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Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy 3/2020

02.07.2019 | KNEE

Static patella tilt and axial engagement in knee extension are mainly influenced by knee torsion, the tibial tubercle–trochlear groove distance (TTTG), and trochlear dysplasia but not by femoral or tibial torsion

verfasst von: P. Kaiser, F. Loth, R. Attal, M. Kummann, P. Schuster, F. Riechelmann, M. Schlumberger

Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy | Ausgabe 3/2020

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Abstract

Purpose

The aim of this study was to investigate the association of femoral (FT), tibial (TT), and knee torsion (KT) on the patella tilt (PT), the axial engagement index (AEI), and the tibial tuberosity–trochlear groove distance (TTTG).

Methods

Femoral torsion, tibial torsion, knee torsion, patella tilt, the axial engagement index, the TTTG, and trochlear dysplasia were retrospectively evaluated on 59 patients suffering from recurrent patella instability or anterior knee pain with 118 torsional lower limb magnetic resonance imaging studies.

Results

FT and TT did not show any significant associations with TTTG, PT, and AEI (n.s.). KT was significantly associated with a higher TTTG, higher PT, and lower AEI (all, p < 0.001). Higher grade trochlear dysplasia was associated with a higher PT and lower AEI (both, p < 0.001). The Dejour classification showed no significant association with FT, TT, KT, and TTTG (n.s.). All measurement parameters showed an excellent interrater agreement (ICC 0.89–0.97).

Conclusions

Static patella tilt and patellofemoral axial engagement in knee extension are mainly influenced by knee torsion, TTTG, and trochlear dysplasia but not by femoral or tibial torsion. These findings help to understand the underlying reasons for the patella position in knee extensions in CT and MRI investigations in patients suffering from patella instability and patellofemoral pain syndrome.

Level of evidence

III.
Literatur
1.
Zurück zum Zitat Abadie P, Galaud B, Michaut M, Fallet L, Boisrenoult P, Beaufils P (2009) Distal femur rotational alignment and patellar subluxation: a CT scan in vivo assessment. Orthop Traumatol Surg Res 95:267–271PubMedCrossRef Abadie P, Galaud B, Michaut M, Fallet L, Boisrenoult P, Beaufils P (2009) Distal femur rotational alignment and patellar subluxation: a CT scan in vivo assessment. Orthop Traumatol Surg Res 95:267–271PubMedCrossRef
2.
Zurück zum Zitat Airanow S, Zippel H (1990) Femoro-tibial torsion in patellar instability. A contribution to the pathogenesis of recurrent and habitual patellar dislocations. Beitr Orthop Traumatol 37:311–316PubMed Airanow S, Zippel H (1990) Femoro-tibial torsion in patellar instability. A contribution to the pathogenesis of recurrent and habitual patellar dislocations. Beitr Orthop Traumatol 37:311–316PubMed
3.
Zurück zum Zitat Askenberger M, Janarv PM, Finnbogason T, Arendt EA (2017) Morphology and anatomic patellar instability risk factors in first-time traumatic lateral patellar dislocations. Am J Sports Med 45:50–58PubMedCrossRef Askenberger M, Janarv PM, Finnbogason T, Arendt EA (2017) Morphology and anatomic patellar instability risk factors in first-time traumatic lateral patellar dislocations. Am J Sports Med 45:50–58PubMedCrossRef
4.
Zurück zum Zitat Balcarek P, Oberthur S, Hopfensitz S, Frosch S, Walde TA, Wachowski MM et al (2014) Which patellae are likely to redislocate? Knee Surg Sports Traumatol Arthrosc 22:2308–2314PubMedCrossRef Balcarek P, Oberthur S, Hopfensitz S, Frosch S, Walde TA, Wachowski MM et al (2014) Which patellae are likely to redislocate? Knee Surg Sports Traumatol Arthrosc 22:2308–2314PubMedCrossRef
5.
Zurück zum Zitat Balcarek P, Radebold T, Schulz X, Vogel D (2019) Geometry of torsional malalignment syndrome: trochlear dysplasia but not torsion predicts lateral patellar instability. Orthop J Sports Med 7:2325967119829790PubMedPubMedCentralCrossRef Balcarek P, Radebold T, Schulz X, Vogel D (2019) Geometry of torsional malalignment syndrome: trochlear dysplasia but not torsion predicts lateral patellar instability. Orthop J Sports Med 7:2325967119829790PubMedPubMedCentralCrossRef
6.
Zurück zum Zitat Balcarek P, Terwey A, Jung K, Walde TA, Frosch S, Schuttrumpf JP et al (2013) Influence of tibial slope asymmetry on femoral rotation in patients with lateral patellar instability. Knee Surg Sports Traumatol Arthrosc 21:2155–2163PubMedCrossRef Balcarek P, Terwey A, Jung K, Walde TA, Frosch S, Schuttrumpf JP et al (2013) Influence of tibial slope asymmetry on femoral rotation in patients with lateral patellar instability. Knee Surg Sports Traumatol Arthrosc 21:2155–2163PubMedCrossRef
8.
Zurück zum Zitat Chassaing V, Zeitoun JM, Camara M, Blin JL, Marque S, Chancelier MD (2017) Tibial tubercle torsion, a new factor of patellar instability. Orthop Traumatol Surg Res 103:1173–1178PubMedCrossRef Chassaing V, Zeitoun JM, Camara M, Blin JL, Marque S, Chancelier MD (2017) Tibial tubercle torsion, a new factor of patellar instability. Orthop Traumatol Surg Res 103:1173–1178PubMedCrossRef
9.
Zurück zum Zitat Dejour D, Le Coultre B (2007) Osteotomies in patello-femoral instabilities. Sports Med Arthrosc 15:39–46PubMedCrossRef Dejour D, Le Coultre B (2007) Osteotomies in patello-femoral instabilities. Sports Med Arthrosc 15:39–46PubMedCrossRef
10.
Zurück zum Zitat Dejour H, Walch G, Nove-Josserand L, Guier C (1994) Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc 2:19–26PubMedCrossRef Dejour H, Walch G, Nove-Josserand L, Guier C (1994) Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc 2:19–26PubMedCrossRef
11.
Zurück zum Zitat Dickschas J, Harrer J, Pfefferkorn R, Strecker W (2012) Operative treatment of patellofemoral maltracking with torsional osteotomy. Arch Orthop Trauma Surg 132:289–298PubMedCrossRef Dickschas J, Harrer J, Pfefferkorn R, Strecker W (2012) Operative treatment of patellofemoral maltracking with torsional osteotomy. Arch Orthop Trauma Surg 132:289–298PubMedCrossRef
12.
Zurück zum Zitat Diederichs G, Kohlitz T, Kornaropoulos E, Heller MO, Vollnberg B, Scheffler S (2013) Magnetic resonance imaging analysis of rotational alignment in patients with patellar dislocations. Am J Sports Med 41:51–57PubMedCrossRef Diederichs G, Kohlitz T, Kornaropoulos E, Heller MO, Vollnberg B, Scheffler S (2013) Magnetic resonance imaging analysis of rotational alignment in patients with patellar dislocations. Am J Sports Med 41:51–57PubMedCrossRef
13.
Zurück zum Zitat Eckhoff DG, Brown AW, Kilcoyne RF, Stamm ER (1997) Knee version associated with anterior knee pain. Clin Orthop Relat Res 339:152–155CrossRef Eckhoff DG, Brown AW, Kilcoyne RF, Stamm ER (1997) Knee version associated with anterior knee pain. Clin Orthop Relat Res 339:152–155CrossRef
14.
Zurück zum Zitat Eckhoff DG, Montgomery WK, Kilcoyne RF, Stamm ER (1994) Femoral morphometry and anterior knee pain. Clin Orthop Relat Res 302:64–68 Eckhoff DG, Montgomery WK, Kilcoyne RF, Stamm ER (1994) Femoral morphometry and anterior knee pain. Clin Orthop Relat Res 302:64–68
15.
Zurück zum Zitat Erkocak OF, Altan E, Altintas M, Turkmen F, Aydin BK, Bayar A (2016) Lower extremity rotational deformities and patellofemoral alignment parameters in patients with anterior knee pain. Knee Surg Sports Traumatol Arthrosc 24:3011–3020PubMedCrossRef Erkocak OF, Altan E, Altintas M, Turkmen F, Aydin BK, Bayar A (2016) Lower extremity rotational deformities and patellofemoral alignment parameters in patients with anterior knee pain. Knee Surg Sports Traumatol Arthrosc 24:3011–3020PubMedCrossRef
16.
Zurück zum Zitat Fleiss J (1986) The design and analysis of clinical experiments. Wiley, New Yoek Fleiss J (1986) The design and analysis of clinical experiments. Wiley, New Yoek
17.
Zurück zum Zitat Freedman BR, Sheehan FT (2013) Predicting three-dimensional patellofemoral kinematics from static imaging-based alignment measures. J Orthop Res 31:441–447PubMedCrossRef Freedman BR, Sheehan FT (2013) Predicting three-dimensional patellofemoral kinematics from static imaging-based alignment measures. J Orthop Res 31:441–447PubMedCrossRef
19.
Zurück zum Zitat Fulkerson JP, Schutzer SF, Ramsby GR, Bernstein RA (1987) Computerized tomography of the patellofemoral joint before and after lateral release or realignment. Arthroscopy 3:19–24PubMedCrossRef Fulkerson JP, Schutzer SF, Ramsby GR, Bernstein RA (1987) Computerized tomography of the patellofemoral joint before and after lateral release or realignment. Arthroscopy 3:19–24PubMedCrossRef
20.
Zurück zum Zitat Grelsamer RP, Weinstein CH, Gould J, Dubey A (2008) Patellar tilt: the physical examination correlates with MR imaging. Knee 15:3–8PubMedCrossRef Grelsamer RP, Weinstein CH, Gould J, Dubey A (2008) Patellar tilt: the physical examination correlates with MR imaging. Knee 15:3–8PubMedCrossRef
21.
Zurück zum Zitat Guilbert S, Chassaing V, Radier C, Hulet C, Remy F, Chouteau J et al (2013) Axial MRI index of patellar engagement: a new method to assess patellar instability. Orthop Traumatol Surg Res 99:S399–S405PubMedCrossRef Guilbert S, Chassaing V, Radier C, Hulet C, Remy F, Chouteau J et al (2013) Axial MRI index of patellar engagement: a new method to assess patellar instability. Orthop Traumatol Surg Res 99:S399–S405PubMedCrossRef
22.
Zurück zum Zitat Hinterwimmer S, Rosenstiel N, Lenich A, Waldt S, Imhoff AB (2012) Femoral osteotomy for patellofemoral instability. Unfallchirurg 115:410–416PubMedCrossRef Hinterwimmer S, Rosenstiel N, Lenich A, Waldt S, Imhoff AB (2012) Femoral osteotomy for patellofemoral instability. Unfallchirurg 115:410–416PubMedCrossRef
24.
Zurück zum Zitat Jend HH, Heller M, Dallek M, Schoettle H (1981) Measurement of tibial torsion by computer tomography. Acta Radiol Diagn (Stockh) 22:271–276CrossRef Jend HH, Heller M, Dallek M, Schoettle H (1981) Measurement of tibial torsion by computer tomography. Acta Radiol Diagn (Stockh) 22:271–276CrossRef
25.
Zurück zum Zitat Kaiser P, Attal R, Kammerer M, Thauerer M, Hamberger L, Mayr R et al (2016) Significant differences in femoral torsion values depending on the CT measurement technique. Arch Orthop Trauma Surg 136:1259–1264PubMedPubMedCentralCrossRef Kaiser P, Attal R, Kammerer M, Thauerer M, Hamberger L, Mayr R et al (2016) Significant differences in femoral torsion values depending on the CT measurement technique. Arch Orthop Trauma Surg 136:1259–1264PubMedPubMedCentralCrossRef
26.
Zurück zum Zitat Kaiser P, Schmoelz W, Schoettle P, Zwierzina M, Heinrichs C, Attal R (2017) Increased internal femoral torsion can be regarded as a risk factor for patellar instability—a biomechanical study. Clin Biomech (Bristol, Avon) 47:103–109CrossRef Kaiser P, Schmoelz W, Schoettle P, Zwierzina M, Heinrichs C, Attal R (2017) Increased internal femoral torsion can be regarded as a risk factor for patellar instability—a biomechanical study. Clin Biomech (Bristol, Avon) 47:103–109CrossRef
27.
Zurück zum Zitat Laugharne E, Bali N, Purushothamdas S, Almallah F, Kundra R (2016) Variability of measurement of patellofemoral indices with knee flexion and quadriceps contraction: an MRI-based anatomical study. Knee Surg Relat Res 28:297–301PubMedPubMedCentralCrossRef Laugharne E, Bali N, Purushothamdas S, Almallah F, Kundra R (2016) Variability of measurement of patellofemoral indices with knee flexion and quadriceps contraction: an MRI-based anatomical study. Knee Surg Relat Res 28:297–301PubMedPubMedCentralCrossRef
28.
Zurück zum Zitat Liebensteiner MC, Ressler J, Seitlinger G, Djurdjevic T, El Attal R, Ferlic PW (2016) High femoral anteversion is related to femoral trochlea dysplasia. Arthroscopy 32:2295–2299PubMedCrossRef Liebensteiner MC, Ressler J, Seitlinger G, Djurdjevic T, El Attal R, Ferlic PW (2016) High femoral anteversion is related to femoral trochlea dysplasia. Arthroscopy 32:2295–2299PubMedCrossRef
29.
Zurück zum Zitat Lin YF, Jan MH, Lin DH, Cheng CK (2008) Different effects of femoral and tibial rotation on the different measurements of patella tilting: an axial computed tomography study. J Orthop Surg Res 3:5PubMedPubMedCentralCrossRef Lin YF, Jan MH, Lin DH, Cheng CK (2008) Different effects of femoral and tibial rotation on the different measurements of patella tilting: an axial computed tomography study. J Orthop Surg Res 3:5PubMedPubMedCentralCrossRef
30.
Zurück zum Zitat Liodakis E, Doxastaki I, Chu K, Krettek C, Gaulke R, Citak M et al (2012) Reliability of the assessment of lower limb torsion using computed tomography: analysis of five different techniques. Skelet Radiol 41:305–311CrossRef Liodakis E, Doxastaki I, Chu K, Krettek C, Gaulke R, Citak M et al (2012) Reliability of the assessment of lower limb torsion using computed tomography: analysis of five different techniques. Skelet Radiol 41:305–311CrossRef
32.
Zurück zum Zitat Petersen W, Ellermann A, Gosele-Koppenburg A, Best R, Rembitzki IV, Bruggemann GP et al (2014) Patellofemoral pain syndrome. Knee Surg Sports Traumatol Arthrosc 22:2264–2274PubMedCrossRef Petersen W, Ellermann A, Gosele-Koppenburg A, Best R, Rembitzki IV, Bruggemann GP et al (2014) Patellofemoral pain syndrome. Knee Surg Sports Traumatol Arthrosc 22:2264–2274PubMedCrossRef
33.
Zurück zum Zitat Post WR, Teitge R, Amis A (2002) Patellofemoral malalignment: looking beyond the viewbox. Clin Sports Med 21:521–546PubMedCrossRef Post WR, Teitge R, Amis A (2002) Patellofemoral malalignment: looking beyond the viewbox. Clin Sports Med 21:521–546PubMedCrossRef
34.
Zurück zum Zitat Powers CM (2003) The influence of altered lower-extremity kinematics on patellofemoral joint dysfunction: a theoretical perspective. J Orthop Sports Phys Ther 33:639–646PubMedCrossRef Powers CM (2003) The influence of altered lower-extremity kinematics on patellofemoral joint dysfunction: a theoretical perspective. J Orthop Sports Phys Ther 33:639–646PubMedCrossRef
35.
Zurück zum Zitat Powers CM, Shellock FG, Pfaff M (1998) Quantification of patellar tracking using kinematic MRI. J Magn Reson Imaging 8:724–732PubMedCrossRef Powers CM, Shellock FG, Pfaff M (1998) Quantification of patellar tracking using kinematic MRI. J Magn Reson Imaging 8:724–732PubMedCrossRef
36.
Zurück zum Zitat Saggin PR, Saggin JI, Dejour D (2012) Imaging in patellofemoral instability: an abnormality-based approach. Sports Med Arthrosc Rev 20:145–151PubMedCrossRef Saggin PR, Saggin JI, Dejour D (2012) Imaging in patellofemoral instability: an abnormality-based approach. Sports Med Arthrosc Rev 20:145–151PubMedCrossRef
37.
Zurück zum Zitat Seitlinger G, Scheurecker G, Hogler R, Labey L, Innocenti B, Hofmann S (2012) Tibial tubercle-posterior cruciate ligament distance: a new measurement to define the position of the tibial tubercle in patients with patellar dislocation. Am J Sports Med 40:1119–1125PubMedCrossRef Seitlinger G, Scheurecker G, Hogler R, Labey L, Innocenti B, Hofmann S (2012) Tibial tubercle-posterior cruciate ligament distance: a new measurement to define the position of the tibial tubercle in patients with patellar dislocation. Am J Sports Med 40:1119–1125PubMedCrossRef
38.
Zurück zum Zitat Souza RB, Draper CE, Fredericson M, Powers CM (2010) Femur rotation and patellofemoral joint kinematics: a weight-bearing magnetic resonance imaging analysis. J Orthop Sports Phys Ther 40:277–285PubMedCrossRef Souza RB, Draper CE, Fredericson M, Powers CM (2010) Femur rotation and patellofemoral joint kinematics: a weight-bearing magnetic resonance imaging analysis. J Orthop Sports Phys Ther 40:277–285PubMedCrossRef
39.
Zurück zum Zitat Takagi S, Sato T, Watanabe S, Tanifuji O, Mochizuki T, Omori G et al (2018) Alignment in the transverse plane, but not sagittal or coronal plane, affects the risk of recurrent patella dislocation. Knee Surg Sports Traumatol Arthrosc 26:2891–2898PubMedCrossRef Takagi S, Sato T, Watanabe S, Tanifuji O, Mochizuki T, Omori G et al (2018) Alignment in the transverse plane, but not sagittal or coronal plane, affects the risk of recurrent patella dislocation. Knee Surg Sports Traumatol Arthrosc 26:2891–2898PubMedCrossRef
40.
Zurück zum Zitat Teitge RA (2006) Osteotomy in the treatment of patellofemoral instability. Tech Knee Surg 5:2–18CrossRef Teitge RA (2006) Osteotomy in the treatment of patellofemoral instability. Tech Knee Surg 5:2–18CrossRef
41.
Zurück zum Zitat Thomas S, Rupiper D, Stacy GS (2014) Imaging of the patellofemoral joint. Clin Sports Med 33:413–436PubMedCrossRef Thomas S, Rupiper D, Stacy GS (2014) Imaging of the patellofemoral joint. Clin Sports Med 33:413–436PubMedCrossRef
42.
Zurück zum Zitat Van Haver A, De Roo K, De Beule M, Labey L, De Baets P, Dejour D et al (2015) The effect of trochlear dysplasia on patellofemoral biomechanics: a cadaveric study with simulated trochlear deformities. Am J Sports Med 43:1354–1361PubMedCrossRef Van Haver A, De Roo K, De Beule M, Labey L, De Baets P, Dejour D et al (2015) The effect of trochlear dysplasia on patellofemoral biomechanics: a cadaveric study with simulated trochlear deformities. Am J Sports Med 43:1354–1361PubMedCrossRef
43.
Zurück zum Zitat Waidelich HA, Strecker W, Schneider E (1992) Computed tomographic torsion-angle and length measurement of the lower extremity. The methods, normal values and radiation load. Rofo 157:245–251PubMedCrossRef Waidelich HA, Strecker W, Schneider E (1992) Computed tomographic torsion-angle and length measurement of the lower extremity. The methods, normal values and radiation load. Rofo 157:245–251PubMedCrossRef
44.
Metadaten
Titel
Static patella tilt and axial engagement in knee extension are mainly influenced by knee torsion, the tibial tubercle–trochlear groove distance (TTTG), and trochlear dysplasia but not by femoral or tibial torsion
verfasst von
P. Kaiser
F. Loth
R. Attal
M. Kummann
P. Schuster
F. Riechelmann
M. Schlumberger
Publikationsdatum
02.07.2019
Verlag
Springer Berlin Heidelberg
Erschienen in
Knee Surgery, Sports Traumatology, Arthroscopy / Ausgabe 3/2020
Print ISSN: 0942-2056
Elektronische ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-019-05588-y

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