The reliability of four widely used patellar height ratios

Duijvenbode, Dennis van; Stavenuiter, Michel H.J.; Burger, Bart J.; Dijke, Cees van; Spermon, Jacco; Hoozemans, M.J.M.

doi:10.1007/s00264-015-2908-2

Cited by 41 publications

(44 citation statements)

References 24 publications

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“…The main contribution of this study is that the API was proposed for assessing patellar height. The evidences suggested the intraclass correlation coe cients of this new method were excellent, comparable with those of previously reported for ISI, mISI, BPI, CDI and PPA (2,5,17). The API seems to have slightly better intra-observer repeatability and inter-observer reproducibility in more than 200 radiographs.…”

Section: Discussionsupporting

confidence: 85%

“…Currently, the ve published methods mentioned in this article are the most popular. However, there are inherent methodological di culties, which may lead to an increase in inter-and intra-observer variability (11,(17)(18)(19). The ISI remains the most popular one, however, it is imperative to standardize the tibial attachment of the patellar tendon in order to avoid a signi cant variation resulting from the obscure morphology and the pathological overgrowth of the tibial tubercle (18,20).…”

Section: Discussionmentioning

confidence: 99%

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The Axis-patella Index: A New Method for Measuring Patellar Height

Han¹,

Zhang²

2020

Preprint

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Background: The widely used methods for measuring patellar height are based on the anatomic landmarks of the patella and the proximal tibia. When the knee undergoes alterations in the articular surface or adjacent structures due to various diseases or operations, the accurate identification of tibial landmarks is challenging. The results of these conventional methods may be biased or even unavailable. The purpose of this study was to introduce and validate a new method, axis-patella index (API), for assessing patellar height. Methods: Patellar heights were respectively measured using the Insall–Salvati, modified Insall–Salvati, Blackburne–Peel, Caton–Deschamps, plateau-patellar angle, and axis-patella methods on the lateral radiographs of 649 knees without anatomic abnormalities. The inter- and intra-observer reliability of all methods were evaluated by calculating intraclass correlation coefficient and Bland-Altman plots. The associations between the API and the established methods were assessed using Pearson’s correlation coefficient. Results: The API was strongly correlated with the five aforementioned methods. Reliability analyses indicated high inter-observer reproducibility and intra-observer repeatability. The mean of API was approximately 1.5, hence the reference range was defined 1.2 - 1.9 according to the 95% confidence interval. Conclusions: The API, a new index of referencing the tibial shaft axis and the fibular head, providing a valid and accurate alternative for the assessment of patellar height. The reference range was 1.2 - 1.9 in radiographically normal knee.

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Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

The Axis-patella Index: A New Method for Measuring Patellar Height

Han¹,

Zhang²

2020

Preprint

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“…An increased tibial TT-TG can be surgically addressed by medial transfer of the tibial tuberosity, and using an index instead of the absolute TT-TG value can be helpful when indicating operative treatment. Similarly, patellar height, which is also an established risk factor for PFI, is assessed with ratios rather than a distance given in millimeters [15]. While Pennock et al suggested to normalize TT-TG to patient height [4], Hingelbaum et al recommended to evaluate TT-TG in relation to the proximal-distal joint size [2] and Camp et al in relation to patella or tibia width [5].…”

Section: Discussionmentioning

confidence: 99%

The use of tibial tuberosity-trochlear groove indices based on joint size in lower limb evaluation

Ferlic

Runer

Dirisamer

et al. 2017

International Orthopaedics (SICOT)

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Purpose The correlation between tibial tuberosity-trochlear groove distance (TT-TG) and joint size, taking into account several different parameters of knee joint size as well as lower limb dimensions, is evaluated in order to assess whether TT-TG indices should be used in instead of absolute TT-TG values. Methods This study comprised a retrospective analysis of knee CT scans, including 36 cases with patellofemoral instability (PFI) and 30 controls. Besides TT-TG, five measures of knee joint size were evaluated in axial CT slices: medio-lateral femur width, antero-posterior lateral condylar height, mediolateral width of the tibia, width of the patella and the proximaldistal joint size (TT-TE). Furthermore, the length of the femur, the tibia and the total leg length were measured in the CT scanogram. Correlation analysis of TT-TG and the other parameters was done by calculating the Spearman correlation coefficient. Results In the PFI group lateral condylar height (r = 0.370), tibia width (r = 0.406) and patella width (r = 0.366) showed significant moderate correlations (p < 0.03) with TT-TG. Furthermore, we found a significant correlation between TT-TG and tibia length (r = 0.371) and total leg length (r = 381). The control group showed no significant correlation between TT-TG and knee joint size or between TT-TG and measures of lower limb length. Conclusions Tibial tuberosity-trochlear groove distance correlates with several parameters of knee joint size and leg length in patients with patellofemoral instability. Application of indices determining TT-TG as a ratio of joint size could be helpful in establishing the indication for medial transfer of the tibial tuberosity in patients with PFI. Level of evidence Level III

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“…All four of classical methods mentioned in this article have intrinstic methodological di culties, especially in patients who performed TKA resulted from severe osteoarthritis, which may lead to an increase in inter-and intra-observer variability [25][26][27][28], and evenly the measurement may be unavailable. Preoperatively, severe osteoarthritis with destruction of the articular surface and osteophytes formation, especially combined with lower extremity malalignment, usually leads to measurement errors to some extent, which are the common shortcomings of these four methods of using a marginal reference [17].…”

Section: Discussionmentioning

confidence: 99%

A new method for evaluation of patellar height and the position of the joint line before and after total knee arthroplasty

Han

Zhang

2020

Preprint

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Background: The measurement of patellar height and restoration of the natural position of the joint line are crucial to total knee arthroplasty (TKA). However, there remains a lack of consensus on an optimal measurement method to associate the patellar height with the joint line position. The objective of this study was to introduce a new method and validate the application in TKA both preoperatively and postoperatively.Methods: Instead of taking marginal landmarks as the tibial references, the tibial shaft axis was used to construct the new measurement method, which comprises the axis-patella (AP), joint axis-patella (jAP) indices and joint line height (JLH). Patellar heights were measured using the Insall-Salvati (IS), modified Insall-Salvati (mIS), Blackburne-Peel (BP), Caton-Deschamps (CD) indices, and the new method in 175 knees both preoperatively and postoperatively. Intraclass correlation coefficients and Pearson’s correlation analyses were respectively used to evaluate the reliabilities and correlations.Results: There were good correlations between the proposed method and the mIS, CD, and BP indices. High inter-observer reproducibility was found for AP (preoperative and postoperative 0.83), jAP (preoperative 0.82; postoperative 0.86) indices and JLH (preoperative 0.88; postoperative 0.95). High intra-observer repeatability was also found for AP (preoperative 0.85; postoperative 0.87), jAP (preoperative 0.83; postoperative 0.87) indices and JLH (preoperative 0.80; postoperative 0.92).Conclusions: The new method is reliable for measuring patellar height before and after TKA, providing an alternative to distinguish between true and pseudo patella baja. Furthermore, JLH can be applied to assess and restore the joint line position in TKA.

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The reliability of four widely used patellar height ratios

Abstract: Although the IS showed best reliability, we advise to use the MIS as it showed the second best reliability but is, according to the literature, associated with better validity.

Cited by 41 publications

References 24 publications

The Axis-patella Index: A New Method for Measuring Patellar Height

The Axis-patella Index: A New Method for Measuring Patellar Height

The use of tibial tuberosity-trochlear groove indices based on joint size in lower limb evaluation

A new method for evaluation of patellar height and the position of the joint line before and after total knee arthroplasty

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