1
|
Gattu N, Sutton M, Doherty DB, Lanfermeijer ND, Rodriguez-Quintana D, Ismaily SK, Pletka CA, Noble PC, Han S. Variations in Trochlear Morphology of Contemporary and Legacy Total Knee Arthroplasty Prostheses: A Review of 22 Designs. J Arthroplasty 2024; 39:1583-1588. [PMID: 38072096 DOI: 10.1016/j.arth.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 12/05/2023] [Accepted: 12/06/2023] [Indexed: 01/01/2024] Open
Abstract
BACKGROUND The morphology of the trochlear compartment of total knee arthroplasty (TKA) prostheses is a major determinant of postoperative patello-femoral kinematics, particularly with unresurfaced patellae. The objective of this study was to quantify and compare the trochlear morphology of a large series of contemporary and legacy TKA designs. METHODS The 3-dimensional surface models of 22 femoral components (13 contemporary and 9 legacy) were created using high-resolution laser scanning. The trochlear profile of each component was analyzed from proximal to distal in 15° increments around the trochlear axis. In each profile, the following variables were measured: sulcus angle, medio-lateral deviation of the sulcus, the height and width of the facets, and the trochlear groove orientation. RESULTS In the contemporary group, the sulcus angle decreased progressively along the trochlear arc to varying degrees, except for 2 symmetrical designs, whereas the sulcus angle of the legacy designs showed considerable variability. The height of the medial facet was very strongly correlated with that of the lateral facet in the contemporary group (R2 = 0.89), whereas the correlation was weak for the legacy designs (R2 = 0.36). Moreover, the trochlear sulcus deviated laterally from distal to proximal in 10 contemporary designs and 7 legacy designs, resulting in a trochlear groove orientation of 4.2 to 11.1° and 4.3 to 10.5°, respectively. In the remaining 5 designs (3 contemporary and 2 legacy), the sulcus was vertical. CONCLUSIONS There is more consistency in trochlear morphology of contemporary TKA designs compared to that of legacy designs, yet there are still large variations between different designs.
Collapse
Affiliation(s)
- Nikhil Gattu
- Department of Orthopedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
| | - Marriah Sutton
- Department of Orthopedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
| | - David B Doherty
- Department of Orthopedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
| | - Nicholas D Lanfermeijer
- Department of Orthopedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
| | - David Rodriguez-Quintana
- Department of Orthopedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
| | - Sabir K Ismaily
- Department of Orthopedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
| | - Camryn A Pletka
- Department of Orthopedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
| | - Philip C Noble
- Department of Orthopedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
| | - Shuyang Han
- Department of Orthopedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
| |
Collapse
|
2
|
Figueroa F, Guiloff R, Bolton S, Figueroa D, Tapasvi S, Stocker E. Specific considerations in female patients with patellar instability: current concepts. J ISAKOS 2024:S2059-7754(24)00068-3. [PMID: 38580053 DOI: 10.1016/j.jisako.2024.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 03/26/2024] [Accepted: 03/29/2024] [Indexed: 04/07/2024]
Abstract
Prior literature suggests that patellofemoral instability (PFI) is significantly more prevalent in women than in men. This higher prevalence is commonly attributed to anatomical differences between sexes, particularly with patellofemoral alignment. These differences encompass a higher rate of trochlear dysplasia (TD), patella alta, an increased Q angle, and soft tissue imbalances. In recent years, worse outcomes have been reported in female patients after patellofemoral stabilization surgery using medial patellofemoral ligament reconstruction (MPFLr) alone or in combination with a tibial tubercle osteotomy (TTO), for this reason an "à la carte" plan (addressing the individuals anatomical risk factors) could be more appropriate for female patients.
Collapse
Affiliation(s)
- Francisco Figueroa
- Clinica Alemana-Universidad del Desarrollo, 7650568, Chile; Hospital Sotero del Rio, 8207257, Chile.
| | - Rodrigo Guiloff
- Clinica Alemana-Universidad del Desarrollo, 7650568, Chile; Hospital Sotero del Rio, 8207257, Chile.
| | - Sarah Bolton
- Fortius Clinic, W1H 6EQ, UK; Chelsea & Westminster Hospital, SW10 9NH, UK.
| | - David Figueroa
- Clinica Alemana-Universidad del Desarrollo, 7650568, Chile.
| | | | | |
Collapse
|
3
|
Bäumler W, Popp D, Ostheim P, Dollinger M, Senk K, Weber J, Stroszczynski C, Schaible J. Magnetic Resonance Image Findings and Potential Anatomic Risk Factors for Chodromalacia in Children and Adolescents Suffering from Non-Overload Atraumatic Knee Pain in the Ambulant Setting. Tomography 2024; 10:243-254. [PMID: 38393287 PMCID: PMC10891981 DOI: 10.3390/tomography10020019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 02/03/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024] Open
Abstract
PURPOSE To evaluate magnetic resonance image (MRI) findings in children and adolescents suffering from knee pain without traumatic or physical overload history and to identify potential anatomic risk factors. MATERIAL AND METHODS A total of 507 MRIs of 6- to 20-year-old patients (251 males; 256 females) were evaluated with regard to detectable pathologies of the knee. The results were compared to a control group without pain (n = 73; 34 males; 39 females). A binary logistic regression model and t-tests for paired and unpaired samples were used to identify possible risk factors and significant anatomic differences of the study population. RESULTS In 348 patients (68.6%), at least one pathology was detected. The most commonly detected finding was chondromalacia of the patellofemoral (PF) joint (n = 205; 40.4%). Chondral lesions of the PF joint occurred significantly more often in knee pain patients than in the control group (40% vs. 11.0%; p = 0.001), especially in cases of a patella tilt angle > 5° (p ≤ 0.001), a bony sulcus angle > 150° (p = 0.002), a cartilaginous sulcus angle > 150° (p = 0.012), a lateral trochlear inclination < 11° (p ≤ 0.001), a lateralised patella (p = 0.023) and a Wiberg type II or III patella shape (p = 0.019). Moreover, a larger patella tilt angle (p = 0.021), a greater bony sulcus angle (p = 0.042), a larger cartilaginous sulcus angle (p = 0.038) and a lower value of the lateral trochlear inclination (p = 0.014) were detected in knee pain patients compared to the reference group. CONCLUSION Chondromalacia of the PF joint is frequently observed in children and adolescents suffering from non-overload atraumatic knee pain, whereby a patella tilt angle > 5°, a bony sulcus angle > 150°, a cartilaginous sulcus angle > 150°, a lateral trochlear inclination < 11°, a lateralised patella and a Wiberg type II or III patella shape seem to represent anatomic risk factors.
Collapse
Affiliation(s)
- Wolf Bäumler
- Department of Radiology, University Hospital Regensburg, 93053 Regensburg, Germany; (M.D.); (K.S.); (C.S.); (J.S.)
| | - Daniel Popp
- Department of Trauma Surgery, University Hospital Regensburg, 93053 Regensburg, Germany; (D.P.); (J.W.)
| | - Patrick Ostheim
- Bundeswehr Institute of Radiobiology, University of Ulm, 80937 Munich, Germany;
| | - Marco Dollinger
- Department of Radiology, University Hospital Regensburg, 93053 Regensburg, Germany; (M.D.); (K.S.); (C.S.); (J.S.)
| | - Karin Senk
- Department of Radiology, University Hospital Regensburg, 93053 Regensburg, Germany; (M.D.); (K.S.); (C.S.); (J.S.)
| | - Johannes Weber
- Department of Trauma Surgery, University Hospital Regensburg, 93053 Regensburg, Germany; (D.P.); (J.W.)
| | - Christian Stroszczynski
- Department of Radiology, University Hospital Regensburg, 93053 Regensburg, Germany; (M.D.); (K.S.); (C.S.); (J.S.)
| | - Jan Schaible
- Department of Radiology, University Hospital Regensburg, 93053 Regensburg, Germany; (M.D.); (K.S.); (C.S.); (J.S.)
| |
Collapse
|
4
|
Perkins CA, Egger AC, Busch MT, Murata A, Willimon SC. Medial Patellofemoral Ligament Reconstruction With or Without Tibial Tubercle Osteotomy in Carefully Selected Patients Results in a 5% Revision Rate: A Preliminary Analysis. J Pediatr Orthop 2024; 44:e144-e150. [PMID: 38031489 DOI: 10.1097/bpo.0000000000002582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
PURPOSE The purpose was to assess the outcomes of medial patellofemoral ligament (MPFL) allograft reconstruction with or without tibial tubercle osteotomy (TTO) in adolescents, with a focus on evaluating demographic and imaging characteristics on outcomes. METHODS A single-institution retrospective study was performed of patients ages 12 to 19 years who underwent MPFL reconstruction +/- TTO for the treatment of lateral patellar instability. Demographic, clinical, surgical, and postoperative information was collected. All x-ray and magnetic resonance imaging measurements were completed independently by 2 surgeons. Patients were contacted to complete patient-reported outcomes at a minimum of 2 years following surgery. The primary outcome measure was recurrent instability resulting in revision surgery. RESULTS Seventy-eight knees in 74 patients, with a median age of 15.3 years (interquartile range: 14.4, 16.1), were included. Forty-five knees underwent isolated MPFL reconstruction and 33 knees had a combined MPFL + TTO. The knees that underwent MPFL + TTO had significantly greater tibial tubercle-trochlear groove distance (19.0 mm vs. 15.4 mm, P =0.015) and patellar tendon-lateral trochlear ridge distance (10.9 mm vs. 5.9 mm, P =0.018) than the knees treated with isolated MPFL reconstruction. Four knees (5.1%) underwent revision stabilization surgery, including 3 knees in the MPFL cohort (6.7%) and 1 knee in the MPFL + TTO cohort (3.0%). The rate of failure between the MPFL and MPFL + TTO knees was not significantly different, P =0.634. There were no differences in age, sex, body mass index, number of dislocations, or any imaging characteristics in patients who underwent revision versus those who did not. Patient-reported outcomes were collected on 50 knees at a median of 36 months (interquartile range: 24, 54) after surgery, and no differences were noted between cohorts. CONCLUSIONS Patellar stabilization surgery, including MPFL reconstruction and TTO in carefully selected patients, had excellent revision-free outcomes in 95% of this adolescent cohort. In this case series, those patients whose treatment included TTO had greater tibial tubercle-trochlear groove and patellar tendon-lateral trochlear ridge as compared to the isolated MPFL cohort. Despite previous literature suggesting demographic and imaging characteristics as risks for recurrent instability, we identified no characteristics within these two distinct surgical treatment groups to be predictive of the need for revision stabilization, regardless of the treatment group. LEVEL OF EVIDENCE Level III-retrospective comparison study.
Collapse
Affiliation(s)
- Crystal A Perkins
- Department of Pediatric Orthopedics, Children's Healthcare of Atlanta, Atlanta, GA
| | | | | | | | | |
Collapse
|
5
|
Gobbi RG, Cavalheiro CM, Giglio PN, Hinckel BB, Camanho GL. Patellar Tilt and Patellar Tendon-Trochlear Groove Angle Present the Optimum Magnetic Resonance Imaging Diagnostic Reliability for Patients With Patellar Instability. Arthroscopy 2023; 39:2339-2351. [PMID: 37116551 DOI: 10.1016/j.arthro.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 04/04/2023] [Accepted: 04/08/2023] [Indexed: 04/30/2023]
Abstract
PURPOSE To describe, in controls and in a population with patellar instability, magnetic resonance imaging values of measurements representing major associated factors for patellar instability (patellar height, trochlear dysplasia, and extensor mechanism alignment), as well as their cutoff values. METHODS In total, 323 knee magnetic resonance imaging scans, 142 with patellar instability and 181 controls without patellofemoral complaints (anterior cruciate, medial collateral ligament, meniscus ruptures or normal) were evaluated. Means, normality values in the control population, ideal cutoff values through receiver operating characteristic curves analysis, and interobserver reliability (intraclass correlation coefficient) were described for a series of measurements. RESULTS All measurements were statistically different in control and instability patients, except for the patellotrochlear index and tibial tuberosity to posterior cruciate ligament distance. The interobserver intraclass correlation coefficient was good or excellent (above 0.75) only for the patellotrochlear index, patellar tendon-trochlear groove (PTTG) angle, and patellar tilt. The optimal cutoff value for each measurement was: PTTG angle ≥25.3o with sensitivity (S) of 70% and specificity (E) of 89%, patellar tilt ≥16o (S: 69% and E: 84%), trochlear sulcus angle ≥153o (S: 75% and E: 76%), Carrillon ≤12.8o (S: 62% and E: 87%), PTTG distance ≥11mm (S: 71% and E: 78%), Caton-Deschamps index ≥1.23 (S: 72% and E: 76%) and trochlear bump ≥3.95 mm (S: 76% and E: 65%). CONCLUSIONS Caton-Deschamps index (≥1.23), trochlear sulcus angle (≥153o), ventral prominence of the trochlea (≥3.95 mm), PTTG distance (≥11 mm), PTTG angle (≥25.3o), Carrillon angle (≤12.8o), and patellar tilt (≥16o) presented better diagnostic performance for patellar instability. Patellotrochlear index and tibial tuberosity to posterior cruciate ligament distance were not related to patellar instability. The interobserver reliability of the factors related to patellar instability was excellent only for the PTTG angle and lateral patellar tilt. LEVEL OF EVIDENCE Level III, retrospective case-control study.
Collapse
Affiliation(s)
- Riccardo Gomes Gobbi
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil; Hcor, São Paulo, Brazil.
| | - Camila Maftoum Cavalheiro
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Pedro Nogueira Giglio
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Betina Bremer Hinckel
- Department of Orthopaedic Surgery, William Beaumont Hospital, Royal Oak, Michigan, U.S.A
| | - Gilberto Luis Camanho
- Instituto de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| |
Collapse
|
6
|
Sasaki A, Hidaka Y, Mochizuki M, Honnami M. Measurement of Femoral Trochlear Morphology in Dogs Using Ultrasonography. Vet Comp Orthop Traumatol 2023; 36:294-301. [PMID: 37487535 DOI: 10.1055/s-0043-1770902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
OBJECTIVE The aim of this study was to examine a method for measuring femoral trochlear morphology in dogs using ultrasonography, and survey femoral trochlear morphology in skeletally normal dogs. STUDY DESIGN To examine the validity of ultrasonography, three raters measured the sulcus angle (SA; the angle between the medial and lateral facets) five times in five skeletally normal dogs. Intra- and interrater reliabilities were then calculated. We also calculated the correlation coefficient between SAs measured using ultrasonography and computed tomography (CT) or magnetic resonance imaging (MRI). Then, we surveyed the femoral trochlear morphology in skeletally normal dogs using ultrasonography. RESULTS The intra- and interrater reliability for SAs measured using ultrasonography was good, and the correlation coefficient between SAs measured using ultrasonography and CT, or MRI, was strong. In skeletally normal dogs, the SAs for osseous contours decreased until 6 months of age. However, the SAs for cartilaginous contours did not change during the growth period. CONCLUSION The ultrasonographic measurement method is reliable for the evaluation of femoral trochlear morphology in dogs. The contour of the articular cartilage surface of the femoral trochlea is already determined early in life, and ossification of the articular cartilage of the femoral trochlea proceeds until 6 months of age. The results of this study will provide crucial information for the evaluation of femoral trochlear morphology in dogs.
Collapse
Affiliation(s)
- Akari Sasaki
- Laboratory of Veterinary Emergency Medicine, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan
| | - Yuki Hidaka
- Veterinary Medical Center, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan
| | - Manabu Mochizuki
- Laboratory of Veterinary Emergency Medicine, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan
- Veterinary Medical Center, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan
| | - Muneki Honnami
- Veterinary Medical Center, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan
| |
Collapse
|
7
|
Wu CH, Hsu KY, Cheng YH, Yang CP, Sheu H, Chang SS, Chen CY, Chiu CH. Reconstruction of High-Grade Trochlea Dysplasia in a Young Female with Recurrent Patella Dislocation: A Case Report. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050986. [PMID: 37241218 DOI: 10.3390/medicina59050986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/15/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023]
Abstract
The patellofemoral joint involves a combination of bony structures and soft tissues to maintain stability. Patella instability is a disabling condition, and the cause is multifactorial. The main risk factors include patella alta, trochlea dysplasia, excessive tibial tuberosity to trochlea grove (TT-TG) distance, and excessive lateral patella tilt. In this case report, we highlight the thinking process of diagnosis and method for selecting the optimal treatment in accordance with the guidelines by Dejour et al. when we are presented with a patient with patella instability. A 20-year-old Asian woman without underlying medical conditions, presented with recurrent (>3 episodes) right patella dislocation for 7 years. Investigations revealed a type D trochlea dysplasia, increased TT-TG distance, and excessive lateral tilt angle. She underwent trochlea sulcus deepening, sulcus lateralization and lateral facet elevation, lateral retinacular release, and medial quadriceps tendon-femoral ligament (MQTFL) reconstruction. Due to the complexity behind the anatomy and biomechanics of patella instability, an easy-to-follow treatment algorithm is essential for the treating surgeon to provide effective and efficient treatment. MQTFL reconstruction is recommended for recurrent patella dislocation due to satisfactory clinical and patient reported outcomes and a reduced risk of iatrogenic patella fracture. Controversies for surgical indication in lateral retinacular release, and whether the sulcus angle is an accurate parameter for diagnosis of trochlea dysplasia, remain, and further research is required.
Collapse
Affiliation(s)
- Chih-Hsuan Wu
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Kuo-Yao Hsu
- Department of Orthopedic Surgery, New Taipei Municipal Tucheng Hospital, New Taipei City 236, Taiwan
| | - You-Hung Cheng
- Department of Orthopedic Surgery, New Taipei Municipal Tucheng Hospital, New Taipei City 236, Taiwan
| | - Cheng-Pang Yang
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Huan Sheu
- Department of Orthopedic Surgery, Taoyuan Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Shih-Sheng Chang
- Department of Orthopedic Surgery, Taoyuan Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Chao-Yu Chen
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Chih-Hao Chiu
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| |
Collapse
|
8
|
Longo F, Memarian P, Knell SC, Contiero B, Pozzi A. Computed tomographic measurements of the femoral trochlea in dogs with and without medial patellar luxation. Vet Surg 2023; 52:395-406. [PMID: 36196803 DOI: 10.1111/vsu.13903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 09/04/2022] [Accepted: 09/11/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine cutoff values in small (SB) and medium/large (MLB) breed dogs with and without medial patellar luxation (MPL) for identifying abnormal femoral trochlea morphology. STUDY DESIGN Original research. ANIMALS A total of 80 computed tomographic (CT) scans from client-owned dogs METHODS: Four groups of 20 dogs were created: (1) control SB, (2) control MLB, (3) MPL-SB, and (4) MPL-MLB. Two authors measured the femoral trochlear groove angle (FTGA), femoral trochlear angle (FTA), and femoral trochlear ridge inclination angle (FTRIA) in two points with CT. ANOVA and ROC-analysis were tested to the control and MPL groups to assess sensitivity, specificity, and cutoff values. Statistical significance was set to p < .05. Intraclass correlation coefficients evaluated the inter-rater agreement. RESULTS FTGA (± SD) in control SB (128.8° ± 4.7°) and control MLB (119.2° ± 5.6°), was smaller (p < .0001) than in MPL-SB (139.4° ± 4.4°) and MPL-MLB (133.7° ± 5.1°). FTA and FTRIA were decreased (p = .12, p = .23) in MPL-SB (2.1° ± 6.8; -0.3° ± 3.3°) and MPL-MLB (3.8° ± 5.6°; 1.7° ± 4.5°) compared to control SB (0.2° ±4.1; -0.1° ± 2.6°) and control MLB (5.3° ± 2.8°; 3.1° ± 1.3°). Cutoff values for FTGA, FTA, and FTRIA were > 134°, < -5.9°, < -2 ° (SB), and > 128.3°, < -0.4°, < -0.4° (MLB). Sensitivity, specificity, and inter-rater agreement were superior for FTGA than FTA and FTRIA. CONCLUSIONS Dogs without MPL had a deeper femoral trochlear groove than MPL dogs. SB had a shallower groove than MLB. The measurement of FTA and FTRIA was not reliable. CLINICAL RELEVANCE A FTGA <134° (SB) and < 128° (MLB) may be considered as a cutoff for trochleoplasty decision-making.
Collapse
Affiliation(s)
- Federico Longo
- Clinic for Small Animal Surgery, University of Zurich, Zurich, Switzerland
| | - Parastoo Memarian
- Department of Animal Medicine, Productions, and Health, University of Padova, Legnaro, Italy
| | | | - Barbara Contiero
- Department of Animal Medicine, Productions, and Health, University of Padova, Legnaro, Italy
| | - Antonio Pozzi
- Clinic for Small Animal Surgery, University of Zurich, Zurich, Switzerland
| |
Collapse
|
9
|
Drapeau-Zgoralski V, Swift B, Caines A, Kerrigan A, Carsen S, Pickell M. Lateral Patellar Instability. J Bone Joint Surg Am 2023; 105:397-409. [PMID: 36728086 DOI: 10.2106/jbjs.22.00756] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
➤ Patellar instability represents a common problem with an evolving understanding and multifactorial pathoetiology. Treatment plans should be based on the identification of contributing anatomical factors and tailored to each individual patient. ➤ Risks for recurrent instability are dependent on several patient-specific factors including patella alta, increased tibial tubercle-to-trochlear groove (TT-TG) distance, trochlear dysplasia, younger skeletal age, and ligamentous laxity. ➤ Cartilage or osteochondral lesions and/or fractures are commonly observed in first-time patellar dislocation, and magnetic resonance imaging (MRI) should be strongly considered. Advanced imaging modalities, such as computed tomography (CT) or MRI, should also be obtained preoperatively to identify predisposing factors and guide surgical treatment. ➤ Medial patellofemoral ligament (MPFL) reconstruction with anatomical femoral tunnel positioning is associated with lower recurrence rates compared with MPFL repair and has become a common and successful reconstructive surgical option in cases of instability. ➤ Lateral retinacular tightness can be addressed with lateral retinacular release or lengthening, but these procedures should not be performed in isolation. ➤ Tibial tubercle osteotomy is a powerful reconstructive tool in the setting of underlying skeletal risk factors for instability and can be of particular benefit in the presence of increased TT-TG distance (>20 mm), and/or in the setting of patella alta. ➤ The indications for trochleoplasty are still developing along with the clinical evidence, but trochleoplasty may be indicated in some cases of severe trochlear dysplasia. Several surgical techniques have indications in specific clinical scenarios and populations, and indications, risks, and benefits to each are progressing with our understanding. ➤ Combined femoral derotational osteotomy and MPFL reconstruction can be considered for patients with a femoral anteversion angle of >30° to improve patient outcomes and reduce recurrence rates.
Collapse
Affiliation(s)
| | - Brendan Swift
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Andrew Caines
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Alicia Kerrigan
- Division of Orthopaedic Surgery, The Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Sasha Carsen
- Division of Orthopaedic Surgery, The Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Michael Pickell
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| |
Collapse
|
10
|
Li W, Wang Q, Wang H, Zhang Z, Wang S. Patellar development after patella instability and early reduction in growing rabbits. BMC Musculoskelet Disord 2023; 24:78. [PMID: 36717908 PMCID: PMC9885565 DOI: 10.1186/s12891-023-06183-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 01/23/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Patella-shaped disorder has been considered as a predisposing factor for patella instability. But the influence of early patella reduction for patellar development remains unclear. This study aimed to evaluate whether early operation in patella instability could improve patella morphology in growing rabbits. METHODS Fifty rabbits (1-month-old) were included in the study. The control group underwent no surgical procedures. The two experimental groups (reduction group and non-reduced group), underwent medial soft tissue restraint release surgery. The reduction group, rabbits underwent the medial soft tissue sutura surgery in order to stabilize the patella 2 months after release surgery. The non-reduced group, rabbits did not undergo suture surgery. Computed Tomography (CT) scans analysis in two experimental endpoints (2, 5 months after release surgery) were selected to evaluate the transverse diameter, thickness, Wiberg index and Wiberg angle. Gross observation was conducted to assess morphological changes of the patella. RESULTS CT scans showed significant difference in the mean transverse diameter, Wiberg angle between the two experimental groups and the control group 2 months after release surgery. 5 months after release surgery, the indices of patella were found no statistically difference in the reduction group versus the control group. However, the transverse diameter, Wiberg angle in the non-reduced group were significantly differences than that in the reduction group (P < 0.05). Gross observation showed a flattened articular surface of the patella in the non-reduced group. CONCLUSIONS The results indicated that patella instability may lead to patella-shaped disorder, showing a flattened morphology. Early patella reduction can improve the patella morphology in growing rabbits.
Collapse
Affiliation(s)
- Weifeng Li
- Department of Orthopaedic Surgery, Baoding No 1 Central Hospital, No. 320 Changcheng Street, Baoding, 071000, Hebei, People's Republic of China
| | - Qian Wang
- The First Department of Operating Room, Baoding No 1 Central Hospital, No. 320 Changcheng Street, Baoding, 071000, Hebei, People's Republic of China
| | - Haiying Wang
- Department of Orthopaedic Surgery, Baoding No 1 Central Hospital, No. 320 Changcheng Street, Baoding, 071000, Hebei, People's Republic of China
| | - Zipeng Zhang
- Department of Orthopaedic Surgery, Baoding No 1 Central Hospital, No. 320 Changcheng Street, Baoding, 071000, Hebei, People's Republic of China
| | - Shunyi Wang
- Department of Orthopaedic Surgery, Baoding No 1 Central Hospital, No. 320 Changcheng Street, Baoding, 071000, Hebei, People's Republic of China.
| |
Collapse
|
11
|
Sharma R, Vaibhav V, Meshram R, Singh B, Khorwal G. A Systematic Review on Quadriceps Angle in Relation to Knee Abnormalities. Cureus 2023; 15:e34355. [PMID: 36874732 PMCID: PMC9974941 DOI: 10.7759/cureus.34355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2023] [Indexed: 01/31/2023] Open
Abstract
Previous studies on the quadriceps (Q) angle and its relation to knee problems have led to conflicting conclusions. In this comprehensive review, we evaluate recent studies on the Q angle and analyze the changes in Q angles. Specifically, we investigate the variation in Q angles when measured under the following conditions: 1) under various measurement techniques; 2) between symptomatic and non-symptomatic groups; 3) between samples of men and women; 4) unilateral versus bilateral Q angles; 5) Q angle in adolescent boys and girls. It is widely believed that Q angles are more significant in symptomatic patients than in asymptomatic individuals or that the right lower leg and left lower limb are equivalent, which is supported by little scientific data. However, research states that young adult females have higher mean Q angles than males.
Collapse
Affiliation(s)
- Rahul Sharma
- Anatomy, All India Institute of Medical Sciences, Rishikesh, IND
| | - Vikas Vaibhav
- Forensic Medicine and Toxicology, All India Institute of Medical Sciences, Rishikesh, IND
| | | | - Brijendra Singh
- Anatomy, All India Institute of Medical Sciences, Rishikesh, IND
| | | |
Collapse
|
12
|
Kolb A, Willegger M, Chiari C, Windhager R. Behandlung der Patellainstabilität. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2022; 160:463-475. [PMID: 33851401 DOI: 10.1055/a-1295-0533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
13
|
Two-type classification system for femoral trochlear dysplasia in recurrent patellar instability based on three-dimensional morphology. Knee Surg Sports Traumatol Arthrosc 2022; 31:1790-1797. [PMID: 35906412 DOI: 10.1007/s00167-022-07077-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 07/18/2022] [Indexed: 10/16/2022]
Abstract
PURPOSE Radiographic and two-dimensional (2D) CT/MRI analysis of femoral trochlear dysplasia play a significant role in surgical decision-making for recurrent patellar instability. However, the three-dimensional morphology of dysplastic trochlea is rarely studied due to the limitations of conventional imaging modalities. This study aimed to (1) develop a 3D morphological classification for trochlear dysplasia based on the concavity of the trochlear groove and (2) analyze the interrater reliability of the classification system. METHODS The 3D trochleae of 132 knees with trochlear dysplasia and recurrent patellar instability were reconstructed using CT scan data and classified using the innovative classification criteria between January 2016 and June 2020. A concave trochlear sulcus with sloped medial and lateral trochlear facets was classified as Type I trochlea. The trochlear groove with no concavity is classified as Type II. Furthermore, in Type II, the trochlea with the elevated trochlear floor at the proximal part was identified as IIa and the trochlea with the hypoplastic trochlear facets as IIb. The intra- and inter-rater reliability was examined using kappa (κ) statistics. RESULTS The 3D classification system showed substantial intra-rater agreement and moderate interrater agreement (0.581 ~ 0.772). The intra- and interrater agreement of Dejour's four-grade classification was fair-to-moderate (0.332 ~ 0.633). Eighty-one trochleae with concave trochlear sulcus were classified as Type I, and fifty-one without concavity as Type II. Twenty-five non-concave trochleae were classified as type IIa due to the elevated trochlear floor and 26 trochleae into IIb with the hypoplasia of trochlear facets. CONCLUSION This study developed a 3D classification system to classify trochlear dysplasia according to trochlear concavity and morphology of the trochlear facets. On CT/MRI scans or 3D reconstructions, the interpretation of features of dysplastic trochleae may vary, especially for the flat and convex trochleae. The novel system provides morphological evidence for when to consider trochleoplasty according to the different types of trochlear sulcus.
Collapse
|
14
|
Sasaki A, Hidaka Y, Mochizuki M, Honnami M. Computed Tomographic Measurements of the Sulcus Angle of the Femoral Trochlea in Small-Breed Dogs with and without Medial Patellar Luxation. Vet Comp Orthop Traumatol 2022; 35:314-320. [PMID: 35760367 DOI: 10.1055/s-0042-1749151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Trochleoplasty is often performed in dogs with medial patellar luxation (MPL); however, the current guidelines on when to perform a trochleoplasty in dogs are vague. The sulcus angle (SA) is used to assess the femoral trochlear morphology in humans. The aim of this study is to describe a method to measure the SA and other parameters of trochlea morphology in dogs using computed tomography. First, we searched for a suitable measuring location for the SA. Transverse images of the femurs were obtained as perpendicular planes to the tangent of the femoral trochlea which was 0 to 60 degrees (every 5 degrees) to the anatomical axis of the femur. The deepest point of the femoral trochlea was found in the transverse images perpendicular to the tangent of the femoral trochlea which was at 15 degrees to the anatomical axis of the femur. The SA and the other parameters of femoral trochlea morphology were measured at the deepest point of the femoral trochlea. The SA of the stifle joints with grade 3 and 4 MPL was significantly higher than the SA of stifle joints not affected by MPL. There was no significant difference in the SA between dogs affected by grade 1 and 2 MPL and dogs not affected by MPL. Further studies are needed to establish whether the SA can be used as selection criteria for trochleoplasty.
Collapse
Affiliation(s)
- Akari Sasaki
- Laboratory of Veterinary Emergency Medicine, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan
| | - Yuki Hidaka
- Veterinary Medical Center, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan
| | - Manabu Mochizuki
- Laboratory of Veterinary Emergency Medicine, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan.,Veterinary Medical Center, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan
| | - Muneki Honnami
- Veterinary Medical Center, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan
| |
Collapse
|
15
|
Chitosan based scaffold applied in patellar cartilage lesions showed positive clinical and MRI results at minimum 2 years of follow up. Knee Surg Sports Traumatol Arthrosc 2022; 31:1714-1722. [PMID: 35678852 DOI: 10.1007/s00167-022-07023-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 05/17/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE New scaffold-based cartilage regeneration techniques have been developed to improve the results of microfractures also in complex locations like the patello-femoral joint. The aim of this study was to analyse the results obtained in patellar lesions treated with a bioscaffold, a mixture composed by a chitosan solution, a buffer, and the patient's whole blood which forms a stable clot into the lesion. METHODS Fifteen patients with ICRS grade 3-4 cartilage lesions of the patellar surface were treated with a chitosan bioscaffold. Fourteen patients were clinically and radiologically evaluated prospectively for a minimum follow-up of 2 years with IKDC, KOOS, Tegner score, and MRI. The mean age of patients at the time of surgery was 31.8 ± 11.9 and nine patients presented degenerative aetiology, four patients with previous trauma, and 1 patient with osteochondritis dissecans. RESULTS: The IKDC subjective score improved from 46.2 ± 19.3 preoperatively to 69.5 ± 20.3 (p < 0.05) and 74.1 ± 23.2 (p < 0.05) at 12 and 24 months, respectively. Also KOOS Pain, KOOS Sport/Rec and KOOS QOL showed a significant improvement from baseline to 12 months and to the final follow-up. MRI evaluation showed a complete filling of the cartilage defect at the final follow-up in 70% of the lesions, obtaining a total MOCART 2.0 score of 71.5 ± 13.6 at 24 months after surgery. CONCLUSION Chondral patellar lesions represent a complex pathology, with lower results compared to other sites. This bioscaffold represents a safe surgical treatment providing a significant clinical improvement at 24 months in the treatment of patellar cartilage lesions. LEVEL OF EVIDENCE IV.
Collapse
|
16
|
Inoue H, Arai Y, Nakagawa S, Fujii Y, Kaihara K, Takahashi K. Analysis of hemodynamic changes after medial patellofemoral ligament reconstruction. Sports Med Int Open 2022; 6:E25-E31. [PMID: 35502361 PMCID: PMC9054922 DOI: 10.1055/a-1807-8549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 03/14/2022] [Indexed: 11/17/2022] Open
Abstract
The resumption of blood flow is an important factor in the remodeling process of
the graft. The purpose of this study is to evaluate hemodynamic changes after
medial patellofemoral ligament (MPFL) reconstruction using magnetic resonance
angiography (MRA) as the evaluation of graft remodeling. Eleven knees that
underwent anatomical MPFL reconstruction with the semitendinosus tendon were
studied. We evaluated the blood flow around the bone tunnel wall in the arterial
phase using MRA approximate 3 months and 1 year after surgery. Clinical and
radiological evaluations were also analyzed. MRA showed an inflow vessel into
the bone tunnel wall from the medial superior genicular artery on the femoral
side, and from the articular branch of the descending genicular artery and the
medial superior genicular artery on the patellar side. This contrast effect was
decreased at 12 months after surgery in all cases. The clinical scores improved
from baseline one year postoperatively. We revealed the blood flow to the bone
tunnel wall after anatomical MPFL reconstruction is detected by MRA. The blood
flow started within 2 or 3 months postoperatively and was sustained for 12
months. This study supported remodeling of the graft continues 3 months after
surgery when the conformity of the patellofemoral joint stabilizes.
Collapse
Affiliation(s)
- Hiroaki Inoue
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yuji Arai
- Department of Sports and Para-Sport Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shuji Nakagawa
- Department of Sports and Para-Sport Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yuta Fujii
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kenta Kaihara
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kenji Takahashi
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| |
Collapse
|
17
|
Ormeci T, Turkten I, Sakul BU. Radiological evaluation of patellofemoral instability and possible causes of assessment errors. World J Methodol 2022; 12:64-82. [PMID: 35433342 PMCID: PMC8984217 DOI: 10.5662/wjm.v12.i2.64] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 10/27/2021] [Accepted: 02/10/2022] [Indexed: 02/06/2023] Open
Abstract
Patellofemoral instability (PI) is the disruption of the patella’s relationship with the trochlear groove as a result of abnormal movement of the patella. To identify the presence of PI, conventional radiographs (anteroposterior, lateral, and axial or skyline views), magnetic resonance imaging, and computed tomography are used. In this study, we examined four main instability factors: Trochlear dysplasia, patella alta, tibial tuberosity–trochlear groove distance, and patellar tilt. We also briefly review some of the other assessment methods used in the quantitative and qualitative assessment of the patellofemoral joint, such as patellar size and shape, lateral trochlear inclination, trochlear depth, trochlear angle, and sulcus angle, in cases of PI. In addition, we reviewed the evaluation of coronal alignment, femoral anteversion, and tibial torsion. Possible causes of error that can be made when evaluating these factors are examined. PI is a multi-factorial problem. Many problems affecting bone structure and muscles morphologically and functionally can cause this condition. It is necessary to understand normal anatomy and biomechanics to make more accurate radiological measurements and to identify causes. Knowing the possible causes of measurement errors that may occur during radiological measurements and avoiding these pitfalls can provide a more reliable road map for treatment. This determines whether the disease will be treated medically and with rehabilitation or surgery without causing further complications.
Collapse
Affiliation(s)
- Tugrul Ormeci
- Department of Radiology, School of Medicine, İstanbul Medipol University, Istanbul 34200, Turkey
| | - Ismail Turkten
- Department of Anatomy, School of Medicine, İstanbul Medipol University, Istanbul 34820, Beykoz, Turkey
| | - Bayram Ufuk Sakul
- Department of Anatomy, School of Medicine, İstanbul Medipol University, Istanbul 34820, Beykoz, Turkey
| |
Collapse
|
18
|
Chen J, Wu C, Ye Z, Zhao J, Xie G. Tibial Tuberosity-Trochlear Groove Distance and Its Components in Patients with and without Episodic Patellar Dislocation: A Study of 781 Knees. J Bone Joint Surg Am 2022; 104:504-511. [PMID: 34851325 DOI: 10.2106/jbjs.21.00656] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purposes of the present study were (1) to measure the tibial tuberosity-trochlear groove distance and its components with the knee in extension, (2) to determine their diagnostic performance in distinguishing between patients with and without episodic patellar dislocation, and (3) to investigate the relationship of each component to the total tibial tuberosity-trochlear groove distance. METHODS We retrospectively reviewed computed tomography (CT) images of the knee joint in a group of patients with episodic patellar dislocation and a group of control subjects who were treated for another type of knee disorder in our institution between 2015 and 2021. Tibial tuberosity-trochlear groove distance, tibial tubercle lateralization, trochlear groove medialization, and knee rotation were measured on axial images. Partial correlation analysis of the measured parameters was performed after adjusting for remaining variables. Receiver operating characteristic (ROC) curves and the areas under the ROC curves (AUCs) were assessed to assess the diagnostic accuracy. A subgroup analysis based on femoral trochlear dysplasia classification was also performed. RESULTS After screening of 653 patients (947 knees) in our hospital's patient registry, a total of 521 patients (781 knees) were analyzed, including 541 knees (69.3%) with episodic patellar dislocation and 240 knees (30.7%) without episodic patellar dislocation (control group). The tibial tuberosity-trochlear groove distance demonstrated the best diagnostic performance, with the AUC being significantly better than that for other parameters (p < 0.001). The tibial tuberosity-trochlear groove distance was moderately to strongly correlated with knee rotation and trochlear groove medialization in the control and episodic patellar dislocation groups (p < 0.001). However, tibial tubercle lateralization showed a weak correlation with the tibial tuberosity-trochlear groove distance in the control group and moderate correlation in the episodic patellar dislocation group (p < 0.001). Knees with a type-D femoral trochlea had a significantly greater tibial tuberosity-trochlear groove distance than those with a type-A, B, or C femoral trochlea (p ≤ 0.011). CONCLUSIONS Tibial tuberosity-trochlear groove distance, a reliable predictor of episodic patellar dislocation, was affected more by knee rotation and trochlear groove medialization and was less affected by tibial tubercle lateralization, and it increased with an increasing grade of femoral trochlear dysplasia. The correlation of the tibial tuberosity-trochlear groove distance and its components as noted in the current study will help to achieve a better understanding of the tibial tuberosity-trochlear groove distance. LEVEL OF EVIDENCE Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Jiebo Chen
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | | | | | | | | |
Collapse
|
19
|
Chen J, Xiong Y, Han K, Xu C, Cai J, Wu C, Ye Z, Zhao J, Xie G. Computed Tomography Imaging Analysis of the MPFL Femoral Footprint Morphology and the Saddle Sulcus: Evaluation of 1094 Knees. Orthop J Sports Med 2022; 10:23259671211073608. [PMID: 35155709 PMCID: PMC8829748 DOI: 10.1177/23259671211073608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 11/08/2021] [Indexed: 11/17/2022] Open
Abstract
Background: The medial patellofemoral ligament (MPFL) has been reported to be anatomically attached from an osseous saddle region (saddle sulcus) between neighboring landmarks on the femur, including the adductor tubercle (AT), medial epicondyle (ME), and medial gastrocnemius tubercle (MGT). However, the position and prevalence of the saddle sulcus remain unknown. Purpose: To study the femoral footprint of MPFL and the prevalence of the saddle sulcus with computed tomography (CT) imaging; quantify the position of the saddle sulcus; and determine the relevant factors of the identified position and measuring distances. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 1094 knees in 753 patients were studied. Knees were organized into an anterior cruciate ligament reconstruction (ACLR) group (controls) and a recurrent patellar dislocation (RPD) group. Using 3-dimensionally reconstructed CT images, the authors determined the prevalence of the saddle sulcus and its position relative to the AT, the ME, the Schöttle point (1.3 mm anterior to the distal posterior cortex and 2.5 mm distal to the posterior origin of the medial femoral condyle), and the Fujino point (approximately 10 mm distal to the AT). Analysis of covariance was used to adjust for age, sex, side, and body mass index on the measurements. Results: There were 555 knees in the control group and 539 knees in the RPD group. The MPFL femoral footprint presented as an oblique, oblong, osseous region (saddle sulcus) in 75.7% of knees (75.0%, ACLR group vs 76.4%, RPD group; P < .001). The saddle sulcus was located a mean of 12.2 mm (95% CI, 12.0-12.4 mm) from a line connecting the apex of the AT to the ME (AT-ME) and a mean of 7.6 mm (95% CI, 7.5-7.8 mm) posteriorly perpendicular to that line. The location as a proportion of the AT-ME distance was 63.1% (95% CI, 62.6%-63.7%) in the X direction and 39.8% (95% CI, 39.1%-40.5%) in the Y direction. The Schöttle and Fujino points lay anterior and proximal to the saddle sulcus more than 5 mm away from the center of the saddle sulcus. Women had a higher prevalence of saddle sulcus (odds ratio [OR], 1.33 [95% CI, 1.00-1.75]; P = .046) compared with men. Conclusion: The saddle sulcus was identified in 75.7% of knees from the medial femoral aspect, with its center located consistently between the AT and ME.
Collapse
Affiliation(s)
- Jiebo Chen
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Yijia Xiong
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Kang Han
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Caiqi Xu
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Jiangyu Cai
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Chenliang Wu
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Zipeng Ye
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Jinzhong Zhao
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Guoming Xie
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| |
Collapse
|
20
|
Dejour DH, Deroche É. Trochleoplasty: Indications in patellar dislocation with high-grade dysplasia. Surgical technique. Orthop Traumatol Surg Res 2022; 108:103160. [PMID: 34863959 DOI: 10.1016/j.otsr.2021.103160] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 05/21/2021] [Indexed: 02/03/2023]
Abstract
Trochlear dysplasia consists in deficient trochlear concavity, giving rise to a flat or convex trochlea, and is the main risk factor for patellar dislocation. Surgical indications depend on familiarity with trochlear dysplasias, and especially those of high grade, identified on clinical examination and standard and cross-sectional imaging, and on quantification of associated instability factors. Treatment strategy is accordingly determined "à la carte" to correct these factors one by one. Sulcus deepening trochleoplasty corrects the morphology and is the appropriate etiological treatment. It gives good results in terms of recurrence of dislocation, but tends to cause knee stiffness and patellofemoral osteoarthritis. Indications are based on objective patellar instability associated to high-grade B or D dysplasia. Medial patellofemoral ligament reconstruction should be systematically associated. The lateral retinaculum is systematically sectioned, as patellar tilt is never reducible in such high-grade dysplasia. Trochleoplasty corrects the sulcus defect, resolves protrusion and enables proximal realignment. The main complications are stiffness and pain due to persistence or onset of cartilage lesions. Trochleoplasty is indicated: 1) in first line for objective patellar instability associated with high-grade dysplasia; or 2) for recurrence in high-grade dysplasia previously managed by other surgery. The aim of the present study was to review the literature on trochleoplasty and address the following questions: how to define high-grade dysplasia? What are the key clinical and radiologic points? What are the risk factors for patellar dislocation? What trochleoplasty techniques are available? What results can be expected? Level of evidence: V; expert opinion.
Collapse
Affiliation(s)
- David H Dejour
- Lyon Ortho Clinic, Clinique Sauvegarde, Lyon cedex, France.
| | - Étienne Deroche
- Orthopaedic Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France
| |
Collapse
|
21
|
Sebastian P, Michael Z, Frederik G, Michael M, Marcus W, Moritz C, Peter B, Chlodwig K. Influence of patella height after patella fracture on clinical outcome: a 13-year period. Arch Orthop Trauma Surg 2022; 142:1557-1561. [PMID: 33825039 PMCID: PMC9217897 DOI: 10.1007/s00402-021-03871-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 03/23/2021] [Indexed: 12/03/2022]
Abstract
INTRODUCTION The incidence of patella fracture is statistically low (0.5-1.5%) compared to other fractures of the extremities [Patella fractures 76(10):987-997, 2005]. In the latter research, patella fractures if treated surgically present an overall inferior functional outcome. Little is known about the influence of the postoperative patella height on the clinical outcome. Therefore, the aim of our study was to analyse the influence of the patella height on the patients' functional outcome after surgery. METHODS In this retrospective study the in-house trauma register of our level I University trauma center was screened for patients suffering patella fractures treated surgically. Patella height of the same patients was evaluated on lateral X-rays using the Insall-Salvati Ratio (ISR). The patients' X-rays were analyzed at two time points for the ISR, whereas group A presents ISR data right after surgery and group B data at the latest follow up (minimum 6 weeks). The change of mean ISR at both time points was tested for significance. The functional outcome was measured by the "Munich Knee Questionaire" (MKQ). These MKQ results of different patella heights and fracture types were compared. RESULTS The screening of our in-house trauma register revealed 375 patients between the years 2003 and 2016. Out of these 54 patients (34f, 20 m) were enrolled. In detail the follow-up time for ISR between group A and B accounted for a mean of 503.8 ± 655.7 days. The MKQ was assessed at a mean of 1367.0 ± 1042.8 days after surgery. According to the AO-classification 10% AO.34 type B and 90% AO.34 type C fractures were found. Group A showed in 9.1% a patella baja and in 27.3% a patella alta compared to group B presenting 20.0% patella baja and 14.5% patella alta. There was no significant difference in functional outcome referring to the MKQ in patella alta (MKQ 69.0% ± 18.2) or baja (MKQ 67.1% ± 17.9) (p = 0.9). No significant functional difference between AO34.type B (MKQ 74.5% ± 11.0) and AO34.type C fractures (MKQ 64.0% ± 15.0) resulted (p = 0.1). CONCLUSION Our results demonstrate that different postoperative patella heights apparently do not influence the functional outcome in the short follow-up.
Collapse
Affiliation(s)
- Pesch Sebastian
- grid.6936.a0000000123222966Department of Trauma Surgery, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Zyskowski Michael
- grid.6936.a0000000123222966Department of Trauma Surgery, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Greve Frederik
- grid.6936.a0000000123222966Department of Trauma Surgery, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Müller Michael
- grid.6936.a0000000123222966Department of Trauma Surgery, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Wurm Marcus
- grid.6936.a0000000123222966Department of Trauma Surgery, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Crönlein Moritz
- grid.6936.a0000000123222966Department of Trauma Surgery, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Biberthaler Peter
- grid.6936.a0000000123222966Department of Trauma Surgery, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Kirchhoff Chlodwig
- grid.6936.a0000000123222966Department of Trauma Surgery, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany
| |
Collapse
|
22
|
Lansdown DA, Christian D, Madden B, Redondo M, Farr J, Cole BJ, Yanke AB. The Sagittal Tibial Tubercle-Trochlear Groove Distance as a Measurement of Sagittal Imbalance in Patients with Symptomatic Patellofemoral Chondral Lesions. Cartilage 2021; 13:449S-455S. [PMID: 31965819 PMCID: PMC8808873 DOI: 10.1177/1947603519900802] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective. To measure the sagittal alignment of the tibial tubercle through the sagittal tibial tubercle-trochlear groove (sTTTG) distance in patients with and without patellar chondral lesions. Design. Patients treated with patellofemoral cartilage restoration or repair procedures were retrospectively reviewed (group 1; N = 17). A control group of patients (group 2; N = 20) undergoing partial meniscectomy with normal patellar cartilage was included. An asymptomatic patellar chondrosis group (group 3; N = 15) was identified as patients undergoing partial meniscectomy with patellar cartilage wear. The sTTTG was measured on the preoperative axial T2 magnetic resonance imaging (MRI) sequence. The first point was the nadir of the anterior trochlear cartilage, and the second point was the anterior tibial tubercle. A line was drawn between these points, perpendicular to the posterior condylar axis. Comparisons were made between the 3 groups using analysis of variance testing with Bonferroni corrections. Significance was defined as P < 0.05. Results. The mean sTTTG was significantly more posterior in group 1 (5.9 ± 5.5 mm posterior to the trochlear groove) relative to group 2 (0.8 ± 5.3 mm posterior; P = 0.018). The mean value for group 3 (2.7 ± 5.3 mm posterior) fell between group 1 and 3 but was not significantly different from group 1 (P = 0.31) or group 2 (P = 0.89). There were no significant differences with regards to sulcus angle, Caton-Deschamps Index, TTTG, or knee flexion angle on the MRI scan. Conclusions. A more posteriorly positioned tibial tubercle was observed in patients with patellar cartilage lesions relative to those with intact patellar cartilage. Intermediate positioning was observed in patients with asymptomatic patellar chondral wear. Level of Evidence. Level 3 diagnostic study.
Collapse
Affiliation(s)
- Drew A. Lansdown
- Department of Orthopedic Surgery,
University of California, San Francisco, San Francisco, CA, USA,Drew A. Lansdown, Department of Orthopedic
Surgery, University of California, San Francisco, 1500 Owens Street, Suite 170,
San Francisco, CA 94158, USA.
| | - David Christian
- Department of Orthopedic Surgery, Rush
University Medical Center, Chicago, IL, USA
| | - Brett Madden
- Department of Orthopedic Surgery, Rush
University Medical Center, Chicago, IL, USA
| | - Michael Redondo
- Department of Orthopedic Surgery, Rush
University Medical Center, Chicago, IL, USA
| | | | - Brian J. Cole
- Department of Orthopedic Surgery, Rush
University Medical Center, Chicago, IL, USA
| | - Adam B. Yanke
- Department of Orthopedic Surgery, Rush
University Medical Center, Chicago, IL, USA
| |
Collapse
|
23
|
Fones L, Jimenez AE, Cheng C, Chevalier N, Brimacombe MB, Cohen A, Pace JL. Trochlear Dysplasia as Shown by Increased Sulcus Angle Is Associated With Osteochondral Damage in Patients With Patellar Instability. Arthroscopy 2021; 37:3469-3476. [PMID: 33964393 DOI: 10.1016/j.arthro.2021.04.054] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 04/14/2021] [Accepted: 04/23/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The primary study objective was to describe the incidence of osteochondral damage (OD) in our cohort of patients with patellar instability (PI). The secondary objective was to assess for associations between patient demographic characteristics, duration of PI, and quantitative radiographic measurements of anatomic risk factors for PI and OD in this cohort. METHODS A retrospective chart review identified patients treated for PI at a tertiary referral center between 2013 and 2018. Patients were evaluated for osteochondral injury with either magnetic resonance imaging if treated nonoperatively or operative reports if treated surgically. The Caton-Deschamps ratio, proximal tibial tubercle-to-trochlear groove (pTT-TG) distance, distal tibial tubercle-to-trochlear groove (dTT-TG) distance, lateral trochlear inclination (LTI) angle, lateral patellar inclination (LPI) angle, and sulcus angle were calculated from magnetic resonance imaging scans. Trochlear dysplasia is an important risk factor for PI that can be reliability quantified by the pTT-TG distance, dTT-TG distance, LTI angle, sulcus angle, and LPI angle. Demographic data including age at first instability event, sex, body mass index, symptom duration, and number of dislocations were documented. RESULTS A total of 125 knees in 118 patients (average age, 13.9 ± 3.4 years; 48% female patients) with PI were identified. Within this cohort, 67% were treated surgically and 53% had OD. No association was identified between osteochondral injury and age, sex, body mass index, symptom duration, LTI angle, LPI angle, dTT-TG distance, pTT-TG distance, or number of dislocations. An increased sulcus angle (more dysplasia) showed a statistically significant association with osteochondral pathology (P = .021), and higher sulcus angles were statistically significantly associated with acute osteochondral fracture compared with chondral injury (P = .001). CONCLUSIONS Using quantitative analysis of trochlear dysplasia, this study identified a significant association between trochlear dysplasia (sulcus angle) and the incidence of OD in our cohort of patients with PI. The frequency of dislocation or subluxation and patient demographic characteristics were not significantly associated with OD. LEVEL OF EVIDENCE Level III, retrospective prognostic study.
Collapse
Affiliation(s)
- Lilah Fones
- University of Connecticut School of Medicine, Farmington, Connecticut, U.S.A
| | - Andrew E Jimenez
- Department of Orthopedic Surgery, University of Connecticut School of Medicine, Farmington, Connecticut, U.S.A..
| | - Chris Cheng
- University of Connecticut School of Medicine, Farmington, Connecticut, U.S.A
| | - Nicole Chevalier
- Elite Sports Medicine, Connecticut Children's Medical Center, Farmington, Connecticut, U.S.A
| | - Michael B Brimacombe
- Department of Research, Connecticut Children's Medical Center, Hartford, Connecticut, U.S.A
| | - Andrew Cohen
- Elite Sports Medicine, Connecticut Children's Medical Center, Farmington, Connecticut, U.S.A
| | - J Lee Pace
- Department of Orthopedic Surgery, University of Connecticut School of Medicine, Farmington, Connecticut, U.S.A.; Elite Sports Medicine, Connecticut Children's Medical Center, Farmington, Connecticut, U.S.A
| |
Collapse
|
24
|
Mantebea H, Batool S, Hammami M, Xia Y. Structural Morphology of Rabbit Patella and Suprapatella Cartilage by Microscopic MRI and Polarized Light Microscopy. Cartilage 2021; 13:356S-366S. [PMID: 33550833 PMCID: PMC8804843 DOI: 10.1177/1947603521990882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE In order to appreciate the roles articular cartilage of sesamoid bones and sesamoid fibrocartilage play in anatomy and pathology, the articular cartilage of the patella (n = 4) and suprapatella (n = 4) (a sesamoid fibrocartilage) of 12 to 14 weeks old New Zealand rabbits were studied qualitatively and quantitatively. DESIGN/METHOD The intact knee joints and block specimens from the joints were imaged using microscopic magnetic resonance imaging (µMRI) at a 97.6-µm pixel resolution for the former and 19.5-µm resolution for the latter. Histological sections were made out of the µMRI-imaged specimens, which were imaged using polarized light microscopy (PLM) at 0.25-, 1-, and 4-µm pixel resolutions. RESULTS The patella cartilage varied in thickness across the medial to lateral ends of the sesamoid bone with the central medial aspect slightly thicker than the lateral aspect. The suprapatella fibrocartilage decreased proximally away from the knee joint. Quantitative results of patellar cartilage showed strong dependence of fiber orientation with the tissue depth. Three histological zones can be clearly observed, which are similar to articular cartilage from other large animals. The sesamoid fibrocartilage has one thin surface layer (10 µm thick) of parallel-arranged structured fibers followed immediately by the majority of random fibers in bulk tissue. T2 relaxation time anisotropy was observed in the patellar cartilage but not in the bulk fibrocartilage. CONCLUSION Given the different functions of these 2 different types of cartilages in joint motion, these quantitative results will be beneficial to future studies of joint diseases using rabbits as the animal model.
Collapse
Affiliation(s)
| | | | | | - Yang Xia
- Oakland University, Rochester, MI,
USA
| |
Collapse
|
25
|
Ishikawa M, Hoo C, Ishifuro M, Kamei G, Omoto T, Kano T, Nakata K, Nekomoto A, Nakamae A, Adachi N. Application of a true lateral virtual radiograph from 3D-CT to identify the femoral reference point of the medial patellofemoral ligament. Knee Surg Sports Traumatol Arthrosc 2021; 29:3809-3817. [PMID: 33459830 DOI: 10.1007/s00167-020-06403-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 12/07/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE The purpose of this study is two-fold: (1) to describe the femoral reference point of the medial patellofemoral ligament (MPFL) on a virtual true lateral radiograph reconstructed from a three-dimensional computed tomography (3D-CT) image and (2) to compare this point with that of patients without patellofemoral instability and with Schöttle's point. METHODS A total of 26 consecutive patients (29 affected knees) with recurrent patellar dislocation (RPD), who underwent MPFL reconstruction were included in this study (4 males; 22 females; mean age, 24.0 years old). Using a true lateral 3DCT image, the MPFL femoral insertion was identified and marked with a 2-mm circle, and this image was reconstructed as a virtual true lateral radiograph. Following Schöttle's method, the point of intersection was described by their anterior-posterior and proximal-distal positions. As a control population, 29 age- and gender-matched patients with anterior cruciate ligament (ACL) injuries were also analysed. RESULTS The points in RPD patients were located significantly posterior (-2.5 ± 2.3 mm, p < 0.01) to the line representing an extension of the posterior cortex of the femur and distal (- 6.9 ± 2.4 mm, p < 0.01) to the posterior origin of the medial femoral condyle compared with those in the control population. The mean reference point of RPD patients was located in a 3.8-mm posterior and 4.4-mm distal position compared with Schöttle's point. CONCLUSIONS An anatomical and radiographic femoral reference point of the MPFL on a true lateral virtual radiograph was described with our method. In patients with RPD, this reference point was identified to be more posterior and distal to Schöttle's point. More anatomical and individualized MPFL reconstruction will be secured using our method. LEVEL OF EVIDENCE Level IV.
Collapse
Affiliation(s)
- Masakazu Ishikawa
- Department of Artificial Joints and Biomaterials, Graduate School of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
| | - Charles Hoo
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Minoru Ishifuro
- Department of Medical Imaging, Hiroshima University Hospital Clinical Support, Hiroshima, Japan
| | - Goki Kamei
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Takenori Omoto
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Toshiya Kano
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kyohei Nakata
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Akinori Nekomoto
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Atsuo Nakamae
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| |
Collapse
|
26
|
Mei X, Ding H, Meng J, Zhao J. Anthropometric measurements of patellar ridge using computed tomography-based three-dimensional computer models. J Orthop Surg Res 2021; 16:436. [PMID: 34229682 PMCID: PMC8259142 DOI: 10.1186/s13018-021-02587-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 06/27/2021] [Indexed: 11/10/2022] Open
Abstract
Background The objectives of this study were to investigate the anatomic morphology of patellar ridge using computed tomography-based three-dimensional (3D) computer models and to assess the center of the patellar ridge after virtual resections. Methods We selected 80 patients, 40 males (age, 33.2±6.8 years) and 40 females (age, 30.6±7.2 years), who were slightly symptomatic with soft tissue injury of the knee joint. The right or left knees were scanned by computed tomography (CT). The CT data of 160 knees was used to construct 3D computer models by image analysis software (Mimics). Variables such as the angle between the patellar ridge and patellar long axis, the distance between the center of the patellar ridge and the center of patellar cut after virtual resections were measured. We detect differences between the sides and genders with the 3D computer models by Student’s t test. Simple linear regression and correlation test was used to correlate the patellar ridge center to the center of the patellar cut. Results According to the available data, there were significant gender differences in the length and width of patellar cut after virtual resections even with strict control for the height and weight of the patients. The angle between the patellar ridge and the patellar long axis was 11.24° ± 3.62°. The angle in male patients was 10.17° ± 4.82°, and it was 12.28°± 3.78° in female patients. The morphological difference was statistically significant (P < 0.05). After using the subchondral method to virtually resect the patellae, with reference to the center of the patellar cut, the center of the patellar ridge lies superiorly and medially in 88.75%, inferiorly and medially in 8.75%, laterally and superiorly in 2.5%, and in no case laterally and inferiorly. The intra-observer reliability regarding the dimensional measurements was excellent in this study. Conclusions Advances in 3D computer models had resulted in the availability of preoperative measurement and virtual planning. The anthropometric dimensions of this study could provide general information for guiding surgical management of the patella in total knee arthroplasty (TKA) and were useful in designing patellar implants. Clinical relevance The placement of the patellar component during TKA differs from one patella to another. The anatomic morphology information of the patellar ridge is helpful for surgeons to perform patellar resurfacing in TKA.
Collapse
Affiliation(s)
- Xiaoliang Mei
- Department of Orthopedics, Jinling Hospital, Jinling Clinical Medical College of Nanjing Medical University, Nanjing, 210002, Jiangsu, People's Republic of China.,Department of Orthopedics, Taizhou Clinical Medical School of Nanjing Medical University, Taizhou, 225300, Jiangsu, People's Republic of China
| | - Hao Ding
- Department of Orthopedics, Jinling Hospital, Jinling Clinical Medical College of Nanjing Medical University, Nanjing, 210002, Jiangsu, People's Republic of China
| | - Jia Meng
- Department of Orthopedics, Jinling Hospital, Jinling Clinical Medical College of Nanjing Medical University, Nanjing, 210002, Jiangsu, People's Republic of China
| | - Jianning Zhao
- Department of Orthopedics, Jinling Hospital, Jinling Clinical Medical College of Nanjing Medical University, Nanjing, 210002, Jiangsu, People's Republic of China.
| |
Collapse
|
27
|
Paiva M, Blønd L, Hölmich P, Barfod KW. Effect of Medialization of the Trochlear Groove and Lateralization of the Tibial Tubercle on TT-TG Distance: A Cross-sectional Study of Dysplastic and Nondysplastic Knees. Am J Sports Med 2021; 49:970-974. [PMID: 33595335 DOI: 10.1177/0363546520987819] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Tibial tubercle-trochlear groove (TT-TG) distance is often used as a measure of lateralization of the TT and is important for surgical planning. PURPOSE To investigate if increased TT-TG distance measured on axial magnetic resonance images is due to lateralization of the TT or medialization of the TG. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS A total of 84 knees (28 normal [NK], 28 with trochlear dysplasia [TD], and 28 with patellar dislocation without TD [PD]) were examined. The medial border of the posterior cruciate ligament (PCL) was chosen as the central anatomic landmark. The distance from the TT to PCL (TT-PCL) was measured to examine the lateralization of the TT. The distance from the TG to the PCL (TG-PCL) was measured to examine the medialization of the TG. Between-group differences were investigated by use of 1-way analysis of variance. RESULTS The mean values for TT-TG distance were 8.7 ± 3.6 mm for NK, 12.1 ± 6.0 mm for PD, and 16.7 ± 4.3 mm in the TD group (P < .01). The mean values for TT-PCL distance were 18.5 ± 3.6 mm for NK, 18.5 ± 4.5 mm for PD, and 21.2 ± 4.2 mm in the TD group (P = .03). The mean values for TG-PCL distance were 9.6 ± 3.0 mm for NK, 7.1 ± 3.4 mm for PD, and 5.1 ± 3.3 mm in the dysplastic group (P < .01). CONCLUSION The present results indicate that increased TT-TG distance is due to medialization of the TG and not lateralization of the TT. Knees with TD had increased TT-TG distance compared with the knees of the control group and the knees with PD. The TT-PCL distance did not differ significantly between groups, whereas the TG-PCL distance declined with increased TT-TG.
Collapse
Affiliation(s)
- Mathias Paiva
- Sports Orthopedic Research Center-Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
| | - Lars Blønd
- Zealand University Hospital, Køge and Aleris-Hamlet Parken, Koge, Denmark
| | - Per Hölmich
- Sports Orthopedic Research Center-Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
| | - Kristoffer Weisskirchner Barfod
- Sports Orthopedic Research Center-Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
| |
Collapse
|
28
|
Niu J, Qi Q, Hao K, Lin W, Piao K, Wang F. The morphology of patella changed significantly after soft tissue correction for children with recurrent patella dislocation. BMC Musculoskelet Disord 2020; 21:833. [PMID: 33302928 PMCID: PMC7731741 DOI: 10.1186/s12891-020-03846-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 11/26/2020] [Indexed: 01/17/2023] Open
Abstract
Background Although morphological improvement of femoral trochlea has been investigated in children with patellar dislocation after surgery, whether the patellar shape changed under the same condition is still unknown. The purpose of the study was to investigate the changes of patellar morphology in transverse plane following surgical correction of recurrent patellar dislocation in children. Methods A total of 22 patients with a mean age of 9.9 years (7 to 12) were included. All had unilateral recurrent patellar dislocation. The knees with recurrent patellar dislocation were treated with medial patellar retinaculum plasty and defined as the affected side. The contralateral knees with no symptom of patellar instability were considered as the unaffected side. All patients were treated between October 2014 and August 2018. Axial CT (Computed Tomography) scans were undertaken in all patients to assess the patella morphological characteristics on a particular axial image preoperatively and at the final follow-up. Results There were not significant differences about patellar transverse diameter, thickness and Wiberg angle between affected side and unaffected side before surgery and at the last follow-up respectively (The mean follow-up period: 28.0 ± 3.3 months). However, before surgery, the Wiberg-index in the affected side (0.74 ± 0.06) was significantly different from that in the unaffected side (0.64 ± 0.04). At the last follow-up, the Wiberg-index in the affected side (0.67 ± 0.05) and the unaffected side (0.65 ± 0.04) were not significantly different. Also, in the affected side, the Wiberg-index at the last follow-up was significantly lower than that before surgery (P < 0.05). The Wiberg-index in the unaffected side was not significantly different before surgery and at the last follow-up. Conclusion The patellar morphology can change significantly after surgical procedures in children with patellar recurrent dislocation whose epiphysis is not closed.
Collapse
Affiliation(s)
- Jinghui Niu
- Department of joint surgery, The third hospital of Hebei Medical University, Shijiazhaung City, Hebei Province, China
| | - Qi Qi
- Department of Cardiology, The third hospital of Hebei Medical University, Shijiazhaung City, Hebei Province, China
| | - Kuo Hao
- Department of joint surgery, The third hospital of Hebei Medical University, Shijiazhaung City, Hebei Province, China
| | - Wei Lin
- Department of joint surgery, The third hospital of Hebei Medical University, Shijiazhaung City, Hebei Province, China
| | - Kang Piao
- Department of joint surgery, The third hospital of Hebei Medical University, Shijiazhaung City, Hebei Province, China
| | - Fei Wang
- Department of joint surgery, The third hospital of Hebei Medical University, Shijiazhaung City, Hebei Province, China.
| |
Collapse
|
29
|
Müller JH, Li K, Reina N, Telmon N, Saffarini M, Cavaignac E. Sexual and ethnic polymorphism result in considerable mismatch between native trochlear geometry and off-the-shelf TKA prostheses. Knee Surg Sports Traumatol Arthrosc 2020; 28:3871-3878. [PMID: 32020254 DOI: 10.1007/s00167-020-05871-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 01/20/2020] [Indexed: 12/26/2022]
Abstract
PURPOSE To determine if trochlear morphology in healthy knees depends on sex and ethnicity, and to compare it to off-the-shelf TKA prostheses. METHODS Three retrospective series of CT angiograms from France (female, 124; male, 135), China (female, 122; male, 137) and South Africa (female, 21; male, 62) were used to digitize osseous landmarks at the level of the femoral epicondyles. Sulcus angle, trochlear rotation, lateral trochlear inclination, trochlear asymmetry ratio, and trochlear depth index were quantified for each knee and for 10 total knee arthroplasty (TKA) models. Univariable regression analyses were performed to determine associations of the five trochlear parameters with sex and ethnicity. Interquartile ranges (IQR) of native trochlear parameters were compared to the trochlear parameters of 10 off-the-shelf TKA prostheses. RESULTS Compared to French knees, Chinese knees had greater sulcus angle (β = 6.3°, p < 0.001), trochlear rotation (β = 0.8°, p = 0.004) and trochlear depth index (β = 1.60, p < 0.001). Conversely, South African knees had greater trochlear rotation (β = 1.9°, p < 0.001) and lateral trochlear inclination (β = 3.7°, p < 0.001). Female knees had smaller trochlear asymmetry ratios (β = - 0.03, p = 0.05) but greater trochlear rotation angles (β = 0.7, p = 0.005). Considerable mismatches in trochlear morphology were revealed between native knees and off-the-shelf TKA prostheses. CONCLUSIONS The findings suggest that thresholds used in the diagnosis of patellofemoral instability should be adapted to patient sex and ethnicity, and that standard off-the-shelf TKA may not restore native trochlear parameters in all patients. LEVEL OF EVIDENCE III, retrospective comparative.
Collapse
Affiliation(s)
| | - Ke Li
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Nicolas Reina
- Laboratoire AMIS, UMR 5288 CNRS, Université Paul Sabatier, Toulouse, France.,Musculoskeletal Institute, Hôpital Pierre Paul Riquet, CHU Toulouse, Toulouse, France
| | - Norbert Telmon
- Laboratoire AMIS, UMR 5288 CNRS, Université Paul Sabatier, Toulouse, France
| | - Mo Saffarini
- ReSurg SA, Rue Saint Jean 22, 1260, Nyon, Switzerland.
| | - Etienne Cavaignac
- Laboratoire AMIS, UMR 5288 CNRS, Université Paul Sabatier, Toulouse, France.,Musculoskeletal Institute, Hôpital Pierre Paul Riquet, CHU Toulouse, Toulouse, France
| |
Collapse
|
30
|
Load Distribution at the Patellofemoral Joint During Walking. Ann Biomed Eng 2020; 48:2821-2835. [DOI: 10.1007/s10439-020-02672-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 10/21/2020] [Indexed: 12/24/2022]
|
31
|
Joseph SM, Cheng C, Solomito MJ, Pace JL. Lateral Trochlear Inclination Angle: Measurement via a 2-Image Technique to Reliably Characterize and Quantify Trochlear Dysplasia. Orthop J Sports Med 2020; 8:2325967120958415. [PMID: 33102608 PMCID: PMC7551490 DOI: 10.1177/2325967120958415] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 03/19/2020] [Indexed: 01/17/2023] Open
Abstract
Background: Trochlear dysplasia (TD) is a risk factor for patellar instability (PI). The
Dejour classification categorizes TD but has suboptimal reliability. Lateral
trochlear inclination (LTI) is a quantitative measurement of trochlear
dysplasia on a single axial magnetic resonance imaging (MRI) scan. Hypothesis: A modified LTI measurement technique using 2 different axial MRI scans that
reference the most proximal aspect of the trochlear cartilage on 1 image and
the fully formed posterior condyles on the second image would be as reliable
as and significantly different from the single-image measurement technique
for LTI. Further, the 2-image LTI would adequately represent overall
proximal trochlear morphologic characteristics. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Patients aged 9 to 18 years treated for PI between 2014 and 2017 were
identified. The Dejour classification was radiographically determined.
Single-image LTI was measured on a single axial MRI scan at the most
proximal aspect of visible trochlear cartilage. A 2-image LTI was measured
from 2 separate MRI scans: 1 at the most proximal aspect of trochlear
cartilage and the second at the fully formed posterior condyles. This
2-image LTI was repeated at 3 subsequent levels (the first measurement is
referred to as LTI-1; repeated measurements are LTI-2, LTI-3, and LTI-4,
moving distally). In total, 65 patients met the inclusion criteria, and 30
were randomly selected for reliability analysis. Results: Inter- and intrarater reliability trended toward more variability for
single-image LTI (intraclass correlation coefficient [ICC], 0.86 and 0.88,
respectively) than for 2-image LTI (ICC, 0.97 and 0.96, respectively). The
Dejour classification had lower intra- and interrater reliability (ICC, 0.31
and 0.73, respectively). Average single-image LTI (9.2° ± 12.6°) was greater
than average 2-image LTI-1 (4.2° SD ± 11.9°) (P = .0125).
Single-image LTI classified 60% of patients with PI as having TD, whereas
the 2-image LTI classified 71% as having TD. The 2-image LTI was able to
capture 91% of overall proximal trochlear morphologic characteristics. Conclusion: LTI has higher reliability when performed using a 2-image measurement
technique compared with single-image LTI and Dejour classification. The
strong correlation between 2-image LTI and average LTI shows that 91% of TD
is represented on the most proximal axial image. Because the single-image
measurement appears to underestimate dysplasia, previously described
thresholds should be reexamined using this 2-image technique to
appropriately characterize TD.
Collapse
Affiliation(s)
- Sheeba M Joseph
- Department of Orthopedic Surgery, Michigan State University, East Lansing, Michigan, USA
| | - Chris Cheng
- Case Western Reserve Hospitals, Cleveland, Ohio, USA
| | | | - J Lee Pace
- Elite Sports Medicine at Connecticut Children's Medical Center, Farmington, Connecticut, USA.,Department of Orthopedic Surgery, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| |
Collapse
|
32
|
Fujii Y, Nakagawa S, Arai Y, Inoue H, Kan H, Hino M, Kaihara K, Mikami Y. Clinical outcomes after medial patellofemoral ligament reconstruction: an analysis of changes in the patellofemoral joint alignment. INTERNATIONAL ORTHOPAEDICS 2020; 45:1215-1222. [PMID: 32770307 DOI: 10.1007/s00264-020-04765-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 07/28/2020] [Indexed: 01/15/2023]
Abstract
PURPOSE Medial patellofemoral ligament (MPFL) reconstruction using the hamstring tendon is widely performed to treat recurrent patellar dislocation. MPFL reconstruction includes a post-operative process of necrosis and reperfusion of the hamstring tendon graft. We hypothesise that the patella gradually shifts laterally because of this process, ultimately affecting the patellofemoral joint alignment. This study aimed to analyse the chronological changes in the patellofemoral joint alignment and the outcomes of MPFL reconstruction. METHODS In this retrospective case-series study, the Knee Society, Lysholm, and Kujala scores were evaluated in 24 consecutive patients (27 knees). To evaluate patellar tracking defects, radiographic indices including the tilting angle, the lateral shift ratio, and the congruence angle were measured before, immediately after, and three, 12, and 36 months after MPFL reconstruction. RESULTS Post-operative Kujala, Knee Society, and Lysholm scores for the study population significantly improved relative to the pre-operative scores. The tilting and congruence angles at three months after the operation significantly increased relative to those recorded immediately after the operation. The tilting and congruence angles were not significantly different at three, 12, and 36 months after the operation. CONCLUSIONS The post-operative outcomes of MPFL reconstruction for recurrent patellar dislocation were favourable. Insufficient union between the bone tunnel and tendon graft, along with an elongation of the necrotic tendon graft, may change the alignment of the patellofemoral joint within three months after the operation. Therefore, we believe it is necessary to refrain from knee rotation that places lateral stress on the patella until three months after the operation.
Collapse
Affiliation(s)
- Yuta Fujii
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shuji Nakagawa
- Department of Sports and Para-Sports Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajiicho 465, Kawaramachi-Hirokoji, Kamigyo-Ku, Kyoto, 602-8566, Japan
| | - Yuji Arai
- Department of Sports and Para-Sports Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajiicho 465, Kawaramachi-Hirokoji, Kamigyo-Ku, Kyoto, 602-8566, Japan.
| | - Hiroaki Inoue
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hiroyuki Kan
- Department of Orthopaedics, Kyoto Interdisciplinary Institute Hospital of Community Medicine, Kyoto, Japan
| | - Manabu Hino
- Department of Orthopaedics, Kyoto Interdisciplinary Institute Hospital of Community Medicine, Kyoto, Japan
| | - Kenta Kaihara
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yasuo Mikami
- Department of Rehabilitation Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| |
Collapse
|
33
|
Dejour DH. Editorial Commentary: Trochleoplasty: Is It Really That Fearsome and Dangerous a Technique? Arthroscopy 2020; 36:2246-2248. [PMID: 32747065 DOI: 10.1016/j.arthro.2020.05.050] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 05/28/2020] [Indexed: 02/02/2023]
Abstract
Trochleoplasty in patellofemoral instability has always been controversial. Most authors recognize the fundamental role of trochlear dysplasia in the genesis of patellar dislocation, and some strongly defend correcting the abnormality, yet others find it too dangerous or unnecessary. Misunderstanding or undervaluation of trochlear dysplasia leads to inappropriate or failed patellofemoral (PF) surgery, the iatrogenic complications of which are well known. Many surgeons miss a key aspect of trochlear dysplasia: the overhang or the prominence of the trochlea relative to the anterior femoral cortex, characterized by a supra-trochlear spur. Trochleoplasty should not be performed as a secondary or revision procedure, but as a primary procedure with clear indications, and the key to improved outcomes is to ensure the right indication for each patient, which can only be determined by understanding the extent of dysplasia in both the axial and sagittal planes.
Collapse
|
34
|
Pace JL, Cheng C, Joseph SM, Solomito MJ. Effect of Trochlear Dysplasia on Commonly Used Radiographic Parameters to Assess Patellar Instability. Orthop J Sports Med 2020; 8:2325967120938760. [PMID: 32782907 PMCID: PMC7385842 DOI: 10.1177/2325967120938760] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 02/19/2020] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Trochlear dysplasia (TD) is an important anatomic risk factor for patellar instability (PI). Several imaging-based risk factors for PI have been established, but it is unclear what effect TD has on these measurements, and the Dejour method of categorizing TD has been shown to be unreliable. The lateral trochlear inclination (LTI) is a quantifiable measurement of proximal trochlear morphology. Recently, a modified technique for measuring LTI referencing the posterior condylar angle has demonstrated near-perfect reliability and may serve as a new standard for quantifying TD. PURPOSE/HYPOTHESIS The purpose of this study was to evaluate how TD, expressed in terms of LTI, affects historically used measures of PI, including the sulcus angle (SA), tibial tuberosity to trochlear groove (TT-TG) distance, lateral patellar inclination (LPI), and Caton-Deschamps (CD) ratio. We hypothesized that lower LTI (ie, more dysplastic trochlea) will correlate with higher SA and TT-TG distances, increased patellar tilt, and more patella alta. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS Patients aged 9 to 18 years treated for PI between January 2014 and August 2017 were queried. On magnetic resonance imaging (MRI), LTI, SA, LPI, and the TT-TG measured at the most proximal (pTT-TG) and distal (dTT-TG) aspects of the fully formed trochlear groove were measured on axial images. CD ratio was measured using sagittal MRI as well as lateral radiographs. All measurements were performed by 2 independent observers. Patients were included if there was a diagnosis of PI that was confirmed with a chart review and if there were appropriate imaging studies to analyze. RESULTS A total of 65 patients met inclusion criteria for this study. Average pTT-TG distance (15.7 ± 4.5 mm) was not significantly different from dTT-TG distance (15.7 ± 4.2 mm) (P = .94). LTI had a weak but significant inverse correlation with pTT-TG (r = -0.40; β = -0.15 mm; P < .001) and SA (r = -0.43; β = -0.478°; P < .001). There was a moderate and significant inverse correlation of LTI with dTT-TG (r = -0.593; β = -0.21 mm; P < .001) and with LPI (r = -0.69; β = -0.54°; P < .001). There was a weak but significant correlation between LTI and the MRI-based CD ratio (r = 0.279; β = 0.149; P = .005). Radiograph-based CD ratio did not show a significant correlation with LTI (r = -0.189; P = .135). CONCLUSION Smaller (ie, more dysplastic) LTI values correlated significantly with larger TT-TG, SA, LPI, and MRI-based CD ratio measurements. The relationship between SA and LTI is intuitive, but the relationship between LTI and the other analyzed variables suggests that they are dependent variables to TD and may not be consistent independent risk factors for PI. Together, these suggest that TD alters the radiographic interpretation of TT-TG and patellar tilt. The correlation between TD and patellar height is unclear and warrants further investigation.
Collapse
Affiliation(s)
- J. Lee Pace
- Elite Sports Medicine, Connecticut Children’s Medical Center, Farmington, Connecticut, USA
- Department of Orthopedic Surgery, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Chris Cheng
- University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | - Sheeba M. Joseph
- Department of Orthopedic Surgery, Michigan State University, East Lansing, Michigan, USA
| | - Matthew J. Solomito
- Elite Sports Medicine, Connecticut Children’s Medical Center, Farmington, Connecticut, USA
| |
Collapse
|
35
|
Stephen J, Ephgrave C, Ball S, Church S. Current concepts in the management of patellofemoral pain - The role of alignment. Knee 2020; 27:280-286. [PMID: 32014409 DOI: 10.1016/j.knee.2019.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 12/11/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Patellofemoral pain is a prevalent and significant clinical problem that is often reported to persist even following evidence based intervention. It is clear therefore that there is much about this complex patient group that is not presently fully understood. This is particularly concerning given the reported links between patellofemoral pain in adolescence and the subsequent development of osteoarthritis and anxiety. ASSESSMENT Clinical assessment has historically focussed on biomechanical factors such as altered lower limb kinematics, muscle weakness and late muscle 'onset or activation' during activity. However when examined it is clear that study findings from patellofemoral populations are often inconsistent. Reasons for this are discussed and specifically the limitations around current 'gold standard' measurement methods, such as motion capture are outlined. A biomechanical approach is applied to demonstrate the importance of ensuring optimal patient alignment during rehabilitation, where optimal is defined as ensuring the most energy efficient muscle or muscles are used by the patient to perform a movement. This in turn ensures that the direction, magnitude and location of load applied to the skeleton during activity is optimal and therefore less likely to lead to injury. TREATMENT The role of alignment in patellofemoral pain and the importance of correcting this during rehabilitation is discussed, and examples provided. Validated, reliable, and reproducible methods of measuring skeletal geometry, muscle geometry, muscle force and direction, and kinematics of activity must be developed as a priority in order for us to further our understanding and improve outcomes in this complex clinical population.
Collapse
Affiliation(s)
- Joanna Stephen
- Fortius Clinic London, United Kingdom of Great Britain and Northern Ireland; Mechanical Engineering, Imperial College London, United Kingdom of Great Britain and Northern Ireland; Physiotherapist London, United Kingdom of Great Britain and Northern Ireland.
| | - Caroline Ephgrave
- Physiotherapist London, United Kingdom of Great Britain and Northern Ireland
| | - Simon Ball
- Fortius Clinic London, United Kingdom of Great Britain and Northern Ireland; Chelsea and Westminster Hospital, London, United Kingdom of Great Britain and Northern Ireland
| | - Sam Church
- Fortius Clinic London, United Kingdom of Great Britain and Northern Ireland
| |
Collapse
|
36
|
Lu J, Wang C, Li F, Ji G, Wang Y, Wang F. Changes in Cartilage and Subchondral Bone of Femoral Trochlear Groove After Patellectomy in Growing Rabbits. Orthop Surg 2020; 12:653-660. [PMID: 32077243 PMCID: PMC7189040 DOI: 10.1111/os.12631] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 01/20/2020] [Accepted: 01/20/2020] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE To explore the effects of patellectomy on the bony and cartilaginous morphology of the trochlear groove in growing rabbits. METHODS Forty-eight 4-week-old New Zealand white rabbits were randomly assigned to two groups. The control group underwent a sham surgical procedure, whereas the patellectomy group underwent patella excision surgery. Half of the rabbits in each group were sacrificed 3 months postoperatively; the rest were sacrificed 6 months postoperatively. Hematoxylin and eosin staining was performed on collected samples. Measurements included the bony and cartilaginous sulcus angles of the trochlear groove. In addition, the thickness of the articular cartilage at the deepest sulcus position (central thickness) and at the mid-position of the medial and lateral facets was measured and compared between groups. RESULTS Three months after surgery, histological images revealed significant differences between the control group and the patellectomy group in cartilaginous sulcus angle (144.2° ± 1.5° vs 151.9° ± 2.4°, respectively; P < 0.001). No obvious difference in bony sulcus angle was found between the groups. Six months after surgery, significant between-group differences were observed in cartilaginous sulcus angle (136.3° ± 2.5° in control group vs 160.7° ± 3.0° in patellectomy group, P < 0.001) and bony sulcus angle (136.2° ± 2.2° in control group vs 160.4° ± 2.6° in patellectomy group, P < 0.001). However, there were no significant intra-group differences between cartilaginous and bony sulcus angles in either group. Three months after surgery, significant between-group differences were detected in articular cartilage thickness at the three different positions (medial facet: 324.3 ± 14.0 μm in control group vs 391.7 ± 98.8 μm in patellectomy group, P = 0.029; central position: 362.1 ± 13.6 μm in control group vs 730.3 ± 76.8 μm in patellectomy group, P < 0.001; lateral facet: 324.6 ± 12.7 μm in control group vs 358.5 ± 38.7 μm in patellectomy group, P = 0.009). No between-group differences in cartilage thickness were found at 6 months. CONCLUSIONS Abnormal mechanical stress (patellectomy) during a rabbit's development can cause flattening of the femoral trochlear cartilage, followed by changes in the subchondral osseous layer. Abnormal mechanical stress is a crucial factor in the development of trochlear groove dysplasia.
Collapse
Affiliation(s)
- Jiangfeng Lu
- Department of Joint Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Chenghai Wang
- Department of Orthopaedic Surgery, Affiliated Hospital of Hebei University of Engineering, Handan, Hebei, China
| | - Faquan Li
- Department of Joint Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Gang Ji
- Department of Joint Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Yanru Wang
- Department of Otorhinolaryngology Head and Neck Surgery, The 980th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army, Shijiazhuang, Hebei, China
| | - Fei Wang
- Department of Joint Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| |
Collapse
|
37
|
Hohenberger GM, Dreu M, Kreuzthaler H, Gruber G, Riedl R, Schwarz A, Vielgut I, Widhalm H, Sadoghi P. Patellar Tendon Length is Associated with Lower Extremity Length but Not Gender. Indian J Orthop 2020; 54:352-357. [PMID: 32399156 PMCID: PMC7205968 DOI: 10.1007/s43465-020-00046-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 01/14/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the patellar tendon length (PTL) with focus on gender differences and possible correlations with the total leg length (TLL) and the long bones of the lower extremity. MATERIALS AND METHODS The sample involved 50 paired lower extremities from human adult cadavers. The TLL was measured between the medial malleolus and the apex of the greater trochanter. The femoral length (FL) was evaluated as the interval between the latter and the distal margin of the lateral epicondyle of the femur and the tibial length (TL) from the distal apex of the medial malleolus to the proximal border of the medial condyle of the tibia. The PTL was measured from the apex of the patella to its proximal insertion point at the tibial tuberosity. RESULTS The PTL was at a mean length of 4.29 ± 0.49 cm (right side) and 4.20 ± 0.55 cm (left side) in females and 4.42 ± 0.53 cm (right) and 4.32 ± 0.55 cm (left) in males. There were no differences regarding gender (p = .412). The left PTL was significantly shorter in both sexes (p = .022). The PTL correlated positively with FL, TL, and TLL in both sexes and sides. CONCLUSION PTL correlates significantly positively with size without gender differences.
Collapse
Affiliation(s)
- Gloria M. Hohenberger
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
| | - Manuel Dreu
- Institute of Anatomy, Medical University of Graz, Harrachgasse 21, 8010 Graz, Austria
| | | | - Gerald Gruber
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
| | - Regina Riedl
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Auenbruggerplatz 2, 8036 Graz, Austria
| | - Angelika Schwarz
- AUVA Trauma Hospital Graz, Göstinger Straße 24, 8020 Graz, Austria
| | - Ines Vielgut
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
| | - Harald Widhalm
- Department of Trauma Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Patrick Sadoghi
- Department of Orthopaedics and Trauma, Medical University of Graz, Auenbruggerplatz 5, 8036 Graz, Austria
| |
Collapse
|
38
|
The effect of medial open wedge high tibial osteotomy on the patellofemoral joint: comparative analysis according to the preexisting cartilage status. BMC Musculoskelet Disord 2019; 20:607. [PMID: 31837699 PMCID: PMC6911704 DOI: 10.1186/s12891-019-2989-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 12/05/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although it has been known that medial open wedge high tibial osteotomy (MOWHTO) would adversely affect the patellofemoral joint, no previous study examined the surgical outcome of MOWHTO according to the preexisting cartilage status of the patellofemoral joint. The aim of this study was to investigate the effect of MOWHTO on the patellofemoral joint with regard to objective and subjective aspects according to the preexisting cartilage status. METHODS Ninety-two patients who underwent MOWHTO and a following second-look arthroscopic assessment were included in this study. The patients were divided into two groups according to the preexisting cartilage status of the patellofemoral joint: group 1 (International Cartilage Repair Society [ICRS] grade 2 or 3) and group 2 (ICRS grade 0 or 1). Comparative analysis was performed regarding clinical scores, radiographic parameters, and arthroscopic measurements between the two groups. RESULTS Clinical outcomes showed overall improvement from baseline to the time of second-look operation, with no significant difference between the two groups at each time point. There were no significant differences in radiographic parameters between the two groups. Radiographic grade of patellofemoral osteoarthritis in both groups showed a tendency to progress, without statistical significance. In arthroscopic assessment, the size of the cartilage lesion on the patellofemoral joint increased with time in both groups (P = 0.003), but the degree of change over time between the two groups was not statistically significant. Consistently, there was no significant difference in the frequency of progression of cartilage lesion grade in the patellofemoral joint between the two groups. CONCLUSIONS MOWHTO would contribute to osteoarthritis progression of the patellofemoral joint regardless of the preexisting cartilage status, without an association with clinical outcomes in short-term follow-up.
Collapse
|
39
|
|
40
|
Yamada Y, Toritsuka Y, Horibe S, Nakamura N, Sugamoto K, Yoshikawa H, Shino K. Classification of dysplasia of the femoral trochlea in patients with patellar instability depends on the evaluation plane. J ISAKOS 2019. [DOI: 10.1136/jisakos-2019-000291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
41
|
Retrograde Intramedullary Nail Fixation for Derotational Femoral Osteotomy for Recurrent Femoropatellar Instability. Case Rep Orthop 2019; 2019:1893042. [PMID: 31612090 PMCID: PMC6755290 DOI: 10.1155/2019/1893042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 08/31/2019] [Indexed: 11/18/2022] Open
Abstract
Axial alignment of the femur and tibia is often misdiagnosed in patients with patellofemoral stability problems. Femoral torsion is critical for patellofemoral biomechanics, so it must be evaluated in every patient before the plan of surgery is decided. This case describes a femoral derotational osteotomy due to excessive internal torsion of the femur fixed with a retrograde femoral nail. This type of fixation provides a biomechanical advantage compared to plates. At the two-year follow-up, the patient achieved excellent results, reaching a functional score of 91 points on the Lysholm scale. Derotational femoral osteotomy should be considered in patellofemoral pathology, and a retrograde femoral nail is a valid fixation method for this surgery.
Collapse
|
42
|
Dzialo CM, Pedersen PH, Jensen KK, de Zee M, Andersen MS. Evaluation of predicted patellofemoral joint kinematics with a moving-axis joint model. Med Eng Phys 2019; 73:85-91. [PMID: 31474509 DOI: 10.1016/j.medengphy.2019.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 07/27/2019] [Accepted: 08/15/2019] [Indexed: 10/26/2022]
Abstract
The main objectives of this study were to expand the moving-axis joint model concept to the patellofemoral joint and evaluate the patellar motion against experimental patellofemoral kinematics. The experimental data was obtained through 2D-to-3D bone reconstruction of EOS images and segmented MRI data utilizing an iterative closest point optimization technique. Six knee model variations were developed using the AnyBody Modeling System and subject-specific bone geometries. These models consisted of various combinations of tibiofemoral (hinge, moving-axis, and interpolated) and patellofemoral (hinge and moving-axis) joint types. The newly introduced interpolated tibiofemoral joint is calibrated from the five EOS quasi-static lunge positions. The patellofemoral axis of the hinge model was defined by performing surface fits to the patellofemoral contact area; and the moving-axis model was defined based upon the position of the patellofemoral joint at 0° and 90° tibiofemoral-flexion. In between these angles, the patellofemoral axis moved linearly as a function of tibiofemoral-flexion, while outside these angles, the axis remained fixed. When using a moving-axis tibiofemoral joint, a hinge patellofemoral joint offers (-5.12 ± 1.23 mm, 5.81 ± 0.97 mm, 14.98 ± 2.30°, -4.35 ± 1.95°) mean differences (compared to EOS) while a moving-axis patellofemoral model provides (-2.69 ± 1.04 mm, 1.13 ± 0.80 mm, 12.63 ± 2.03°, 1.74 ± 1.46°) in terms of lateral-shift, superior translation, patellofemoral-flexion, and patellar-rotation, respectively. Furthermore, the model predictive capabilities increased as a direct result of adding more calibrated positions to the tibiofemoral model (hinge-1, moving-axis-2, and interpolated-5). Overall, a novel subject-specific moving-axis patellofemoral model has been established; that produces realistic patellar motion and is computationally fast enough for clinical applications.
Collapse
Affiliation(s)
- C M Dzialo
- AnyBody Technology, A/S Niels Jernes Vej 10, DK 9220 Aalborg, Denmark; Department of Materials and Production, Aalborg University, Fibigerstræde 16, DK-9220 Aalborg, Denmark.
| | - P H Pedersen
- Department of Orthopedic Surgery, Aalborg University Hospital, Hobrovej 18-22, DK-9000 Aalborg, Denmark
| | - K K Jensen
- Department of Radiology, Aalborg University Hospital, Hobrovej 18-22, DK-9000 Aalborg, Denmark
| | - M de Zee
- Department of Health Science and Technology, Sport Sciences, Aalborg University, Fredrik Bajers Vej 7D, DK-9220 Aalborg, Denmark
| | - M S Andersen
- Department of Materials and Production, Aalborg University, Fibigerstræde 16, DK-9220 Aalborg, Denmark
| |
Collapse
|
43
|
Hiemstra LA, Peterson D, Youssef M, Soliman J, Banfield L, Ayeni OR. Trochleoplasty provides good clinical outcomes and an acceptable complication profile in both short and long-term follow-up. Knee Surg Sports Traumatol Arthrosc 2019; 27:2967-2983. [PMID: 30499027 DOI: 10.1007/s00167-018-5311-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 11/20/2018] [Indexed: 01/17/2023]
Abstract
PURPOSE The purpose of this study is to report on the global distribution and clinical outcomes of published articles related to trochleoplasty. METHODS The online databases OVID Medline, OVID EMBASE, and the Cochrane Library were searched for the literature assessing trochleoplasty performed for lateral patellofemoral instability (LPI). Study data were abstracted looking at global trends in the literature, as well as clinical and patient-reported outcomes following this technique. RESULTS For the assessment of global distribution, 29 studies including 998 patients met the inclusion criteria. The majority of the studies were conducted in Europe (93%) and most used an open thin flap technique (52%). For the secondary analysis of clinical outcomes, 21 studies were included with significant heterogeneity in patient selection, reporting on the degree of trochlear dysplasia, and patient-reported outcomes. All trochleoplasty techniques showed statistically significant improvement in clinical outcomes at average 50 months (range 3-228 months) post-operative, with most patients being satisfied with their procedure. Re-dislocation and complication rates were low. CONCLUSIONS European centers have published majority of data on trochleoplasty surgery, which has been shown to be an acceptable procedure for patients with high-grade trochlear dysplasia and LPI. Trochleoplasty has demonstrated good clinical outcomes, a low re-dislocation rate, and an acceptable complication profile in both short and long-term follow-up. This study highlights the difficulty in reporting outcomes in this group of patients due to heterogeneity in patient selection, grading of trochlear dysplasia, and the lack of disease-specific outcome measures. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Laurie A Hiemstra
- Banff Sport Medicine, Box 1300, Banff, AB, T1L 1B3, Canada. .,Department of Surgery, University of Calgary, Calgary, AB, Canada.
| | - Devin Peterson
- Division of Orthopaedic Surgery, Department Surgery, McMaster University, Hamilton, ON, Canada
| | - Michael Youssef
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - John Soliman
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Laura Banfield
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, Department Surgery, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
44
|
Jibri Z, Jamieson P, Rakhra KS, Sampaio ML, Dervin G. Patellar maltracking: an update on the diagnosis and treatment strategies. Insights Imaging 2019; 10:65. [PMID: 31201575 PMCID: PMC6570735 DOI: 10.1186/s13244-019-0755-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 05/21/2019] [Indexed: 02/08/2023] Open
Abstract
Patellar maltracking occurs as a result of an imbalance in the dynamic relationship between the patella and trochlea. This is often secondary to an underlying structural abnormality. The clinical evaluation can provide useful clues for the presence of such entity; however, the diagnosis can often be challenging especially in the absence of a documented history of patellar dislocation. Imaging, particularly MRI, can detect subtle features that could lead to the diagnosis, probably even more importantly when there is no clear history of patellar dislocation or before its development. This can provide a road map for formulating a treatment strategy that would be primarily aimed at stabilizing the patellofemoral joint to halt or slow the progression of articular cartilage loss. The purpose of this article is to discuss the clinical and radiologic evaluation of patellar maltracking providing an update on the cross-sectional imaging assessment and also a synopsis of the management options.
Collapse
Affiliation(s)
- Zaid Jibri
- Department of Medical Imaging, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada. .,Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada.
| | - Paul Jamieson
- Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada.,Division of Orthopaedic Surgery, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
| | - Kawan S Rakhra
- Department of Medical Imaging, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada.,Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada
| | - Marcos L Sampaio
- Department of Medical Imaging, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada.,Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada
| | - Geoffrey Dervin
- Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada.,Division of Orthopaedic Surgery, The Ottawa Hospital, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada
| |
Collapse
|
45
|
Preoperative planning of tibial tubercle medialisation according to the trochlear groove angle. Orthop Traumatol Surg Res 2019; 105:129-131. [PMID: 30470522 DOI: 10.1016/j.otsr.2018.09.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 09/12/2018] [Accepted: 09/18/2018] [Indexed: 02/02/2023]
Abstract
The tibial tubercle-trochlear groove distance (TT-TG) was first described four decades ago. Since then, a considerable body of research has become available on the pathophysiology of chronic patellar instability, whose diagnosis and treatment remain challenging. Tibial tubercle medialisation can correct an abnormal TT-TG. Preoperative planning based on the TT-TG and trochlear angle may avoid both under-correction inducing persistent instability and overcorrection responsible for pain. Preoperative planning should be patient-specific. With appropriate preoperative planning, compensation for moderate trochlear dysplasia can be achieved without any additional procedure.
Collapse
|
46
|
Patellar tracking should be taken into account when measuring radiographic parameters for recurrent patellar instability. Knee Surg Sports Traumatol Arthrosc 2018; 26:3593-3600. [PMID: 29159672 DOI: 10.1007/s00167-017-4795-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Accepted: 11/08/2017] [Indexed: 01/16/2023]
Abstract
PURPOSE To date, many radiographic parameters on patellar instability have their measurements taken statically, and have not been studied in various degrees of flexion according to the patellar tracking. There are also limited data regarding the use of these parameters in predicting recurrent patellar dislocation. The current study aims to review the radiographic parameters of the patellofemoral joint in different degrees of knee flexion and to correlate them with the presence of recurrent instability. METHODS A 10-year retrospective study was conducted on all patients who had computed tomography patellar-tracking scan done for patellar instability when aged 18 years or younger. The computed tomography patellar-tracking scans were performed with the knee in extension, 10° flexion, and 20° flexion. The axial radiographic parameters were evaluated at the patellar equator, roman arch, and distal patellar pole. Sagittal and coronal parameters were noted. Radiographic parameters were then correlated with recurrent patellar instability. RESULTS The femoral sulcus angle and trochlear groove depth at the distal patellar pole in 10° knee flexion (p value 0.04 and 0.03, respectively) and patellar equator in 20° knee flexion (p value 0.02 and 0.03, respectively) had the most significant clinical correlations with recurrent instability on multivariate analysis. Other radiographic parameters found to have significant clinical correlation on univariate analysis include the patellar tilt angle, congruence angle, femoral sulcus angle, trochlear groove depth, and Wiberg's classification. CONCLUSIONS As per the knee dynamics, axial radiographic parameters had the most significant correlation with recurrent patellar instability when measured at the distal patellar pole in 10° knee flexion and at the patellar equator in 20° knee flexion. Future axial radiographic evaluation of patellofemoral instability should then be performed at these degrees of knee flexion and axial cuts. Trochlear dysplasia, as measured by the femoral sulcus angle and trochlear groove depth, was the most significant predictor of recurrent patellar instability in the skeletally immature. Wiberg's classification was also a novel factor found to have clinical correlation with patellofemoral instability. LEVEL OF EVIDENCE III.
Collapse
|
47
|
Abstract
Patellar instability is defined by clinical and radiologic criteria. The surgical treatment is aimed at restoring the congruence of the patellofemoral articulation and correcting extensor mechanism malalignment, to prevent recurrence of dislocation. The standard soft-tissue procedures are lateral release and vastus medialis advancement and medial patello femoral ligament plasty. Bony procedures are frequently performed in addition to soft-tissue surgery, to realign the extensor mechanism by means of tibial tubercle medialization, or to correct the patellar index in patella alta. In a smaller number of patients, the trochlea may be reshaped, by elevating the lateral trochlear facet or by lowering the floor of the sulcus. The morphologic abnormalities encountered are studied and quantified in the light of preoperative investigations (conventional radiographs and computed tomography), and addressed at surgery using the technique or techniques most appropriate for the management of the individual patient's pattern.
Collapse
|
48
|
Abstract
Trochleoplasty is a very effective procedure for correcting trochlear dysplasia and addressing instability of the patella. With an increasing knowledge about the anatomy and biomechanics of the anterior distal femur, a wider array of surgical techniques may be applied to address specific conditions. Patients must be carefully selected to undergo trochleoplasty by use of a thorough history and physical examination as well as basic and advanced imaging. The presence of a "J sign" on physical examination, a history of recurrent instability, patella alta, trochlear dysplasia, and elevated tibial tubercle to trochlear groove are signs and symptoms for which the patient should be evaluated. We attempt to elucidate when trochleoplasty is indicated by means of addressing all aspects of evaluation.
Collapse
|
49
|
Saffarini M, Müller JH, La Barbera G, Hannink G, Cho KJ, Toanen C, Dejour D. Inadequacy of computed tomography for pre-operative planning of patellofemoral arthroplasty. Knee Surg Sports Traumatol Arthrosc 2018; 26:1485-1492. [PMID: 28271370 DOI: 10.1007/s00167-017-4474-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 02/08/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE To evaluate the accuracy of preoperative planning for patellofemoral arthroplasty (PFA) by comparing: (1) virtual implant positioning simulated on pre-operative images versus (2) real implant positioning from post-operative images. METHODS The authors prospectively studied 15 patients that received a PFJ implant (Tornier, Montbonnot France). A pre-operative planning software was established to determine the size and position of the trochlear component. Pre-operative scans were used to perform virtual implantations by two different operators, which were then compared to the post-operative scans to calculate errors (ε) in implant positioning and intra-class correlation coefficients (ICC) for intra- and inter-observer repeatability. RESULTS Analysis was performed for 13 patients, for whom agreement between virtual and real surgery was excellent for anteroposterior (AP) position (ICC = 0.84; ε max = 3.5 mm), fair for proximodistal (PD) position (ICC = 0.50; ε max = 9.5 mm), and poor for mediolateral (ML) position (ICC = 0.07; ε max = 9.0 mm). It was fair for flexum-recurvatum (FR) alignment (ICC = 0.53; ε max = 8.2°), poor for varus-valgus (VV) alignment (ICC = 0.34; ε max = 10.0°), and internal-external (IE) rotation (ICC = 0.34; ε max = 10.6°). CONCLUSIONS Pre-operative planning was insufficiently accurate to follow intra-operatively, the greatest errors being angular alignment (VV and FR). The clinical relevance of these findings is that PFA is difficult to plan pre/operatively due to non-visibility of cartilage on CT scans and to trochlear dysplasia in most cases. LEVEL OF EVIDENCE Prospective evaluation of operative tools on consecutive patients, Level III.
Collapse
Affiliation(s)
- Mo Saffarini
- ReSurg SA, 35 ch. de la Vuarpillière, 1260, Nyon, Switzerland.
| | - Jacobus H Müller
- Department of Mechanical and Mechatronic Engineering Stellenbosch University, Private Bag X1, Matieland, 7600, Stellenbosch, South Africa
| | - Giuseppe La Barbera
- Lyon-Ortho-Clinic, Clinique de la Sauvegarde, 8 Avenue Ben Gourion, 69009, Lyon, France
| | - Gerjon Hannink
- Orthopaedic Research Laboratory, Radboud University Medical Center, PO Box 9101, 6500HB, Nijmegen, The Netherlands
| | - Kyung Jin Cho
- Department of Mechanical and Mechatronic Engineering Stellenbosch University, Private Bag X1, Matieland, 7600, Stellenbosch, South Africa
| | - Cécile Toanen
- Lyon-Ortho-Clinic, Clinique de la Sauvegarde, 8 Avenue Ben Gourion, 69009, Lyon, France
| | - David Dejour
- Lyon-Ortho-Clinic, Clinique de la Sauvegarde, 8 Avenue Ben Gourion, 69009, Lyon, France
| |
Collapse
|
50
|
Length change patterns and shape of a grafted tendon after anatomical medial patellofemoral ligament reconstruction differs from that in a healthy knee. Knee Surg Sports Traumatol Arthrosc 2018; 26:1245-1251. [PMID: 28741155 DOI: 10.1007/s00167-017-4620-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Accepted: 06/19/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Recurrent patellar dislocation is currently treated with anatomical reconstruction of the medial patellofemoral ligament (MPFL), and favourable postoperative outcomes have been reported. However, it is uncertain if healthy MPFL function is restored by anatomical reconstruction. The hypothesis in this study was that stabilization of the patella following MPFL reconstruction would be improved compared with that before surgery, but that function of the grafted tendon would differ from that of a healthy MPFL. The objective was to analyse the length change patterns of the MPFL before surgery and the grafted tendon after surgery in patients with recurrent patellar dislocation treated with anatomical MPFL reconstruction. METHODS The subjects were 12 patients (13 knees) in whom recurrent patellar dislocation was treated with anatomical MPFL reconstruction. The length change patterns of the MPFL and reconstructed ligament were analysed at extension and flexion of the knee joint using open MRI. RESULTS The postoperative grafted tendon length was significantly shorter than that of the preoperative MPFL at knee extension, and significantly longer at 90° and 120° of knee flexion. The postoperative length of the grafted tendon only changed slightly from 0° to 30° of knee flexion, and then significantly decreased at flexion of 30° or more. The morphology of the grafted tendon was linear until 60° knee flexion, but became convex toward the extraarticular side at flexion of 90° or more. CONCLUSION The grafted tendon length at knee extension was shorter than that of the preoperative MPFL, but there was no significant difference at 30° flexion. These findings suggest that the effect of damping of the patella with a grafted tendon after MPFL reconstruction may differ from that in a healthy knee. In addition, the morphology at 60° knee flexion was improved to linear after surgery, suggesting that ligament morphology at this flexion was normalized by MPFL reconstruction. LEVEL OF EVIDENCE III.
Collapse
|