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Siegel M, Taghizadeh E, Fuchs A, Maier P, Schmal H, Lange T, Yilmaz T, Meine H, Izadpanah K. [Influence of the quadriceps muscles on the patellofemoral contact in patients with low flexion patellofemoral instability after MPFL reconstruction]. ORTHOPADIE (HEIDELBERG, GERMANY) 2023; 52:834-842. [PMID: 37567919 PMCID: PMC10539450 DOI: 10.1007/s00132-023-04413-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/29/2023] [Indexed: 08/13/2023]
Abstract
INTRODUCTION MPFL reconstruction represents one of the most important surgical treatment options for recurrent patellar dislocations at low flexion angles associated with low flexion patellofemoral instability. Nevertheless, the role of quadriceps muscles in patients with patellofemoral instability before and after patellofemoral stabilization using MPFL reconstruction has not been fully elucidated. The present study investigates the influence of quadriceps muscles on the patellofemoral contact in patients with low flexion patellofemoral instability (PFI) before and after surgical patellofemoral stabilization using MPFL reconstruction using 3 T MRI datasets in early degrees of flexion (0-30°). METHODS In this prospective cohort study, 15 patients with low flexion PFI before and after MPFL reconstruction and 15 subjects with healthy knee joints were studied using dynamic MRI scans. MRI scans were performed in a custom-made pneumatic knee loading device to determine the patellofemoral cartilage contact area (CCA) with and without quadriceps activation (50 N). Comparative measurements were performed using 3D cartilage and bone meshes in 0-30° knee flexion in the patients with patellofemoral instability preoperatively and postoperatively. RESULTS The preoperative patellofemoral CCA of patients with low flexion PFI was 67.3 ± 47.3 mm2 in 0° flexion, 118.9 ± 56.6 mm2 in 15° flexion, and 267.6 ± 96.1 mm2 in 30° flexion. With activated quadriceps muscles (50 N), the contact area was 72.4 ± 45.9 mm2 in extension, 112.5 ± 54.9 mm2 in 15° flexion, and 286.1 ± 92.7 mm2 in 30° flexion without statistical significance. Postoperatively determined CCA revealed 159.3 ± 51.4 mm2 , 189.6 ± 62.2 mm2 and 347.3 ± 52.1 mm2 in 0°, 15° and 30° flexion. Quadriceps activation with 50 N showed a contact area in extension of 141.0 ± 63.8 mm2, 206.6 ± 67.7 mm2 in 15° flexion, and 353.5 ± 64.6 mm2 in 30° flexion, also without statistical difference compared with unloaded CCAs. Subjects with healthy knee joints showed an increase of 10.3% in CCA at 30° of flexion (p = 0.003). CONCLUSION Although patellofemoral CCA increases significantly after isolated MPFL reconstruction in patients with low flexion patellofemoral instability, there is no significant influence of quadriceps muscles either preoperatively or postoperatively.
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Affiliation(s)
- Markus Siegel
- Department of Orthopedic Surgery and Traumatology, Freiburg University Hospital, Albert Ludwigs University Freiburg, Hugstetter Straße 55, 79106, Freiburg, Deutschland.
| | - Elham Taghizadeh
- Institute for Medical Image Computing, Fraunhofer MEVIS, Universitätsallee 29, 28359, Bremen, Deutschland
| | - Andreas Fuchs
- Department of Orthopedic Surgery and Traumatology, Freiburg University Hospital, Albert Ludwigs University Freiburg, Hugstetter Straße 55, 79106, Freiburg, Deutschland
| | - Philipp Maier
- Department of Orthopedic Surgery and Traumatology, Freiburg University Hospital, Albert Ludwigs University Freiburg, Hugstetter Straße 55, 79106, Freiburg, Deutschland
| | - Hagen Schmal
- Department of Orthopedic Surgery and Traumatology, Freiburg University Hospital, Albert Ludwigs University Freiburg, Hugstetter Straße 55, 79106, Freiburg, Deutschland
- Dep. Of Orthopedic Surgery, University Hospital Odense, Sdr. Boulevard 29, 5000, Odense, Dänemark
| | - Thomas Lange
- Division of Medical Physics, Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Killianstraße 5a, 79106, Freiburg, Deutschland
| | - Tayfun Yilmaz
- Department of Orthopedic Surgery and Traumatology, Freiburg University Hospital, Albert Ludwigs University Freiburg, Hugstetter Straße 55, 79106, Freiburg, Deutschland
| | - Hans Meine
- Institute for Medical Image Computing, Fraunhofer MEVIS, Universitätsallee 29, 28359, Bremen, Deutschland
| | - Kaywan Izadpanah
- Department of Orthopedic Surgery and Traumatology, Freiburg University Hospital, Albert Ludwigs University Freiburg, Hugstetter Straße 55, 79106, Freiburg, Deutschland
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Watts RE, Gorbachova T, Fritz RC, Saad SS, Lutz AM, Kim J, Chaudhari AS, Shea KG, Sherman SL, Boutin RD. Patellar Tracking: An Old Problem with New Insights. Radiographics 2023; 43:e220177. [PMID: 37261964 DOI: 10.1148/rg.220177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Patellofemoral pain and instability are common indications for imaging that are encountered in everyday practice. The authors comprehensively review key aspects of patellofemoral instability pertinent to radiologists that can be seen before the onset of osteoarthritis, highlighting the anatomy, clinical evaluation, diagnostic imaging, and treatment. Regarding the anatomy, the medial patellofemoral ligament (MPFL) is the primary static soft-tissue restraint to lateral patellar displacement and is commonly reconstructed surgically in patients with MPFL dysfunction and patellar instability. Osteoarticular abnormalities that predispose individuals to patellar instability include patellar malalignment, trochlear dysplasia, and tibial tubercle lateralization. Clinically, patients with patellar instability may be divided into two broad groups with imaging findings that sometimes overlap: patients with a history of overt patellar instability after a traumatic event (eg, dislocation, subluxation) and patients without such a history. In terms of imaging, radiography is generally the initial examination of choice, and MRI is the most common cross-sectional examination performed preoperatively. For all imaging techniques, there has been a proliferation of published radiologic measurement methods. The authors summarize the most common validated measurements for patellar malalignment, trochlear dysplasia, and tibial tubercle lateralization. Given that static imaging is inherently limited in the evaluation of patellar motion, dynamic imaging with US, CT, or MRI may be requested by some surgeons. The primary treatment strategy for patellofemoral pain is conservative. Surgical treatment options include MPFL reconstruction with or without osseous corrections such as trochleoplasty and tibial tubercle osteotomy. Postoperative complications evaluated at imaging include patellar fracture, graft failure, graft malposition, and medial patellar subluxation. ©RSNA, 2023 Quiz questions for this article are available in the supplemental material.
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Affiliation(s)
- Robert E Watts
- From the Departments of Radiology (R.E.W., A.M.L., R.D.B.) and Orthopaedic Surgery (S.L.S.), Stanford University School of Medicine, 300 Pasteur Dr, Stanford, CA 94305-5101; Department of Radiology, Einstein Healthcare Network and Jefferson Health, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA (T.G.); Department of Musculoskeletal Radiology, National Orthopedic Imaging Associates, Greenbrae, CA (R.C.F.); Department of Musculoskeletal Radiology, Atlantic Medical Imaging, Galloway, NJ (S.S.S.); Department of Radiology, Benning Martin Army Community Hospital, Fort Benning, GA (J.K.); Departments of Radiology and Biomedical Data Science, Stanford University, Stanford, CA (A.S.C.); and Department of Orthopaedic Surgery, Lucile Packard Children's Hospital at Stanford, Palo Alto, CA (K.G.S.)
| | - Tetyana Gorbachova
- From the Departments of Radiology (R.E.W., A.M.L., R.D.B.) and Orthopaedic Surgery (S.L.S.), Stanford University School of Medicine, 300 Pasteur Dr, Stanford, CA 94305-5101; Department of Radiology, Einstein Healthcare Network and Jefferson Health, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA (T.G.); Department of Musculoskeletal Radiology, National Orthopedic Imaging Associates, Greenbrae, CA (R.C.F.); Department of Musculoskeletal Radiology, Atlantic Medical Imaging, Galloway, NJ (S.S.S.); Department of Radiology, Benning Martin Army Community Hospital, Fort Benning, GA (J.K.); Departments of Radiology and Biomedical Data Science, Stanford University, Stanford, CA (A.S.C.); and Department of Orthopaedic Surgery, Lucile Packard Children's Hospital at Stanford, Palo Alto, CA (K.G.S.)
| | - Russell C Fritz
- From the Departments of Radiology (R.E.W., A.M.L., R.D.B.) and Orthopaedic Surgery (S.L.S.), Stanford University School of Medicine, 300 Pasteur Dr, Stanford, CA 94305-5101; Department of Radiology, Einstein Healthcare Network and Jefferson Health, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA (T.G.); Department of Musculoskeletal Radiology, National Orthopedic Imaging Associates, Greenbrae, CA (R.C.F.); Department of Musculoskeletal Radiology, Atlantic Medical Imaging, Galloway, NJ (S.S.S.); Department of Radiology, Benning Martin Army Community Hospital, Fort Benning, GA (J.K.); Departments of Radiology and Biomedical Data Science, Stanford University, Stanford, CA (A.S.C.); and Department of Orthopaedic Surgery, Lucile Packard Children's Hospital at Stanford, Palo Alto, CA (K.G.S.)
| | - Sherif S Saad
- From the Departments of Radiology (R.E.W., A.M.L., R.D.B.) and Orthopaedic Surgery (S.L.S.), Stanford University School of Medicine, 300 Pasteur Dr, Stanford, CA 94305-5101; Department of Radiology, Einstein Healthcare Network and Jefferson Health, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA (T.G.); Department of Musculoskeletal Radiology, National Orthopedic Imaging Associates, Greenbrae, CA (R.C.F.); Department of Musculoskeletal Radiology, Atlantic Medical Imaging, Galloway, NJ (S.S.S.); Department of Radiology, Benning Martin Army Community Hospital, Fort Benning, GA (J.K.); Departments of Radiology and Biomedical Data Science, Stanford University, Stanford, CA (A.S.C.); and Department of Orthopaedic Surgery, Lucile Packard Children's Hospital at Stanford, Palo Alto, CA (K.G.S.)
| | - Amelie M Lutz
- From the Departments of Radiology (R.E.W., A.M.L., R.D.B.) and Orthopaedic Surgery (S.L.S.), Stanford University School of Medicine, 300 Pasteur Dr, Stanford, CA 94305-5101; Department of Radiology, Einstein Healthcare Network and Jefferson Health, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA (T.G.); Department of Musculoskeletal Radiology, National Orthopedic Imaging Associates, Greenbrae, CA (R.C.F.); Department of Musculoskeletal Radiology, Atlantic Medical Imaging, Galloway, NJ (S.S.S.); Department of Radiology, Benning Martin Army Community Hospital, Fort Benning, GA (J.K.); Departments of Radiology and Biomedical Data Science, Stanford University, Stanford, CA (A.S.C.); and Department of Orthopaedic Surgery, Lucile Packard Children's Hospital at Stanford, Palo Alto, CA (K.G.S.)
| | - Jiyoon Kim
- From the Departments of Radiology (R.E.W., A.M.L., R.D.B.) and Orthopaedic Surgery (S.L.S.), Stanford University School of Medicine, 300 Pasteur Dr, Stanford, CA 94305-5101; Department of Radiology, Einstein Healthcare Network and Jefferson Health, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA (T.G.); Department of Musculoskeletal Radiology, National Orthopedic Imaging Associates, Greenbrae, CA (R.C.F.); Department of Musculoskeletal Radiology, Atlantic Medical Imaging, Galloway, NJ (S.S.S.); Department of Radiology, Benning Martin Army Community Hospital, Fort Benning, GA (J.K.); Departments of Radiology and Biomedical Data Science, Stanford University, Stanford, CA (A.S.C.); and Department of Orthopaedic Surgery, Lucile Packard Children's Hospital at Stanford, Palo Alto, CA (K.G.S.)
| | - Akshay S Chaudhari
- From the Departments of Radiology (R.E.W., A.M.L., R.D.B.) and Orthopaedic Surgery (S.L.S.), Stanford University School of Medicine, 300 Pasteur Dr, Stanford, CA 94305-5101; Department of Radiology, Einstein Healthcare Network and Jefferson Health, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA (T.G.); Department of Musculoskeletal Radiology, National Orthopedic Imaging Associates, Greenbrae, CA (R.C.F.); Department of Musculoskeletal Radiology, Atlantic Medical Imaging, Galloway, NJ (S.S.S.); Department of Radiology, Benning Martin Army Community Hospital, Fort Benning, GA (J.K.); Departments of Radiology and Biomedical Data Science, Stanford University, Stanford, CA (A.S.C.); and Department of Orthopaedic Surgery, Lucile Packard Children's Hospital at Stanford, Palo Alto, CA (K.G.S.)
| | - Kevin G Shea
- From the Departments of Radiology (R.E.W., A.M.L., R.D.B.) and Orthopaedic Surgery (S.L.S.), Stanford University School of Medicine, 300 Pasteur Dr, Stanford, CA 94305-5101; Department of Radiology, Einstein Healthcare Network and Jefferson Health, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA (T.G.); Department of Musculoskeletal Radiology, National Orthopedic Imaging Associates, Greenbrae, CA (R.C.F.); Department of Musculoskeletal Radiology, Atlantic Medical Imaging, Galloway, NJ (S.S.S.); Department of Radiology, Benning Martin Army Community Hospital, Fort Benning, GA (J.K.); Departments of Radiology and Biomedical Data Science, Stanford University, Stanford, CA (A.S.C.); and Department of Orthopaedic Surgery, Lucile Packard Children's Hospital at Stanford, Palo Alto, CA (K.G.S.)
| | - Seth L Sherman
- From the Departments of Radiology (R.E.W., A.M.L., R.D.B.) and Orthopaedic Surgery (S.L.S.), Stanford University School of Medicine, 300 Pasteur Dr, Stanford, CA 94305-5101; Department of Radiology, Einstein Healthcare Network and Jefferson Health, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA (T.G.); Department of Musculoskeletal Radiology, National Orthopedic Imaging Associates, Greenbrae, CA (R.C.F.); Department of Musculoskeletal Radiology, Atlantic Medical Imaging, Galloway, NJ (S.S.S.); Department of Radiology, Benning Martin Army Community Hospital, Fort Benning, GA (J.K.); Departments of Radiology and Biomedical Data Science, Stanford University, Stanford, CA (A.S.C.); and Department of Orthopaedic Surgery, Lucile Packard Children's Hospital at Stanford, Palo Alto, CA (K.G.S.)
| | - Robert D Boutin
- From the Departments of Radiology (R.E.W., A.M.L., R.D.B.) and Orthopaedic Surgery (S.L.S.), Stanford University School of Medicine, 300 Pasteur Dr, Stanford, CA 94305-5101; Department of Radiology, Einstein Healthcare Network and Jefferson Health, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA (T.G.); Department of Musculoskeletal Radiology, National Orthopedic Imaging Associates, Greenbrae, CA (R.C.F.); Department of Musculoskeletal Radiology, Atlantic Medical Imaging, Galloway, NJ (S.S.S.); Department of Radiology, Benning Martin Army Community Hospital, Fort Benning, GA (J.K.); Departments of Radiology and Biomedical Data Science, Stanford University, Stanford, CA (A.S.C.); and Department of Orthopaedic Surgery, Lucile Packard Children's Hospital at Stanford, Palo Alto, CA (K.G.S.)
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Frings J, Dust T, Meyer J, Krause M, Frosch KH, Adam G, Henes FO, Spink C, Maas KJ. The Influence of Surgical Realignment Procedures on Dynamic Patellar Tracking: A Dynamic Magnetic Resonance Imaging-Controlled Feasibility Study. Diagnostics (Basel) 2022; 12:diagnostics12112761. [PMID: 36428821 PMCID: PMC9689423 DOI: 10.3390/diagnostics12112761] [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] [Received: 10/22/2022] [Revised: 11/08/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022] Open
Abstract
Persisting patellar maltracking following surgical realignment often remains unseen. The aim of this study was to analyze the effects of realignment procedures on patellofemoral kinematics in patients with patellofemoral instability (PFI) and patellofemoral maltracking (PM) by using dynamic magnetic resonance imaging (MRI). Patients planned for surgical patellar realignment due to PFI and a clinically and radiologically apparent PM between December 2019 and May 2022 were included. Patients without PM, limited range of motion, joint effusion, or concomitant injuries were excluded. Dynamic mediolateral translation (dMPT) and patella tilt (dPT) were measured preoperatively and three months postoperatively. In 24 patients (7 men, 17 women; mean age 23.0 years), 10 tibial tubercle transfers, 5 soft tissue patella tendon transfers, 6 trochleoplasties, 3 lateral lengthenings, 1 varizating distal femoral osteotomy (DFO), and 1 torsional DFO were performed. At final follow-up, dMPT (from 10.95 ± 5.93 mm to 4.89 ± 0.40 mm, p < 0.001) and dPT (from 14.50° ± 10.33° to 8.44° ± 7.46°, p = 0.026) were significantly improved. All static radiological parameters were corrected to physiological values. Surgical patellar realignment contributed to the significant improvement of patellofemoral kinematics, with an approximation to normal values. The postoperative application of dynamic MRI allowed for a quantification of the performed correction, allowing for a postoperative control of success.
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Affiliation(s)
- Jannik Frings
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
- Correspondence:
| | - Tobias Dust
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Jennifer Meyer
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Matthias Krause
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Karl-Heinz Frosch
- Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
- Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Hospital Hamburg, 21033 Hamburg, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Frank Oliver Henes
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
- Department of Diagnostic and Interventional Radiology, BG Hospital Hamburg, 21033 Hamburg, Germany
| | - Clemens Spink
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Kai-Jonathan Maas
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
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