FULL WEIGHT BEARING KINEMATIC MRI STUDY OF TT-TG DISTANCE: COMPARING PATIENTS WITH PATELLOFEMORAL PAIN TO HEALTHY INDIVIDUALS

2015 ◽  
Vol 21 (4.1) ◽  
pp. 638-642
Author(s):  
Andrius Brazaitis ◽  
Algirdas Tamosiunas ◽  
Janina Tutkuviene
Keyword(s):  
Patellar Instability ◽  
Weight Bearing ◽  
Patellofemoral Pain ◽  
Full Weight Bearing ◽  
Trochlear Groove ◽  
Patellar Tilt ◽  
Full Extension ◽  
Low Degrees ◽  
Mri Study ◽  
Kinematic Magnetic Resonance Imaging

Purpose. The aim of the present study was to investigate tibial tuberosity-trochlear groove (TT-TG) distance dynamics in patients with patellofemoral pain (PFP) and pain free individuals by using full weight bearing kinematic magnetic resonance imaging (MRI) And correlation with patellar instability. Materials and methods. 51 female individuals with PFP and 26 pain free female individuals participated in the study. The kinematic MRI was performed with 1,5 T MRI unit and full-weight bearing. TT-TG distance, bissect offset (BSO) and patellar tilt angle (PTA) were measured in steps of 10° between 50° of flexion to full extension. Results. The TT–TG was higher in PFP patients compared to volunteers’ from 40° to full extension. This difference was statistically significant (p<0.01). PFP patients demonstrated statistically significantly greater TT-TG distance increase from 30° to full extension. BSO and PTA were moderately correlated to TT-TG from 20° of flexion to full extension. Conclusion. TT-TG distance is dynamic and increases significantly during extension in patients with PFP and pain free individuals, depending on knee flexion angle. It shows different pattern of dynamics in PFP group. TT-TG distance is associated with patellar instability (BSO and PTA) at low degrees of flexion.

scholarly journals Patellar Kinematics, Part II: The Influence of the Depth of the Trochlear Groove in Subjects With and Without Patellofemoral Pain

2000 ◽  
Vol 80 (10) ◽  
pp. 965-973 ◽  
Author(s):  
Christopher M Powers
Keyword(s):  
Knee Flexion ◽  
Important Determinant ◽  
Knee Extension ◽  
Patellofemoral Pain ◽  
Trochlear Groove ◽  
Resonance Imaging ◽  
Patellar Tilt ◽  
Patellar Kinematics ◽  
Sulcus Angle ◽  
Kinematic Magnetic Resonance Imaging

Abstract Background and Purpose. A shallow intercondylar groove has been implicated as being contributory to abnormal patellar alignment. The purpose of this study was to assess the influence of the depth of the intercondylar groove on patellar kinematics. Subjects. Twenty-three women (mean age=26.8 years, SD=8.5, range=14–46) with a diagnosis of patellofemoral pain and 12 women (mean age=29.1 years, SD=5.0, range=24–38) without patellofemoral pain participated. Only female subjects were studied because of potential biomechanical differences between sexes. Methods. Patellar kinematics were assessed during resisted knee extension using kinematic magnetic resonance imaging. Measurements of medial and lateral patellar displacement and tilt were correlated with the depth of the trochlear groove (sulcus angle) at 45, 36, 27, 18, 9, and 0 degrees of knee flexion using regression analysis. Results. The depth of the trochlear groove was found to be correlated with patellar kinematics, with increased shallowness being predictive of lateral patellar tilt at 27, 18, 9, and 0 degrees of flexion and of lateral patellar displacement at 9 and 0 degrees of flexion (r=.51–.76). Conclusions and Discussion. The results of this study indicate that bony structure is an important determinant of patellar kinematics at end-range knee extension (0°–30°).

scholarly journals THE EFFECT OF TROCHLEAR DYSPLASIA ON COMMONLY USED RADIOGRAPHIC PARAMETERS TO ASSESS PATELLAR INSTABILITY

2019 ◽  
Vol 7 (3_suppl) ◽  
pp. 2325967119S0004
Author(s):  
Christopher Cheng ◽  
Sheeba M. Joseph ◽  
Matthew J. Solomito ◽  
James L. Pace
Keyword(s):  
Regression Analysis ◽  
Patellar Instability ◽  
Trochlear Dysplasia ◽  
Inverse Correlation ◽  
Patellar Height ◽  
Trochlear Groove ◽  
Significant Inverse Correlation ◽  
Patellar Tilt ◽  
Rater Reliability ◽  
Novel Technique

Background: Patellar instability (PI) is a relatively rare knee condition but most commonly occurs in children and adolescents. The etiology of PI is complex and multi-faceted. Trochlear dysplasia, patellar tilt, tibial tuberosity-trochlear groove (TT-TG) distance, and patella alta have all been cited as contributory factors. Some authors have postulated that trochlear dysplasia (TD) alters the patellofemoral joint such that several of these radiographic parameters are changed relative to the amount of TD present. However, methods to quantify TD have not reached universal agreement. The lateral trochlear inclination (LTI) is one measure that has been described to characterize and quantify trochlear morphology on axial MRI images. Recently, a modified technique for measuring LTI that references the femur’s posterior condylar axis has demonstrated near-perfect inter- and within-rater reliability (ICC: 0.971, 95% CI: 0.88 – 0.97) and may serve as a new method to reliably quantify TD. The purpose of this study was to evaluate this modified LTI measurement against historically used radiographic measures of PI including TT-TG distance, lateral patellar inclination (LPI) angle, and the Caton-Deschamps (CD) ratio. We hypothesized that lower LTI measurements (i.e. more dysplastic trochleas) would be associated with higher TT-TG distances, increased patellar tilt, more patella alta and vice versa. Methods: Patients aged nine to eighteen years who were treated for PI at our tertiary referral center between January 2014 and August 2017 were queried. Radiographs and MRI exams of the symptomatic knee were obtained for measurement. On MRI, LTI measurements were made using the novel technique with reference to the orientation of the fully-formed posterior condyles. LPI measurements were conducted using a novel technique where the angle of the widest portion of the patella is measured relative to the posterior femoral condyles (ICC = 0.885, 95% CI: 0.77 – 0.95). TT-TG distances were measured on MRI from both the proximal (pTT-TG) and distal (dTT-TG) extents of the trochlea. The CD ratio was measured on lateral radiographs. All measurements were made by three independent observers. A separate cohort was randomly selected from the original list for the same measurements on two occasions, at least two weeks apart. Inter- and intra-rater correlation coefficients were then calculated using this subgroup and regression analysis was performed using data from the entire cohort. Results: Sixty-five patients met inclusion criteria for this study, from which thirty were selected for reliability analysis. Average pTT-TG distance (15.7±4.5 mm) was not significantly different from dTT-TG distance (15.7±4.2 mm) (p=0.94). Good inter-rater reliability was found for both pTT-TG (ICC=0.78, 95% CI: 0.59-0.89) and dTT-TG (ICC=0.83, 95% CI: 0.66-0.91). Both measurements also had excellent within-rater reliability (ICC=0.95, 95% CI: 0.90-0.98 for pTT-TG; ICC=0.90, 95% CI: 0.80-0.95 for dTT-TG). Linear regression analysis showed LTI to have a weak but significant inverse correlation with both pTT-TG (r = -0.40, b=-0.15 mm, p<0.001) and dTT-TG (r = -0.59, b=-0.21 mm, p<0.001). LTI also showed moderate and significant inverse correlation with LPI (r = -0.69, b=-0.54degrees, p<0.001). The average CD ratio was 1.3±0.3 (range 0.8-2.1). LTI did not show significant correlation with the CD ratio (r = -0.19, p=0.14). Moderate inter-rater reliability (ICC=0.62, 95% CI: 0.34-0.80) and high intra-rater reliability (ICC=0.82, 95% CI: 0.66-0.91) were found for CD ratio measurements. Conclusion/Significance: In our cohort, smaller LTI measurements (higher levels of dysplasia) were found to be significantly correlated with larger TT-TG measurements and greater patellar inclination angles which supports the notion that these radiographic measures are dependent variables relative to dysplasia and thus may not be consistent independent risk factors for patellar instability. Interestingly, pTT-TG and dTT-TG distances were not significantly different, suggesting that while TD tends to medialize the trochlear groove, once the groove is formed it proceeds distally in a fairly straight line. The CD ratio was not found to be correlated with dysplasia represented by LTI in this cohort which suggests that patellar height is independent of dysplasia. Taken together, the results of this study suggest that TD may be the principal anatomic risk factor for patellar instability and that the TT-TG and patellar tilt are altered secondary to TD. Patellar height did not have a correlation with TD and thus should be analyzed separately as to its role in patellar instability.

scholarly journals Current methods of patellar instability imaging in children. Selection of the best treatment approach

2018 ◽  
Vol 6 (2) ◽  
pp. 29-36 ◽  
Author(s):  
Alexander A. Sautenko ◽  
Egor V. Ogarev ◽  
Alexander G. Eltsin ◽  
Vladimir N. Merkulov ◽  
Dmitry S. Mininkov
Keyword(s):  
Patellar Dislocation ◽  
Patellar Instability ◽  
Multislice Ct ◽  
Diagnostic Algorithm ◽  
Treatment Method ◽  
Optimal Treatment ◽  
Tibial Tubercle ◽  
Trochlear Groove ◽  
Patellar Tilt ◽  
Selection Of

Background. Patellar instability is a common problem in pediatric patients. Up to 2%–3% of all knee injuries are associated with acute patellar dislocation. According to the data in the literature, patients aged 10–17 years are at the highest risk of patellar dislocation and subsequent instability. These patients must be evaluated according to the proposed algorithm to select the optimal treatment method. Aim. To diagnose patellar instability in children and subsequently select the optimal treatment method based on acquired data. Materials and methods. The study is based on data acquired through the examination and treatment of 147 patients at the 9th Department of Pediatric Traumatology and Orthopedics. Great emphasis was put on computed tomography (CT) data, its essential parameters, which require the most thorough analysis, and assessment methods. These parameters include patellar tilt, dysplasia of the distal metaepiphysis of the femur, the tibial tubercle–trochlear groove index, and the rotational relation of the femur and tibia. Results. A novel algorithm for patient examination using CT is proposed. Data obtained by multislice CT (MSCT) had a significant influence on the selection of the surgical method for treating patients with patellar instability. Conclusion. The examination of patients with patellar instability using MSCT in adherence to the proposed diagnostic algorithm allows the selection of the optimal treatment method, which will increase the likelihood of rapid recovery of patients and their return to the level of activity similar to that before injury.

scholarly journals Predictors of Patellofemoral Pain Applying Full Weight Bearing Kinematic MRI

2015 ◽  
Vol 12 ◽  
pp. 43-51 ◽  
Author(s):  
Andrius Brazaitis ◽  
Andrius Gocentas ◽  
Algirdas Tamošiūnas ◽  
Janina Tutkuvienė
Keyword(s):  
Weight Bearing ◽  
Patellofemoral Pain ◽  
Full Weight Bearing

scholarly journals Effect of Trochlear Dysplasia on Commonly Used Radiographic Parameters to Assess Patellar Instability

2020 ◽  
Vol 8 (7) ◽  
pp. 232596712093876
Author(s):  
J. Lee Pace ◽  
Chris Cheng ◽  
Sheeba M. Joseph ◽  
Matthew J. Solomito
Keyword(s):  
Risk Factors ◽  
Patellar Instability ◽  
Trochlear Dysplasia ◽  
Inverse Correlation ◽  
Trochlear Groove ◽  
Modified Technique ◽  
Significant Inverse Correlation ◽  
Patellar Tilt ◽  
Level Of Evidence ◽  
The Relationship

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.

scholarly journals Patellar instability MRI measurements are associated with knee joint degeneration after reconstruction of the medial patellofemoral ligament

2021 ◽  
Author(s):  
Paula Giesler ◽  
Frederic A. Baumann ◽  
Dominik Weidlich ◽  
Dimitrios C. Karampinos ◽  
Matthias Jung ◽  
...  
Keyword(s):  
Risk Factors ◽  
Knee Joint ◽  
Patellar Instability ◽  
Mpfl Reconstruction ◽  
Trochlear Groove ◽  
Joint Degeneration ◽  
Patellar Tilt ◽  
Magnetic Resonance Imaging Mri ◽  
Patellar Stability

Abstract Objective To qualitatively and quantitatively evaluate the 2-year magnetic resonance imaging (MRI) outcome after MPFL reconstruction at the knee and to assess MRI-based risk factors that predispose for inferior clinical and imaging outcomes. Materials and methods A total of 31 patients with MPFL reconstruction were included (22 ± 6 years, 10 female). MRI was performed preoperatively in 21/31 patients. Two-year follow-up MRI included quantitative cartilage T2 and T1rho relaxation time measurements at the ipsilateral and contralateral knee. T2relative was calculated as T2patellofemoral/T2femorotibial. Morphological evaluation was conducted via WORMS scores. Patellar instability parameters and clinical scores were obtained. Statistical analyses included descriptive statistics, t-tests, multivariate regression models, and correlation analyses. Results Two years after MPFL reconstruction, all patellae were clinically stable. Mean total WORMS scores improved significantly from baseline to follow-up (mean difference ± SEM, − 4.0 ± 1.3; P = 0.005). As compared to patients with no worsening of WORMS subscores over time (n = 5), patients with worsening of any WORMS subscore (n = 16) had lower trochlear depth, lower facetal ratio, higher tibial-tuberosity to trochlear groove (TTTG) distance, and higher postoperative lateral patellar tilt (P < 0.05). T2relative was higher at the ipsilateral knee (P = 0.010). T2relative was associated with preoperatively higher patellar tilt (P = 0.021) and higher TTTG distance (P = 0.034). TTTG distance, global T2 values, and WORMS progression correlated with clinical outcomes (P < 0.05). Conclusion MPFL reconstruction is an optimal treatment strategy to restore patellar stability. Still, progressive knee joint degeneration and patellofemoral cartilage matrix degeneration may be observed, with patellar instability MRI parameters representing particular risk factors.

scholarly journals MPFL reconstruction and tibial tuberosity transposition in patients with patellar instability: May it troubleshots also trochlear dysplasia?

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
A. Castelli ◽  
E. Jannelli ◽  
E. Ferranti Calderoni ◽  
G. Galanzino ◽  
A. Ivone ◽  
...  
Keyword(s):  
Patellar Instability ◽  
Trochlear Dysplasia ◽  
Functional Results ◽  
Activity Level ◽  
Tibial Tuberosity ◽  
Mpfl Reconstruction ◽  
Trochlear Groove ◽  
Patellar Tilt ◽  
Sulcus Angle

Abstract Purpose This study aimed to highlight short- and medium-term outcomes of combined medial patello-femoral ligament (MPFL) reconstruction and anterior tibial tuberosity (ATT) transposition surgery in patients with recurrent patellar instability and different degrees of trochlear dysplasia. Methods Between January 2014 and May 2019, 25 patients with patellar instability underwent a surgical procedure combining the lowering/transposition of the ATT and the MPFL reconstruction. Each patient were preoperative assessed by Kujala score, International Knee Documentation Committee (IKDC), Tegner activity level scale. The assessment of instability predisposing factors was carried out with patellar height, tibial tuberosity-trochlear groove (TT-TG) distance, trochlear dysplasia, sulcus angle, patellar tilt and MPFL injuries. Functional outcomes were evaluated with Kujala, IKDC and Tegner scores at 3, 6 and 12 months after surgery. Results The average age of the patients was 20 years (range 13–43 years). Pre- operative Caton–Deschamps index was pathological in 10 (40%). Sulcus angle was elevated in 13 patients (52%) and TT-TG distance was irregular in 17 patients (68%). Trochlear dysplasia was present in 13 patients (9 type A, 3 type B, 1 type C according to Dejour’s Classification). No re-dislocation occurred during the follow-up. There was a significant increase in the Kujala, IKDC and Lysholm scores after 3, 6 and 12 months, and the results were compared for the different follow-up times and patient’s trochlear dysplasia degree. Conclusion This prospective observational longitudinal study identified good clinical outcomes in patients who underwent MPFL reconstruction and ATT transposition for patellar instability. Finally, the different risk factors for patellar instability examined, particularly the presence of trochlear dysplasia, did not significantly influence the final functional results, which range from good to excellent without re-dislocation episodes.

scholarly journals Arthroscopy pull through for management of eminentia tibia fracture in 15 years old adolescent: a case report

2020 ◽  
Vol 8 (12) ◽  
pp. 4476
Author(s):  
Anak Agung Gde Duta Maha Putra ◽  
Made Agus Maharjana
Keyword(s):  
Functional Outcome ◽  
Cruciate Ligament ◽  
Weight Bearing ◽  
Left Knee ◽  
Tibia Fracture ◽  
Full Weight Bearing ◽  
Full Extension ◽  
Multiple Treatment ◽  
Tibial Eminence ◽  
Pull Through

Tibial eminence fractures are rare injuries. Multiple treatment techniques are described and there is a lack of consensus with regard to the choice of treatment. In this case, we present the left eminentia tibia fracture which stabilized using arthroscopy pull through technique in a 15 years old male adolescent. A male 15 years old adolescent complained of pain on his left knee after climbing a tree and jumped with his left knee in hyperextention. On physical examination, tenderness was felt around the apex of patella. Left knee X-Ray confirmed a fracture of eminentia tibia. On arthroscopic evaluation, there was a fracture of medial eminentia tibia meyers and mckeever IIIA. The fractures were treated by using 1 mm ethibond which was inserted through the anterior cruciate ligament and pull through the tibia plateau. 10 weeks evaluation after the procedure, patient was able to walk independently with full weight bearing and was able to flex his knee in 130˚ and full extension without any pain. Management of displaced fracture of eminentia tibia is somewhat controversial and the ideal method of fixation has not been defined. In this patient, there were perfect anatomic and functional outcome without any serious complication. Arthroscopic reduction and internal fixation by pull through suture provide perfect anatomic and functional outcome for displaced type II and type III tibial eminence fracture.

Patellofemoral joint biomechanics in the females with anterior knee pain applying full weight bearing kinematic MRI

2015 ◽  
Vol 22 (1) ◽  
pp. 47-53
Author(s):  
Andrius Brazaitis ◽  
Algirdas Tamošiūnas ◽  
Janina Tutkuvienė
Keyword(s):  
Tilt Angle ◽  
Patellofemoral Joint ◽  
Weight Bearing ◽  
Full Weight Bearing ◽  
Femoral Rotation ◽  
Full Extension ◽  
Patella Tilt ◽  
Significant Difference ◽  
Joint Biomechanics ◽  
Lateral Patella

Purpose. The aim of the study was to evaluate biomechanics of the patellofemoral joint using full weight bearing kinematic MRI. We postulated that females with unilateral PFP might have greater medial femoral rotation in comparrison to the contralateral knee, also greater lateral patella tilt and displacement. Methods. Forty four females aged 20–40  years with unilateral PFP were included in the study. The kinematic MRI examination was performed with a 1.5 T MRI unit. Full-weight bearing was used. Sagittal and axial images of the patellofemoral joint were acquired with a transmit-receive surface body coil. The study parameters, i. e. bisect offset, patella tilt angle, medial femoral rotation, patellar rotation at 0, 10, 20, 30, 40, 50° of flexion, were measured for both knees. Results. Statistically significant changes were confirmed for greater bisect offset at all angles of flexion. The patella tilt angle increased steadily throughout full extension, but there was no significant difference in the tilt angle at 50° flexion. Greater medial femoral rotation was observed at all degrees of flexion, while patellar rotation showed no difference. Conclusions. Our study has confirmed the growing body of literature, theorizing that the primary cause of PFP pain is altered femur dynamics under relatively stable patella.

Patellar position in weight-bearing radiographs compared with non-weight-bearing: significance for the detection of osteoarthritis

2016 ◽  
Vol 58 (3) ◽  
pp. 331-337 ◽  
Author(s):  
Nikolaj Skou ◽  
Niels Egund
Keyword(s):  
Supine Position ◽  
Weight Bearing ◽  
Joint Space Width ◽  
Joint Space ◽  
Standing Position ◽  
Trochlear Groove ◽  
Patellar Tilt ◽  
Patellar Position ◽  
Age Range ◽  
Space Width

Background Diagnosis and treatment of patellofemoral disorders including osteoarthritis are currently often based on imaging and clinical assessment with patients in the supine position. Purpose To evaluate differences in patellar position in the trochlear groove and to assess the detection of medial and lateral patellofemoral (PF) osteoarthritis (OA) on axial radiographs in supine and standing positions, respectively. Material and Methods Thirty-five women and 23 men (mean age, 56 years; age range, 18–87 years) referred for routine radiographic examinations of the knees were included. Axial radiographs of the PF joint in both supine non-weight-bearing and standing weight-bearing position in 30° knee flexion were obtained of 111 knees. Measurements performed on the radiographs: patellar tilt, patellar displacement, joint space width, and grade of OA according to Ahlbäck. Results From supine to standing position the patella moved medially and medial joint space width and lateral patellar tilt angle decreased ( P < 0.0001 for the three measured parameters). In the standing position, medial PF OA was observed in 19 knees compared to three knees in the supine position. Fourteen knees had lateral PF OA with almost unchanged grade of OA irrespective of position. Conclusion In weight-bearing positions, the patella is positioned medially in the trochlear groove compared to supine non-weight-bearing positions. Therefore, this study suggests that the common occurrence of medial PF OA can generally not be detected on axial radiographs in supine non-weight-bearing positions and confirms the importance of imaging the PF joint in standing weight-bearing positions.

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