Skip to main content
Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy 4/2021

08.06.2020 | KNEE

Malalignment sign on knee magnetic resonance imaging: a new predictor for excessive femoral anteversion in patients with patellar dislocation

verfasst von: Zijie Xu, Hua Zhang, Minkang Guo, Zhenxing Wen, Jian Zhang, Aiguo Zhou

Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy | Ausgabe 4/2021

Einloggen, um Zugang zu erhalten

Abstract

Purpose

To evaluate the clinical relevance of the newly identified malalignment sign in predicting excessive femoral anteversion in patients with patellar dislocations.

Methods

A total of 55 patients with patellar dislocation who underwent surgical treatment between 2016 and 2019 were included in this study. Femoral anteversion, tibial torsion, and the femorotibial index were measured via a CT scan. The malalignment sign on the knee MRI was defined as a malalignment between the lateral side of the intercondylar fossa of the femur and the lateral intercondylar eminence of the tibial plateau.

Results

A positive malalignment sign was observed in 36 of the 55 patients. Increased femoral anteversion was significantly correlated with the number of frames with a positive malalignment sign (r = 0.511, P < 0.001). The value of femoral anteversion was significantly greater in the group with a positive malalignment sign (P = 0.02). For a femoral anteversion value of 32°, the sensitivity and specificity of the malalignment sign reached the maximal level of 89.5% and 47.2%, respectively.

Conclusion

Increased femoral anteversion correlated significantly with a positive malalignment sign on knee MRI. However, tibial torsion did not affect the malalignment sign. A positive malalignment sign is evidence for femoral derotation osteotomy.

Level of evidence

Level IV.
Literatur
1.
Zurück zum Zitat Ateschrang A, Freude T, Grunwald L, Schaffler A, Stockle U, Schroter S (2014) Patella dislocation: an algorithm for diagnostic and treatment considering the rotation. Z Orthop Unfall 152:59–67CrossRef Ateschrang A, Freude T, Grunwald L, Schaffler A, Stockle U, Schroter S (2014) Patella dislocation: an algorithm for diagnostic and treatment considering the rotation. Z Orthop Unfall 152:59–67CrossRef
2.
Zurück zum Zitat Botser I, Ozoude G, Martin D, Siddiqi A, Kuppuswami S, Domb B (2012) Femoral anteversion in the hip: comparison of measurement by computed tomography, magnetic resonance imaging, and physical examination. Arthroscopy 28:619–627CrossRef Botser I, Ozoude G, Martin D, Siddiqi A, Kuppuswami S, Domb B (2012) Femoral anteversion in the hip: comparison of measurement by computed tomography, magnetic resonance imaging, and physical examination. Arthroscopy 28:619–627CrossRef
3.
Zurück zum Zitat Bouras T, Edmond U, Brown A, Gallacher P, Barnett A (2019) Isolated medial patellofemoral ligament reconstruction significantly improved quality of life in patients with recurrent patella dislocation. Knee Surg Sports Traumatol Arthrosc 27:3513–3517CrossRef Bouras T, Edmond U, Brown A, Gallacher P, Barnett A (2019) Isolated medial patellofemoral ligament reconstruction significantly improved quality of life in patients with recurrent patella dislocation. Knee Surg Sports Traumatol Arthrosc 27:3513–3517CrossRef
5.
Zurück zum Zitat Chen X, Li D, Wang W, Xin H, Wang Y, Wang J (2015) Cartilage status in knees with recurrent patellar instability using magnetic resonance imaging T2 relaxation time value. Knee Surg Sports Traumatol Arthrosc 23:2292–2296CrossRef Chen X, Li D, Wang W, Xin H, Wang Y, Wang J (2015) Cartilage status in knees with recurrent patellar instability using magnetic resonance imaging T2 relaxation time value. Knee Surg Sports Traumatol Arthrosc 23:2292–2296CrossRef
6.
Zurück zum Zitat Dickschas J, Harrer J, Reuter B, Schwitulla J, Strecker W (2015) Torsional osteotomies of the femur. J Orthop Res 33:318–324CrossRef Dickschas J, Harrer J, Reuter B, Schwitulla J, Strecker W (2015) Torsional osteotomies of the femur. J Orthop Res 33:318–324CrossRef
7.
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 41:51–57CrossRef 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 41:51–57CrossRef
8.
Zurück zum Zitat Fabricant P, Fields K, Taylor S, Magennis E, Bedi A, Kelly B (2015) The effect of femoral and acetabular version on clinical outcomes after arthroscopic femoroacetabular impingement surgery. J Bone Joint Surg Am 97:537–543CrossRef Fabricant P, Fields K, Taylor S, Magennis E, Bedi A, Kelly B (2015) The effect of femoral and acetabular version on clinical outcomes after arthroscopic femoroacetabular impingement surgery. J Bone Joint Surg Am 97:537–543CrossRef
9.
Zurück zum Zitat Franciozi CE, Ambra LF, Albertoni LJ, Debieux P, Rezende FC, Oliveira MA et al (2017) Increased femoral anteversion influence over surgically treated recurrent patellar instability patients. Arthroscopy 33:633–640CrossRef Franciozi CE, Ambra LF, Albertoni LJ, Debieux P, Rezende FC, Oliveira MA et al (2017) Increased femoral anteversion influence over surgically treated recurrent patellar instability patients. Arthroscopy 33:633–640CrossRef
10.
Zurück zum Zitat Frosch KH, Schmeling A (2016) A new classification system of patellar instability and patellar maltracking. Arch Orthop Trauma Surg 136:485–497CrossRef Frosch KH, Schmeling A (2016) A new classification system of patellar instability and patellar maltracking. Arch Orthop Trauma Surg 136:485–497CrossRef
11.
Zurück zum Zitat Goutallier D, Van Driessche S, Manicom O, Sariali E, Bernageau J, Radier C (2006) Influence of lower-limb torsion on long-term outcomes of tibial valgus osteotomy for medial compartment knee osteoarthritis. J Bone Joint Surg Am 88:2439–2447CrossRef Goutallier D, Van Driessche S, Manicom O, Sariali E, Bernageau J, Radier C (2006) Influence of lower-limb torsion on long-term outcomes of tibial valgus osteotomy for medial compartment knee osteoarthritis. J Bone Joint Surg Am 88:2439–2447CrossRef
12.
Zurück zum Zitat Hiemstra L, Kerslake S, Lafave M (2017) Assessment of demographic and pathoanatomic risk factors in recurrent patellofemoral instability. Knee Surg Sports Traumatol Arthrosc 25:3849–3855CrossRef Hiemstra L, Kerslake S, Lafave M (2017) Assessment of demographic and pathoanatomic risk factors in recurrent patellofemoral instability. Knee Surg Sports Traumatol Arthrosc 25:3849–3855CrossRef
13.
Zurück zum Zitat Hiemstra LA, Kerslake SA, Lafave MR (2019) Influence of risky pathoanatomy and demographic factors on clinical outcomes after isolated medial patellofemoral ligament reconstruction: a regression analysis. Am J Sports Med 47:2904–2909CrossRef Hiemstra LA, Kerslake SA, Lafave MR (2019) Influence of risky pathoanatomy and demographic factors on clinical outcomes after isolated medial patellofemoral ligament reconstruction: a regression analysis. Am J Sports Med 47:2904–2909CrossRef
14.
Zurück zum Zitat Imhoff FB, Funke V, Muench LN, Sauter A, Englmaier M, Woertler K et al (2020) The complexity of bony malalignment in patellofemoral disorders: femoral and tibial torsion, trochlear dysplasia, TT-TG distance, and frontal mechanical axis correlate with each other. Knee Surg Sports Traumatol Arthrosc 28:897–904CrossRef Imhoff FB, Funke V, Muench LN, Sauter A, Englmaier M, Woertler K et al (2020) The complexity of bony malalignment in patellofemoral disorders: femoral and tibial torsion, trochlear dysplasia, TT-TG distance, and frontal mechanical axis correlate with each other. Knee Surg Sports Traumatol Arthrosc 28:897–904CrossRef
15.
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 32:2295–2299CrossRef Liebensteiner MC, Ressler J, Seitlinger G, Djurdjevic T, El Attal R, Ferlic PW (2016) High femoral anteversion is related to femoral trochlea dysplasia. Arthroscopy 32:2295–2299CrossRef
16.
Zurück zum Zitat Liu JN, Wu HH, Garcia GH, Kalbian IL, Strickland SM, Shubin Stein BE (2018) Return to sports after tibial tubercle osteotomy for patellofemoral pain and osteoarthritis. Arthroscopy 34:1022–1029CrossRef Liu JN, Wu HH, Garcia GH, Kalbian IL, Strickland SM, Shubin Stein BE (2018) Return to sports after tibial tubercle osteotomy for patellofemoral pain and osteoarthritis. Arthroscopy 34:1022–1029CrossRef
17.
Zurück zum Zitat Moiz M, Smith N, Smith TO, Chawla A, Thompson P, Metcalfe A (2018) Clinical outcomes after the nonoperative management of lateral patellar dislocations: a systematic review. Orthop J Sports Med 6:2325967118766275PubMedPubMedCentral Moiz M, Smith N, Smith TO, Chawla A, Thompson P, Metcalfe A (2018) Clinical outcomes after the nonoperative management of lateral patellar dislocations: a systematic review. Orthop J Sports Med 6:2325967118766275PubMedPubMedCentral
18.
Zurück zum Zitat Murphy SB, Simon SR, Kijewski PK, Wilkinson RH, Griscom NT (1987) Femoral anteversion. J Bone Joint Surg Am 69:1169–1176CrossRef Murphy SB, Simon SR, Kijewski PK, Wilkinson RH, Griscom NT (1987) Femoral anteversion. J Bone Joint Surg Am 69:1169–1176CrossRef
19.
Zurück zum Zitat Nelitz M, Dreyhaupt J, Williams SR, Dornacher D (2015) Combined supracondylar femoral derotation osteotomy and patellofemoral ligament reconstruction for recurrent patellar dislocation and severe femoral anteversion syndrome: surgical technique and clinical outcome. Int Orthop 39:2355–2362CrossRef Nelitz M, Dreyhaupt J, Williams SR, Dornacher D (2015) Combined supracondylar femoral derotation osteotomy and patellofemoral ligament reconstruction for recurrent patellar dislocation and severe femoral anteversion syndrome: surgical technique and clinical outcome. Int Orthop 39:2355–2362CrossRef
20.
Zurück zum Zitat Nguyen A, Boling M, Levine B, Shultz S (2009) Relationships between lower extremity alignment and the quadriceps angle. Clin J Sport Med 19:201–206CrossRef Nguyen A, Boling M, Levine B, Shultz S (2009) Relationships between lower extremity alignment and the quadriceps angle. Clin J Sport Med 19:201–206CrossRef
21.
Zurück zum Zitat Nwachukwu B, So C, Schairer W, Shubin-Stein B, Strickland S, Green D et al (2017) Economic decision model for first-time traumatic patellar dislocations in adolescents. Am J Sports Med 45:2267–2275CrossRef Nwachukwu B, So C, Schairer W, Shubin-Stein B, Strickland S, Green D et al (2017) Economic decision model for first-time traumatic patellar dislocations in adolescents. Am J Sports Med 45:2267–2275CrossRef
22.
Zurück zum Zitat Qin L, Li M, Yao W, Shen J (2017) Relationship between bony tunnel and knee function in patients after patellar dislocation triple surgeries-a CT-based study. Sci Rep 7:41360CrossRef Qin L, Li M, Yao W, Shen J (2017) Relationship between bony tunnel and knee function in patients after patellar dislocation triple surgeries-a CT-based study. Sci Rep 7:41360CrossRef
23.
Zurück zum Zitat Quanbeck AE, Russell JA, Handley SC, Quanbeck DS (2017) Kinematic analysis of hip and knee rotation and other contributors to ballet turnout. J Sports Sci 35:331–338CrossRef Quanbeck AE, Russell JA, Handley SC, Quanbeck DS (2017) Kinematic analysis of hip and knee rotation and other contributors to ballet turnout. J Sports Sci 35:331–338CrossRef
24.
Zurück zum Zitat Seitlinger G, Moroder P, Scheurecker G, Hofmann S, Grelsamer RP (2016) The contribution of different femur segments to overall femoral torsion. Am J Sports Med 44:1796–1800CrossRef Seitlinger G, Moroder P, Scheurecker G, Hofmann S, Grelsamer RP (2016) The contribution of different femur segments to overall femoral torsion. Am J Sports Med 44:1796–1800CrossRef
25.
Zurück zum Zitat Sherman SL, Humpherys J, Farr J (2019) Optimizing patellofemoral cartilage restoration and instability with tibial tubercle osteotomy. Arthroscopy 35:2255–2256CrossRef Sherman SL, Humpherys J, Farr J (2019) Optimizing patellofemoral cartilage restoration and instability with tibial tubercle osteotomy. Arthroscopy 35:2255–2256CrossRef
27.
Zurück zum Zitat Xu Z, Zhang H, Chen J, Mohamed SI, Zhou A (2020) Femoral anteversion is related to tibial tubercle-trochlear groove distance in patients with patellar dislocation. Arthroscopy 36:1114–1120CrossRef Xu Z, Zhang H, Chen J, Mohamed SI, Zhou A (2020) Femoral anteversion is related to tibial tubercle-trochlear groove distance in patients with patellar dislocation. Arthroscopy 36:1114–1120CrossRef
28.
Zurück zum Zitat Yang GM, Wang YY, Zuo LX, Li FQ, Dai YK, Wang F (2019) Good outcomes of combined femoral derotation osteotomy and medial retinaculum plasty in patients with recurrent patellar dislocation. Orthop Surg 11:578–585CrossRef Yang GM, Wang YY, Zuo LX, Li FQ, Dai YK, Wang F (2019) Good outcomes of combined femoral derotation osteotomy and medial retinaculum plasty in patients with recurrent patellar dislocation. Orthop Surg 11:578–585CrossRef
29.
Zurück zum Zitat Zaffagnini S, Previtali D, Tamborini S, Pagliazzi G, Filardo G, Candrian C (2019) Recurrent patellar dislocations: trochleoplasty improves the results of medial patellofemoral ligament surgery only in severe trochlear dysplasia. Knee Surg Sports Traumatol Arthrosc 27:3599–3613CrossRef Zaffagnini S, Previtali D, Tamborini S, Pagliazzi G, Filardo G, Candrian C (2019) Recurrent patellar dislocations: trochleoplasty improves the results of medial patellofemoral ligament surgery only in severe trochlear dysplasia. Knee Surg Sports Traumatol Arthrosc 27:3599–3613CrossRef
30.
Zurück zum Zitat Zhang Z, Zhang H, Song G, Wang X, Zhang J, Zheng T et al (2020) A high-grade j sign is more likely to yield higher postoperative patellar laxity and residual maltracking in patients with recurrent patellar dislocation treated with derotational distal femoral osteotomy. Am J Sports Med 48:117–127CrossRef Zhang Z, Zhang H, Song G, Wang X, Zhang J, Zheng T et al (2020) A high-grade j sign is more likely to yield higher postoperative patellar laxity and residual maltracking in patients with recurrent patellar dislocation treated with derotational distal femoral osteotomy. Am J Sports Med 48:117–127CrossRef
32.
Metadaten
Titel
Malalignment sign on knee magnetic resonance imaging: a new predictor for excessive femoral anteversion in patients with patellar dislocation
verfasst von
Zijie Xu
Hua Zhang
Minkang Guo
Zhenxing Wen
Jian Zhang
Aiguo Zhou
Publikationsdatum
08.06.2020
Verlag
Springer Berlin Heidelberg
Erschienen in
Knee Surgery, Sports Traumatology, Arthroscopy / Ausgabe 4/2021
Print ISSN: 0942-2056
Elektronische ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-020-06080-8

Weitere Artikel der Ausgabe 4/2021

Knee Surgery, Sports Traumatology, Arthroscopy 4/2021 Zur Ausgabe

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen. 
» Jetzt entdecken

Ein Drittel der jungen Ärztinnen und Ärzte erwägt abzuwandern

07.05.2024 Klinik aktuell Nachrichten

Extreme Arbeitsverdichtung und kaum Supervision: Dr. Andrea Martini, Sprecherin des Bündnisses Junge Ärztinnen und Ärzte (BJÄ) über den Frust des ärztlichen Nachwuchses und die Vorteile des Rucksack-Modells.

Aquatherapie bei Fibromyalgie wirksamer als Trockenübungen

03.05.2024 Fibromyalgiesyndrom Nachrichten

Bewegungs-, Dehnungs- und Entspannungsübungen im Wasser lindern die Beschwerden von Patientinnen mit Fibromyalgie besser als das Üben auf trockenem Land. Das geht aus einer spanisch-brasilianischen Vergleichsstudie hervor.

Endlich: Zi zeigt, mit welchen PVS Praxen zufrieden sind

IT für Ärzte Nachrichten

Darauf haben viele Praxen gewartet: Das Zi hat eine Liste von Praxisverwaltungssystemen veröffentlicht, die von Nutzern positiv bewertet werden. Eine gute Grundlage für wechselwillige Ärztinnen und Psychotherapeuten.

Proximale Humerusfraktur: Auch 100-Jährige operieren?

01.05.2024 DCK 2024 Kongressbericht

Mit dem demographischen Wandel versorgt auch die Chirurgie immer mehr betagte Menschen. Von Entwicklungen wie Fast-Track können auch ältere Menschen profitieren und bei proximaler Humerusfraktur können selbst manche 100-Jährige noch sicher operiert werden.

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.