scholarly journals A Computed Tomography Study of the Association Between Increased Patellar Tilt Angle and Femoral Anteversion in 30 Patients with Recurrent Patellar Dislocation

2019 ◽  
Vol 25 ◽  
pp. 4370-4376
Author(s):  
Huijun Kang ◽  
Conglei Dong ◽  
Gengshuang Tian ◽  
Fei Wang
Keyword(s):  
Computed Tomography ◽  
Tilt Angle ◽  
Patellar Dislocation ◽  
Femoral Anteversion ◽  
Recurrent Patellar Dislocation ◽  
Patellar Tilt ◽  
Patellar Tilt Angle

scholarly journals Clinical Outcomes After Medial Patellofemoral Ligament Reconstruction With Suture Fixation of the Gracilis Tendon via Transosseous Tunnels

2020 ◽  
Vol 8 (2) ◽  
pp. 232596711990037
Author(s):  
Hangzhou Zhang ◽  
Mao Ye ◽  
Qingwei Liang
Keyword(s):  
Patellar Dislocation ◽  
Medial Patellofemoral Ligament ◽  
Case Series ◽  
Mpfl Reconstruction ◽  
Suture Fixation ◽  
Recurrent Patellar Dislocation ◽  
Patellar Tilt ◽  
Transosseous Suture ◽  
Patellar Tilt Angle

Background: Several fixation methods have been introduced in medial patellofemoral ligament (MPFL) reconstruction. However, the optimal management of patients with recurrent patellar dislocation remains controversial. Purpose: To present a case series with a minimum 2-year follow-up of 29 patients with recurrent patellar dislocation who underwent a new transosseous suture fixation technique for MPFL reconstruction. Study Design: Case series; Level of evidence, 4. Methods: From January 2014 through February 2016, a total of 29 patients with recurrent patellar dislocation for which the MPFL was reconstructed with transosseous suture patellar fixation were studied. All patients were available for follow-up (mean, 37.52 months; range, 26-48 months). The patellar attachment was fixed by transosseous patellar sutures. The International Knee Documentation Committee (IKDC) subjective knee score, Kujala score, Tegner score, range of motion, congruence angle, patellar tilt angle, and complications were assessed both pre- and postoperatively. Results: No recurrent dislocation was observed in any of the 29 patients for a minimum of 2 years. All outcome scores improved significantly from preoperatively to postoperatively: the average IKDC subjective knee evaluation score from 53 to 87, Kujala from 54 to 90, Lysholm from 50 to 89, and Tegner from 3 to 5 ( P < .001 for all). The congruence angle significantly decreased from 22° preoperatively to –3° postoperatively, and the patellar tilt angle (Merchant) decreased from 23° preoperatively to 5° postoperatively ( P < .001 for both). In total, 25 patients (25/29; 86.21%) were completely pain-free when performing activities of daily living at the last follow-up, and 27 patients (93.1%) rated themselves as very satisfied or satisfied with the results. Conclusion: In patients with chronic recurrent patellar dislocation, transosseous patellar suture fixation for MPFL reconstruction can significantly improve patellar stability and achieve good results at short-term follow-up.

scholarly journals Automatic Segmentation and Measurement on Knee Computerized Tomography Images for Patellar Dislocation Diagnosis

2020 ◽  
Vol 2020 ◽  
pp. 1-13
Author(s):  
Limin Sun ◽  
Qi Kong ◽  
Yan Huang ◽  
Jiushan Yang ◽  
Shaoshan Wang ◽  
...  
Keyword(s):  
Computerized Tomography ◽  
Tilt Angle ◽  
Patellar Dislocation ◽  
Automatic Segmentation ◽  
Automatic Measurement ◽  
Ct Images ◽  
Lateral Shift ◽  
Patellar Tilt ◽  
Cad System ◽  
Patellar Tilt Angle

Traditionally, for diagnosing patellar dislocation, clinicians make manual geometric measurements on computerized tomography (CT) images taken in the knee area, which is often complex and error-prone. Therefore, we develop a prototype CAD system for automatic measurement and diagnosis. We firstly segment the patella and the femur regions on the CT images and then measure two geometric quantities, patellar tilt angle (PTA), and patellar lateral shift (PLS) automatically on the segmentation results, which are finally used to assist in diagnoses. The proposed quantities are proved valid and the proposed algorithms are proved effective by experiments.

Evidence of Abnormal Anteroposterior Patellar Tilt in Patients with Patellar Tendinitis with Use of a New Radiographic Measurement

2002 ◽  
Vol 30 (3) ◽  
pp. 396-401 ◽  
Author(s):  
Timothy F. Tyler ◽  
Elliott B. Hershman ◽  
Stephen J. Nicholas ◽  
Jeffery H. Berg ◽  
Malachy P. McHugh
Keyword(s):  
Tilt Angle ◽  
Sagittal Plane ◽  
High Reliability ◽  
Normal Population ◽  
Normal Subjects ◽  
Patellofemoral Pain ◽  
Radiographic Measurement ◽  
Patellar Tilt ◽  
Radiographic Measurements ◽  
Patellar Tilt Angle

Background A number of clinical conditions of the patellofemoral joint have been correlated with abnormal patellofemoral radiographic measurements. Hypothesis An abnormal anteroposterior patellar-tilt angle may be a contributing factor to pathologic conditions of the knee. Study Design Prospective nonrandomized clinical trial. Methods The anteroposterior patellar-tilt angle was measured in cadaveric knees to determine the best knee position. The radiographs of normal subjects and patients with patellar tendinitis or patellofemoral pain syndrome were examined for differences in patellar-tilt angle. Results Cadaveric measurements demonstrated highest intertester and intratester reliability at 30° of knee flexion and neutral femoral rotation. Intratester measurements on normal subjects exhibited high reliability, with a mean anteroposterior tilt angle of 30.8° ± 6.7°. In the patellofemoral pain group the mean anteroposterior tilt angle was 29.1° ± 8.5°; however, for patients with patellar tendinitis, it was 25.6° ± 7.0°, significantly lower than in the normal population. Furthermore, there was no difference between the angles of involved and uninvolved knees of patients with unilateral patellar tendinitis. Conclusion The anteroposterior patellar-tilt angle is a clinically reliable measurement of patellar tilt in the sagittal plane that can be used to study patellofemoral tilt in a variety of clinical situations. The results of this study demonstrate that patients with patellar tendinitis have abnormal patellar tilt in the sagittal plane.

Anatomical Medial Patellofemoral Ligament Reconstruction for Recurrent Patella Dislocation: Two-Strand Grafts versus Four-Strand Grafts

2019 ◽  
Author(s):  
Jinghui Niu ◽  
Wei Lin ◽  
Qi Qi ◽  
Jiangfeng Lu ◽  
Yike Dai ◽  
...  
Keyword(s):  
Tilt Angle ◽  
Medial Patellofemoral Ligament ◽  
Lysholm Score ◽  
Mpfl Reconstruction ◽  
Patella Dislocation ◽  
Reconstruction Method ◽  
Patellar Tilt ◽  
Kujala Score ◽  
Patellar Tilt Angle

AbstractThe purpose of this study was to describe two anatomical medial patellofemoral ligament (MPFL) reconstruction methods: reconstruction with two-strand grafts and reconstruction with four-strand grafts and to evaluate the clinical and radiological results. From January 2010 to January 2013, patients who sustained recurrent patella dislocation and met inclusion criteria were included in the study and divided into two groups randomly to undergo MPFL reconstruction either by two-strand grafts (T group) or four-strand grafts (F group). Patients were followed up 1 month, 1 year, 2 years, and 3 years postoperatively. The apprehension test was applied to test patella stability. The Kujala score, Lysholm score, and Crosby–Insall grading were used to evaluate the function of the affected knee. The patellar congruence and patellar tilt angle were used to measure the morphology of the patellofemoral joint. In addition, patients' subjective assessments and complications were recorded. Thirty-eight patients in T group and 38 patients in F group were followed for at least 36 months. The apprehension test was positive in all patients preoperatively but was negative at follow-up. The Kujala score, Lysholm score, patellar congruence angle, and the patellar tilt angle of patients in both groups improved significantly at 36-month follow-up when compared with those assessed preoperatively. However, patients in the F group achieved better clinical results in terms of Kujala score, patellar congruence angle, patellar tilt angle, and Crosby–Insall grading when compared with those in the T group 3 years after the operation. Most patients (92% of patients in the T group and 97% of patients in the F group) were satisfied with the surgery. The anatomical MPFL reconstruction with two-strand grafts or four-strand grafts were both safe techniques for recurrent patella dislocation with satisfactory clinical outcomes. The anatomical fixation with four-strand grafts achieved better clinical and radiographic results in the follow-up, which may be a better reconstruction method.

scholarly journals Increased tibial tubercle-trochlear groove and patellar height indicate a higher risk of recurrent patellar dislocation following medial reefing

2021 ◽  
Author(s):  
Marc-Daniel Ahrend ◽  
Tobias Eisenmann ◽  
Moritz Herbst ◽  
Boyko Gueorguiev ◽  
Gabriel Keller ◽  
...  
Keyword(s):  
Patellar Dislocation ◽  
Recurrent Dislocation ◽  
Patellar Height ◽  
Tibial Tubercle ◽  
Trochlear Groove ◽  
Recurrent Patellar Dislocation ◽  
Patellar Tilt ◽  
Level Of Evidence ◽  
Sulcus Angle ◽  
Patellar Shift

Abstract Purpose Identifying anatomical risk factors on recurrent dislocation after medial reefing is important for deciding surgical treatment. The present study aimed to retrospectively analyze the preoperative magnetic resonance imaging (MRI)-based parameters of patients treated with medial reefing and whether these parameters lead to a higher risk of recurrent dislocation. Methods Fifty-five patients (18.6 ± 6.6 years) who underwent medial reefing after primary traumatic patellar dislocation (84% with medial patellofemoral ligament [MPFL] rupture) were included. Patients were followed up for at least 24 months postoperatively (3.8 ± 1.2 years) to assess the incidence of recurrent patellar dislocation. In patients without recurrent dislocation, the Kujala and subjective IKDC scores were assessed. Moreover, the tibial tubercle-trochlear groove (TT-TG), sulcus angle, patellar tilt, patellar shift, and lateral trochlea index (LTI) were measured. The patellar height was measured using the Caton-Dechamps (CDI), Blackburne-Peel (BPI), and Insall-Salvati index (ISI). The cohort was subclassified into two groups with and without recurrent dislocation. Differences between groups were analyzed with respect to the MRI parameters. Results Forty percent had a pathological sulcus angle of > 145°, 7.2% had an LTI of < 11°, 47.3% had a patellar tilt of > 20°, and 36.4% had a TT-TG of ≥ 16 mm. Increased patellar height was observed in 34.5, 65.5, and 34.5% of the patients as per CDI, BPI, and ISI, respectively. Nineteen (34.5%) patients suffered from recurrent dislocation. Compared with patients without recurrent dislocation, those with recurrent dislocation had a significantly lower LTI (p = 0.0467). All other parameters were not significantly different between the groups. Risk factor analysis showed higher odds ratios (OR > 2), although not statistically significant, for MPFL rupture (OR 2.05 [95% confidence interval 0.38–11.03], LTI (6.6 [0.6–68.1]), TT-TG (2.9 [0.9–9.2]), and patellar height according to ISI (2.3 [0.7–7.5]) and CDI (2.3 [0.7–7.5])). Patients without recurrent dislocation had a Kujala score of 93.7 ± 12.1 (42–100) points and an IKDC score of 90.6 ± 11.7 (55.2–100) points. Conclusion Anatomical, MRI-based parameters should be considered before indicating medial reefing. A ruptured MPFL, an LTI < 11°, a TT-TG ≥ 16 mm, a patellar tilt > 20 mm, and an increased patellar height according to ISI and CDI were found to be associated, although not significantly, with a higher risk (OR > 2) of recurrent patellar dislocation after medial reefing. Thorough preoperative analysis is crucial to reduce the risk of recurrent dislocation in young patient cohorts. Level of evidence Level IV

scholarly journals Relationship of Patellofemoral Angles and Tibiofemoral Rotational Angles With Jumper’s Knee in Professional Dancers: An MRI Analysis

2021 ◽  
Vol 9 (3) ◽  
pp. 232596712098522
Author(s):  
Neslihan Aksu ◽  
Vefa Atansay ◽  
Işık Karalök ◽  
Taner Aksu ◽  
Ayhan Nedim Kara ◽  
...  
Keyword(s):  
Patellar Tendon ◽  
Tilt Angle ◽  
Patella Alta ◽  
Jumper’S Knee ◽  
Patellar Tilt ◽  
Sulcus Angle ◽  
Significant Difference ◽  
Mri Scans ◽  
Professional Dancers ◽  
Patellar Tilt Angle

Background: Jumper’s knee is a type of tendinopathy affecting the distal insertion of the quadriceps tendon (25% of cases) or the patellar tendon. It has been shown that frontal-plane measurements, such as genu valgum, genu varum, an increased quadriceps angle, a protuberant tibial tuberosity, patella alta, and short hamstring muscles, may be related to jumper’s knee. Purpose: To investigate the effects of tibiofemoral rotational angles and patellofemoral (PF) angles on the development of jumper’s knee in professional folk dancers. Study Design: Case-control study; Level of evidence, 3. Methods: We examined 26 dancers (16 male, 10 female) with knee pain using magnetic resonance imaging (MRI), for a total of 32 knees. Of the knees, 21 with quadriceps tendinopathy (QT) and 7 with patellar tendinopathy (PT) were detected. Using MRI scans, we measured PF angles (PF sulcus angle, lateral PF angle, patellar tilt angle, lateral trochlear inclination angle, lateral patellar tilt angle, and PF congruence angle) and tibiofemoral rotational angles (condylar twist angle, posterior condylar angle, femoral Insall angle, tibial Insall angle, posterior tibiofemoral angle, and angle between the Whiteside line and posterior femoral condylar line) and noted specifics such as patella alta, patella baja, and the Wiberg classification of the patellar shape between the patients with versus without QT and between patients with versus without PT to understand if there was any relationship with tendinopathy. Results: No statistically significant difference was observed in age, sex, patella alta, or the Wiberg classification between the QT groups (with vs without) and between the PT groups (with vs without) ( P > .05). Having QT was found to be significantly associated with the PF sulcus angle ( P = .009), and having PT was found to be significantly associated with the femoral Insall angle ( P = .029). Conclusion: Jumper’s knee was found to be associated with anatomic variations of the PF sulcus angle and rotation of the patellar tendon in relation to the femur (femoral Insall angle) on axial MRI scans in professional dancers. Unlike those of other athletes, dancers’ knees are exposed more to external rotation forces because of turnout, and this can be the cause of jumper’s knee.

1053 Comparing MRI Parameters in Quantifying Patellofemoral Instability

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
S Nagi ◽  
C Hing
Keyword(s):  
Soft Tissue ◽  
Tilt Angle ◽  
Patellofemoral Joint ◽  
Patellofemoral Instability ◽  
Trochlear Groove ◽  
Magnetic Resonance Imaging Measurement ◽  
Patellar Tilt ◽  
Significant Difference ◽  
Soft Tissue Changes ◽  
Patellar Tilt Angle

Abstract Aim Patellofemoral instability is where various stabilising factors of the patellofemoral joint undergo pathomorphological changes. It has an incidence rate of 5.8 per 100,000 in UK and has been associated with osteoarthritis[1]. Variations in the factors that stabilise the patellofemoral joint can be observed on MRI including measurements of the trochlea in relation to the patella, the femur and soft tissue changes. This study aims to compare different measures used to detect and quantify patellofemoral instability on MRIs and to look for any significant difference in their use both in isolation and together. Method 109 MRI reports of 78 patients diagnosed with patellofemoral instability were reviewed and all quantitative and qualitative parameters reported were inputted in a data table. Quantitative elements known as the Dejour protocol included the trochlear sulcus angle, patellar tilt angle, tibial tuberosity-trochlear groove distance and the Insall-Salvati ratio. Qualitative factors involved facet changes, patellar position, and any damage to soft tissue. Results It was found that the Insall-Salvati ratio greater than 1.2 and the patellar tilt angle of greater than 11 degrees irregular ranges had the greatest incidence in the MRI reports found 77.1% and 87.6% respectively in MRIs that reported them. Conclusions There is a discrepancy between quantitative parameters in their correlation with patellofemoral instability for the MRI reports observed. [1]: Ye Q, Yu T, Wu Y, Ding X, Gong X. Patellar instability: the reliability of magnetic resonance imaging measurement parameters. BMC Musculoskeletal Disorders. 2019;20(1).

scholarly journals Comparison of the Radiologic, Morphometric, and Clinical Outcomes between Kinematically and Mechanically Aligned Total Knee Arthroplasty: A Propensity Matching Study

2021 ◽  
Author(s):  
Tae Woo Kim ◽  
Jae Ik Lee ◽  
Han Gyeol Choi ◽  
Hyun Jin Yoo ◽  
Kyu Tae Kim ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Clinical Outcomes ◽  
Knee Arthroplasty ◽  
Tilt Angle ◽  
Patellar Tilt ◽  
Functional Scores ◽  
Propensity Matching ◽  
Total Knee ◽  
Preoperative Status ◽  
Patellar Tilt Angle

AbstractThe purpose of this study was to compare radiologic, morphometric, and clinical outcomes between kinematically aligned (KA) and mechanically aligned (MA) total knee arthroplasty (TKA) in Korean patients. Overall, 168 patients who underwent primary TKA were retrospectively reviewed, and propensity matching (age, sex, and body mass index) was performed as 1:3 ration (KA TKAs [n = 42]: MA TKAs [n = 126]). Joint-line orientation angle (JLOA), coronal and axial alignments of implants, hip–knee–ankle (HKA) angle, and patellar tilt angle were assessed using full-length standing radiograph, axial computed tomography (CT) scan, and plain radiographs. Morphometric assessment was performed by analyzing the intraoperative measurement of the femoral cut surface and femoral components fitting in five zones. Clinical outcomes more than 2 years of follow-up were evaluated with the Knee Society (KS) knee and functional scores, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, and the Short-Form Health Survey (SF-36). In radiologic results, JLOA was more parallel to the floor in KA TKAs (KA: medial tilt 0.9 ± 1.5 degrees; MA: lateral tilt 1.7 ± 1.5 degrees, p < 0.05), and patellar tilt angle was closer to preoperative status after KA TKA (KA: 2.0 ± 1.6 degrees; MA;0.3 ± 1.2 degrees, p < 0.05). HKA angle and rotational mismatch were similar between two groups. In morphometric analysis, entire overhang of anterior femoral cutting surface was reduced in KA TKA compared with MA TKA (KA: 11.7 ± 6.2 mm; MA: 14.4 ± 5.9 mm, p < 0.05). However, both of MA and KA TKAs showed underhang in mediolateral dimension without difference. There were no significant differences in clinical scores between two groups. KA TKA showed more parallel JLOA to floor, closer patellar tilt to preoperative status, and better anterior flange fitting that can reproduce more natural knee kinematics compared with MA TKA. Although clinical outcomes assessed by conventional evaluating tools were similar between two groups, further evaluation focusing on the patellofemoral symptoms or unawareness of TKA is necessary to clarify the clinical benefit of KA TKA.

Arthroscopic Medial Patellofemoral Ligament Reconstruction for Recurrent Patellar Dislocation: Short-term Clinical Results

2020 ◽  
Author(s):  
Yong Huang ◽  
Yuan Yang ◽  
Mingjin Zhong ◽  
Fan Su ◽  
Jian Xu ◽  
...  
Keyword(s):  
Patellar Dislocation ◽  
Medial Patellofemoral Ligament ◽  
Recurrent Dislocation ◽  
Clinical Results ◽  
Recurrent Patellar Dislocation ◽  
Patellar Tilt ◽  
Kujala Score ◽  
The Mean ◽  
Tegner Score

Abstract The present study aimed to introduce a novel technique to reconstruct medial patellofemoral ligament (MPFL) via arthroscopy for recurrent patellar dislocation. A retrospective review of a prospectively collected registry was undertaken. A total of 34 patients (35 knees) who underwent arthroscopic reconstruction of MPFL from December 2017 to August 2019 were identified. Kujala score, Tegner score, Lyscholm score, patellar tilt, and congruence angle were recorded preoperatively and postoperatively. The occurrences of patient satisfaction, complications, and recurrent dislocation were recorded. The cohort consisted of both genders equally, and the mean age was 21.0±7.8 years, the mean body mass index was 22.5±3.5, and the mean follow-up time was 21.8±5.6 months. The patellar tiltdecreased from 46.4±19.3° to 12.5±16.9° (P < 0.001), the congruence angle decreased from 46.4±19.3° to 12.5±16.9° (P < 0.001), Kujala score improved from 55.1±4 to 88.7±4.4 (P < 0.001); Tegner score improved from 1.3±0.4 to 3.7±1.1 (P < 0.001), and Lyscholm score improved from 55.5±3.9 to 89.1±4.8 (P < 0.001). Among them, 30 (88.2%) patients fully recovered to normal pain-free daily life, 24 patients (70.6%) returned to sports, 32 patients were satisfied with surgery, and no redislocations were encountered. MPFL reconstruction via arthroscopy improves the knee joint function in patients with recurrent patellar dislocation and is a safe and effective surgical treatment for recurrent patellar dislocation.

Sign in / Sign up

Export Citation Format

Share Document