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

Abstract

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.

Does Medial Patellofemoral Ligament Reconstruction Decrease Patellar Height? A Preliminary Report

“…[33][34][35][36][37] The Blackburne-Peel and Caton-Deschamps indices assess the patellar height in relation to the tibial plateau and are considered to be more reliable in children compared with the Insall-Salvati index, which is dependent on the ossification of the tibial tubercle. When used in children or adolescents, one has to account for growth and ossification pattern around the knee and their influence on these indices.…”

Anterior Knee Pain in Patients with Cerebral Palsy

“…All radiographic images were digitally acquired using a picture archiving and communication system (PACS; Impax, Agfa, Antwerp, Belgium), and assessments were subsequently carried out using the PACS software. A previous report demonstrated that the Insall-Salvati (IS) 12) and the Koshino-Sugimoto (KS) 13) methods have reasonable reliability and validity with respect to depicting the patellar height in children and adolescents, 14) and therefore, IS and KS ratios were used to determine the patellar height. On lateral knee radiographs, the IS method was used to measure patellar tendon length relative to patellar bone length, and the KS method was to measure the ratio of the distance between the proximal tibial physis and the center of the patella to the distance between the distal femoral physis and the proximal tibial physis.…”

Permanent patellar dislocation after a nonoperative treatment of recurrent dislocation of the patella because of trochlear dysplasia

“…As the Insall-Salvati method has been shown to be the most reliable, it was used to measure patella alta [11]. As the Insall-Salvati method has been shown to be the most reliable, it was used to measure patella alta [11].…”