joint degeneration over 48 months was significantly increased in subjects with SPFP signal alteration, suggesting an association between SPFP abnormalities and the progression of patellofemoral OA. Permalink

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Section: Magnetic Resonance Imaging and Analysismentioning

confidence: 99%

Hyperintense signal alteration in the suprapatellar fat pad on MRI is associated with degeneration of the patellofemoral joint over 48 months: data from the Osteoarthritis Initiative

et al. 2017

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“…The Insall-Salvati ratio is the length of the patellar tendon divided by the proximal-to-distal length of the patella, measured on lateral radiographs of the knee; patella alta, which is defined by an Insall-Salvati ratio greater than 1.2, is a common anatomic abnormality of the patellofemoral joint [10]. Patella alta has been reported to be associated with patella subluxation, episodic dislocation, and patellofemoral joint instability [18,31].…”

Section: Introductionmentioning

confidence: 99%

Does Patella Tendon Tenodesis Improve Tibial Tubercle Distalization in Treating Patella Alta? A Computational Study

Liao

Yang

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Patellofemoral malalignment associated with patella alta may cause pain and arthritis; because of this, the condition sometimes is treated surgically. Two common procedures are tibial tubercle distalization with or without patellar tendon tenodesis. However, the biomechanical consequences of these interventions for patella alta are not clearly understood. Questions/purposes We evaluated changes in patellofemoral joint contact mechanics after tibial tubercle distalization and tibial tubercle distalization combined with patella tendon tenodesis. Specifically, we asked: (1) Are there biomechanical differences between these two types of procedures? (2) Is there an ideal range to distalize the patella? Methods Subject-specific finite-element models were created for 10 individuals with patella alta (mean InsallSalvati ratio of 1.34 ± 0.05). Input parameters for the finite-element models included subject-specific joint geometry, quadriceps muscle forces, and weightbearing patellofemoral joint kinematics. Virtual operations were conducted to simulate the two procedures. For distalization, the tibial tubercle and patella were displaced distally 4 mm to 20 mm in 4-mm increments based on the original model. At each level of distalization, the patella tendon was attached back to its original insertion to simulate the additional tenodesis procedure. Cartilage stress, contact area, and contact forces were quantified and compared between procedures and distalization levels. Results Distalization and distalization + tenodesis reduced patellofemoral joint stress compared with the baseline of 1.02 ± 0.11 MPa. Distalization led to lower cartilage stress than distalization + tenodesis, and the effect size was relatively large (0.88 ± 0. Conclusions Cartilage stress appears lower using distalization as opposed to distalization + tenodesis in this finite-element analysis simulation. An Insall-Salvati ratio of 0.95 may be an ideal level for distalization; further distalization does not show additional benefits. Clinical Relevance This study suggests that distalization may result in less stress than distalization + tenodesis,

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“…Various methods have been described to measure patellar position or height on lateral radiographs [5,11,15,18]. However, most of these methods use bony landmarks, and thus, they may not be applicable to young children whose ossification is not completed.…”

Section: Introductionmentioning

confidence: 99%

Which is the Best Method to Determine the Patellar Height in Children and Adolescents?

Park

Chung

Lee

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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Patellar height is associated with various clinical syndromes. We asked which of three methods was the most appropriate for measuring patellar height for different age groups in terms of applicability, validity, and reliability. We evaluated 108 children and adolescents with available MR images and lateral knee radiographs using Insall-Salvati (IS), Blackburne-Peel, and Koshino-Sugimoto (KS) methods. Subjects were divided equally into three age groups (A, 5-10.9 years; B, 11-12.9 years; C, 13-18 years). The applicabilities of the three methods were evaluated using bony landmarks identified on lateral radiographs. For validation testing, standardized patellar tendon lengths determined by MRI were used as reference standards, and concurrent validity was analyzed by performing correlation tests. Intraobserver and interobserver reliability were determined using intraclass correlation coefficients. Of the three methods used to measure patellar height in this study, the IS appeared to be the most reliable and valid in patients older than 13 years with nearly complete ossification. Before this stage of ossification had been achieved, the KS was the only applicable and most reliable but less valid method in younger children. Level of Evidence: Level I, diagnostic study. See Guidelines for Authors for a complete description of levels of evidence.

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The Modified Insall-Salvati Ratio for Assessment of Patellar Height

Cited by 266 publications

References 0 publications

Hyperintense signal alteration in the suprapatellar fat pad on MRI is associated with degeneration of the patellofemoral joint over 48 months: data from the Osteoarthritis Initiative

Hyperintense signal alteration in the suprapatellar fat pad on MRI is associated with degeneration of the patellofemoral joint over 48 months: data from the Osteoarthritis Initiative

Does Patella Tendon Tenodesis Improve Tibial Tubercle Distalization in Treating Patella Alta? A Computational Study

Which is the Best Method to Determine the Patellar Height in Children and Adolescents?

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