The relationship between patellar tilt and quadriceps patellar tendon angle with anatomical variations and pathologies of the knee joint

Çilengir, Atilla Hikmet; Çetinoğlu, Yusuf Kenan; Kazımoğlu, Cemal; Gelal, Mustafa Fazıl; Mete, Berna Dirim; Elmalı, Ferhan; Tosun, Özgür

doi:10.1016/j.ejrad.2021.109719

Cited by 11 publications

(37 citation statements)

References 42 publications

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“… 6 , 33 The tilt of the patella can be affected by multiple anatomic factors in patients with patellar dislocation. Cilengir et al 4 reported that trochlear dysplasia, tibial tubercle lateralization, and patellar tendon angle contributed to abnormal patellar tilt. The results of the present study indicated that abnormal torsion in the mid and distal femur is also a contributor to patellofemoral malalignment.…”

Section: Discussionmentioning

confidence: 99%

Pathological Thresholds of Segmental Femoral Torsion in Patients With Patellar Dislocation: Influence on Patellofemoral Malalignment

Song

Deng

et al. 2022

Orthopaedic Journal of Sports Medicine

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Background Femoral torsion can be evaluated from different femoral segments. The pathological thresholds for femoral torsion of different segments and the influence of segmental femoral torsion on patellofemoral alignment remain unknown. Purpose To compare femoral torsion between patients with recurrent patellar dislocation and healthy individuals, to determine the statistical physiological range and pathological thresholds of femoral torsion in different segments, and to investigate the influence of femoral torsion on patellofemoral malalignment. Study Design Cross-sectional study; Level of evidence, 3. Methods We retrospectively reviewed the records of patients with patellar dislocation who received surgical treatment in our department between 2019 and 2020. Healthy participants were recruited as the control group. The control patients were asymptomatic and had no history of lower extremity disorders. The differences in femoral torsion between the study and control groups were compared. The diagnostic capacity of femoral torsion in different segments and their correlation with patellar tilt were investigated. The mean value and 95% CI of femoral torsion in different segments were established using data from healthy volunteers. Results A total of 60 patients with patellar dislocation and 100 healthy volunteers were included in this study. The total, mid, and distal femoral torsion values differed significantly between the study and control groups ( P < .01). Total femoral torsion had the highest diagnostic value (area under the receiver operating curve = 0.733). Total torsion ( r = 0.432; P < .001), mid torsion ( r = 0.242; P = .002), and distal torsion ( r = 0.324; P < .001) showed significant correlations with patellar tilt. The pathological thresholds of excessive femoral torsion of the total, proximal, mid, and distal femoral segments were 24.73°, 46.68°, –6.55°, and 14.92°, respectively. Conclusion Patients with patellar dislocation had greater femoral torsion than healthy individuals in multiple femoral segments. Excessive mid, distal, and total torsion was associated with more significant patellar tilt.

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Section: Discussionmentioning

confidence: 99%

Pathological Thresholds of Segmental Femoral Torsion in Patients With Patellar Dislocation: Influence on Patellofemoral Malalignment

Song

Deng

et al. 2022

Orthopaedic Journal of Sports Medicine

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“…We did not examine the relationship between QPA and ligament and meniscus tears. Cilengir et al (3) reported that higher QPA related to an increase in TSA and a decrease in LTI. They also found that increased QPA was associated with fat pad edema and quadriceps tendinosis.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

“…Medial and lateral meniscal (MM and LM) injuries, anterior and posterior cruciate ligament (ACL and PCL) tears, peripatellar fat pad edema, chondromalacia, and effusion are among the most frequently reported pathologies involving the knee joint on magnetic resonance imaging (MRI) (1). Only limited data are available on the relationship between radiological features, such as patellar tendon length, patellar height, tibial tubercletrochlear groove (TT-TG) distance, patella angle, trochlear sulcus angle (TSA), trochlear groove depth (TGD), medial trochlea length (MT), lateral trochlea length (LT), medial trochlear/lateral trochlear length (MT/LT) ratio, lateral patellar tilt angle (LPTA), patellapatellar tendon angle (P-PTA), quadriceps patellar tendon angle (QPA), Insall-Salvati index (ISI), medial trochlear inclination (MTI), lateral trochlear inclination (LTI), and the reported pathologies (2,3,4). These variations may cause some patient groups to be more prone to ligament and meniscal injuries.…”

Section: Evaluation Of Anatomical Variations With Morphological Measu...mentioning

confidence: 99%

“…The patients were divided into two groups according to LPTA angle degrees. While an LPTA < 5° is accepted as a normal reference value, an LPTA > 5° is considered abnormal (3). During the LPTA measurement, for the first line passing through the lateral facet of the patella, the section in which the largest diameter of the patella was seen was selected from the images in the axial section.…”

Section: Measurementsmentioning

confidence: 99%

“…While an LPTA <5 degrees is accepted as a normal reference value, an LPTA> 5 degrees is considered abnormal. 3 During the LPTA measurement, for the first line passing through the lateral facet of the patella, the section in which the largest diameter of the patella was seen was selected from the images in the axial section. For the second line, a line was drawn passing through the most posterior femoral condyles.…”

Section: Measurementsmentioning

confidence: 99%

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Evaluation of Anatomical Variations with Morphological Measurements and Their Relationship to Meniscal Injury and Ligament Damage

Oğuzdoğan

Arslan

2022

J Knee Surg

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Introduction: The purpose of this study was to reveal the anatomical risk factors for anterior and posterior cruciate ligament (ACL and PCL) injuries and menisci injury. We aim to investigate whether there are significant relationship between tibial tubercle-trochlear groove distance distance (TT-TG), patella angle, trochlear sulcus angle (TSA), trochlear groove depth (TGD), medial and lateral trochlea length (MT and LT), MT/LT ratio, lateral patellar tilt angle (LPTA), patella-patellar tendon angle (P-PTA), quadriceps-patellar tendon angle (QPA), Insall-Salvati index (ISI), medial and lateral trochlear inclination (MTI and LTI) measurements and important common pathologies such as ACL, PCL, medial and lateral meniscal injuries (MM and LM), peripatellar fat pad edema, chondromalacia and effusion. Thus, the mechanisms of injury will be better understood by revealing important anatomical variations for meniscus and ligament damage. Material and Methods: Three hundred eighty patients with knee magnetic resonance imaging examination included in this study. Our patients who underwent knee MRI were divided into groups according to the presence of MM tear, LM tear, ACL tear, PCL tear, peripatellar fat pad edema, chondromalacia and effusion. TT-TG distance, patella angle, TSA, TGD, MT, LT, MT/LT ratio, LPTA, P-PTA, QPA, ISI, MTI and LTI were measured. Results: In patients with ACL tear; age, LT, ML/LT ratio and QPA measurements were found to be significantly higher. There was no significant difference between the participants' LPTA value and the presence of ACL tear, MM and LM injury. MT and ML/LT ratio were found to be significantly lower in the group with MM tear (p<0.001). The TT-TG distance was found to be significantly lower in the group with LM tear. Conclusion: Increased age, LT, ML/LT ratio and QPA are predispose risk for ACL tear. Decreased MT and ML/LT ratio are among the risk factors for MM tear. The anatomical variations are associated with ligamant and meniscal injury.

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Prefemoral Fat Pad Dysfunction

Charalambous

2021

The Knee Made Easy

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The relationship between patellar tilt and quadriceps patellar tendon angle with anatomical variations and pathologies of the knee joint

Cited by 11 publications

References 42 publications

Pathological Thresholds of Segmental Femoral Torsion in Patients With Patellar Dislocation: Influence on Patellofemoral Malalignment

Pathological Thresholds of Segmental Femoral Torsion in Patients With Patellar Dislocation: Influence on Patellofemoral Malalignment

Evaluation of Anatomical Variations with Morphological Measurements and Their Relationship to Meniscal Injury and Ligament Damage

Prefemoral Fat Pad Dysfunction

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