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Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy 9/2016

05.05.2015 | Knee

Patellar instability: CT and MRI measurements and their correlation with internal derangement findings

verfasst von: Rashmi S. Thakkar, Filippo Del Grande, Vibhor Wadhwa, Majid Chalian, Gustav Andreisek, John A. Carrino, John Eng, Avneesh Chhabra

Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy | Ausgabe 9/2016

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Abstract

Purpose

To test the inter-observer and inter-method reliability among the measures suggesting patellofemoral joint disorder on both CT and MRI in the same subject and find possible association with internal derangements of the patellofemoral joint on MRI.

Methods

Institutional review board approval was obtained with waiver of the informed consent in this HIPPA-compliant study. CT and MRI were evaluated in 32 knees in 32 respective subjects (10 men/22 women, mean age 38 ± 19 years). Three trained observers assessed tibial tuberosity–trochlear groove (TT–TG) distance, trochlear angle and trochlear depth on both CT and MRI. Intra-class correlation coefficient (ICC) was used to evaluate inter-observer and inter-method reliability. Two radiologists’ consensus reading was used to evaluate their association with soft tissue abnormalities of the patellofemoral joint. Chi-square test was used to assess the statistical significance of the qualitative variables.

Results

There was an excellent inter-observer reliability (ICC for CT >0.89 and for MRI >0.90) and inter-method reliability (ICC >0.86) for all the quantitative measurements. There was a significant association between increased TT–TG distance value on MR imaging and lateral facet patellar cartilage abnormality and joint effusion (p < 0.05).

Conclusion

Quantitative trochlear parameters can be reliably calculated on MRI, and an abnormal TT–TG distance is the most useful measurement among various static MR imaging parameters to correlate with patellar chondrosis and joint effusion. TT–TG distance should be reported in patellofemoral pain syndrome patients.

Level of evidence

IV.
Literatur
1.
Zurück zum Zitat Arendt EA, Dahm DL, Dejour D, Fithian DC (2014) Patellofemoral joint: from instability to arthritis. Instr Course Lect 63:355–368PubMed Arendt EA, Dahm DL, Dejour D, Fithian DC (2014) Patellofemoral joint: from instability to arthritis. Instr Course Lect 63:355–368PubMed
2.
Zurück zum Zitat Arendt EA, Dejour D (2013) Patella instability: building bridges across the ocean a historic review. Knee Surg Sports Traumatol Arthrosc 21:279–293CrossRefPubMed Arendt EA, Dejour D (2013) Patella instability: building bridges across the ocean a historic review. Knee Surg Sports Traumatol Arthrosc 21:279–293CrossRefPubMed
3.
4.
Zurück zum Zitat Balcarek P, Jung K, Frosch KH, Sturmer KM (2011) Value of the tibial tuberosity–trochlear groove distance in patellar instability in the young athlete. Am J Sports Med 39:1756–1761CrossRefPubMed Balcarek P, Jung K, Frosch KH, Sturmer KM (2011) Value of the tibial tuberosity–trochlear groove distance in patellar instability in the young athlete. Am J Sports Med 39:1756–1761CrossRefPubMed
5.
Zurück zum Zitat Brattstörm H (1970) Patella alta in non-dislocating knee joints. Acta Orthop Scand 41:578–588CrossRef Brattstörm H (1970) Patella alta in non-dislocating knee joints. Acta Orthop Scand 41:578–588CrossRef
6.
Zurück zum Zitat Charles MD, Haloman S, Chen L, Ward SR, Fithian D, Afra R (2013) Magnetic resonance imaging-based topographical differences between control and recurrent patellofemoral instability patients. Am J Sports Med 41:374–384CrossRefPubMed Charles MD, Haloman S, Chen L, Ward SR, Fithian D, Afra R (2013) Magnetic resonance imaging-based topographical differences between control and recurrent patellofemoral instability patients. Am J Sports Med 41:374–384CrossRefPubMed
7.
Zurück zum Zitat Chhabra A, Subhawong TK, Carrino JA (2011) A systematised MRI approach to evaluating the patellofemoral joint. Skelet Radiol 40:375–387CrossRef Chhabra A, Subhawong TK, Carrino JA (2011) A systematised MRI approach to evaluating the patellofemoral joint. Skelet Radiol 40:375–387CrossRef
8.
Zurück zum Zitat Cooney AD, Kazi Z, Caplan N, Newby M, St Clair Gibson A, Kader DF (2012) The relationship between quadriceps angle and tibial tuberosity–trochlear groove distance in patients with patellar instability. Knee Surg Sports Traumatol Arthrosc 20:2399–2404CrossRefPubMed Cooney AD, Kazi Z, Caplan N, Newby M, St Clair Gibson A, Kader DF (2012) The relationship between quadriceps angle and tibial tuberosity–trochlear groove distance in patients with patellar instability. Knee Surg Sports Traumatol Arthrosc 20:2399–2404CrossRefPubMed
9.
Zurück zum Zitat Dejour D, Arendt E, Zaffagnini S (2014) Rediscovering the patellofemoral joint. Knee Surg Sports Traumatol Arthrosc 22:2261–2263CrossRefPubMed Dejour D, Arendt E, Zaffagnini S (2014) Rediscovering the patellofemoral joint. Knee Surg Sports Traumatol Arthrosc 22:2261–2263CrossRefPubMed
10.
Zurück zum Zitat Dejour DH (2013) The patellofemoral joint and its historical roots: the Lyon School of Knee Surgery. Knee Surg Sports Traumatol Arthrosc 21:1482–1494CrossRefPubMed Dejour DH (2013) The patellofemoral joint and its historical roots: the Lyon School of Knee Surgery. Knee Surg Sports Traumatol Arthrosc 21:1482–1494CrossRefPubMed
11.
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 2:19–26CrossRefPubMed Dejour H, Walch G, Nove-Josserand L, Guier C (1994) Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc 2:19–26CrossRefPubMed
12.
Zurück zum Zitat Diederichs G, Issever AS, Scheffler S (2010) MR imaging of patellar instability: injury patterns and assessment of risk factors. Radiographics 30:961–981CrossRefPubMed Diederichs G, Issever AS, Scheffler S (2010) MR imaging of patellar instability: injury patterns and assessment of risk factors. Radiographics 30:961–981CrossRefPubMed
13.
Zurück zum Zitat Diks MJ, Wymenga AB, Anderson PG (2003) Patients with lateral tracking patella have better pain relief following CT-guided tuberosity transfer than patients with unstable patella. Knee Surg Sports Traumatol Arthrosc 11:384–388CrossRefPubMed Diks MJ, Wymenga AB, Anderson PG (2003) Patients with lateral tracking patella have better pain relief following CT-guided tuberosity transfer than patients with unstable patella. Knee Surg Sports Traumatol Arthrosc 11:384–388CrossRefPubMed
14.
15.
Zurück zum Zitat Feller JA, Amis AA, Andrish JT, Arendt EA, Erasmus PJ, Powers CM (2007) Surgical biomechanics of the patellofemoral joint. Arthroscopy 23:542–553CrossRefPubMed Feller JA, Amis AA, Andrish JT, Arendt EA, Erasmus PJ, Powers CM (2007) Surgical biomechanics of the patellofemoral joint. Arthroscopy 23:542–553CrossRefPubMed
16.
Zurück zum Zitat Fithian DC, Paxton EW, Stone ML, Silva P, Davis DK, Elias DA, White LM (2004) Epidemiology and natural history of acute patellar dislocation. Am J Sports Med 32:1114–1121CrossRefPubMed Fithian DC, Paxton EW, Stone ML, Silva P, Davis DK, Elias DA, White LM (2004) Epidemiology and natural history of acute patellar dislocation. Am J Sports Med 32:1114–1121CrossRefPubMed
17.
Zurück zum Zitat France L, Nester C (2001) Effect of errors in the identification of anatomical landmarks on the accuracy of Q angle values. Clin Biomech (Bristol, Avon) 16:710–713CrossRef France L, Nester C (2001) Effect of errors in the identification of anatomical landmarks on the accuracy of Q angle values. Clin Biomech (Bristol, Avon) 16:710–713CrossRef
18.
Zurück zum Zitat Guerra JP, Arnold MJ, Gajdosik RL (1994) Q angle: effects of isometric quadriceps contraction and body position. J Orthop Sports Phys Ther 19:200–204CrossRefPubMed Guerra JP, Arnold MJ, Gajdosik RL (1994) Q angle: effects of isometric quadriceps contraction and body position. J Orthop Sports Phys Ther 19:200–204CrossRefPubMed
19.
Zurück zum Zitat Juhn MS (1999) Patellofemoral pain syndrome: a review and guidelines for treatment. Am Fam Physician 60:2012–2022PubMed Juhn MS (1999) Patellofemoral pain syndrome: a review and guidelines for treatment. Am Fam Physician 60:2012–2022PubMed
20.
Zurück zum Zitat Maquet P (1976) Advancement of the tibial tuberosity. Clin Orthop Relat Res 115:225–230PubMed Maquet P (1976) Advancement of the tibial tuberosity. Clin Orthop Relat Res 115:225–230PubMed
21.
Zurück zum Zitat Pfirrmann CW, Zanetti M, Romero J, Hodler J (2000) Femoral trochlear dysplasia: MR findings. Radiology 216:858–864CrossRefPubMed Pfirrmann CW, Zanetti M, Romero J, Hodler J (2000) Femoral trochlear dysplasia: MR findings. Radiology 216:858–864CrossRefPubMed
22.
Zurück zum Zitat Salzmann GM, Weber TS, Spang JT, Imhoff AB, Schottle PB (2010) Comparison of native axial radiographs with axial MR imaging for determination of the trochlear morphology in patients with trochlear dysplasia. Arch Orthop Trauma Surg 130:335–340CrossRefPubMed Salzmann GM, Weber TS, Spang JT, Imhoff AB, Schottle PB (2010) Comparison of native axial radiographs with axial MR imaging for determination of the trochlear morphology in patients with trochlear dysplasia. Arch Orthop Trauma Surg 130:335–340CrossRefPubMed
23.
Zurück zum Zitat Saudan M, Fritschy D (2000) AT–TG (anterior tuberosity–trochlear groove): interobserver variability in CT measurements in subjects with patellar instability. Rev Chir Orthop Reparatrice Appar Mot 86:250–255PubMed Saudan M, Fritschy D (2000) AT–TG (anterior tuberosity–trochlear groove): interobserver variability in CT measurements in subjects with patellar instability. Rev Chir Orthop Reparatrice Appar Mot 86:250–255PubMed
24.
Zurück zum Zitat Schoettle PB, Zanetti M, Seifert B, Pfirrmann CW, Fucentese SF, Romero J (2006) The tibial tuberosity–trochlear groove distance; a comparative study between CT and MRI scanning. Knee 13:26–31CrossRefPubMed Schoettle PB, Zanetti M, Seifert B, Pfirrmann CW, Fucentese SF, Romero J (2006) The tibial tuberosity–trochlear groove distance; a comparative study between CT and MRI scanning. Knee 13:26–31CrossRefPubMed
25.
Zurück zum Zitat Schottle PB, Fucentese SF, Pfirrmann C, Bereiter H, Romero J (2005) Trochleaplasty for patellar instability due to trochlear dysplasia: a minimum 2-year clinical and radiological follow-up of 19 knees. Acta Orthop 76:693–698CrossRefPubMed Schottle PB, Fucentese SF, Pfirrmann C, Bereiter H, Romero J (2005) Trochleaplasty for patellar instability due to trochlear dysplasia: a minimum 2-year clinical and radiological follow-up of 19 knees. Acta Orthop 76:693–698CrossRefPubMed
26.
Zurück zum Zitat Sherman SL, Plackis AC, Nuelle CW (2014) Patellofemoral anatomy and biomechanics. Clin Sports Med 33:389–401CrossRefPubMed Sherman SL, Plackis AC, Nuelle CW (2014) Patellofemoral anatomy and biomechanics. Clin Sports Med 33:389–401CrossRefPubMed
27.
Zurück zum Zitat Sillanpaa P, Mattila VM, Iivonen T, Visuri T, Pihlajamaki H (2008) Incidence and risk factors of acute traumatic primary patellar dislocation. Med Sci Sports Exerc 40:606–611CrossRefPubMed Sillanpaa P, Mattila VM, Iivonen T, Visuri T, Pihlajamaki H (2008) Incidence and risk factors of acute traumatic primary patellar dislocation. Med Sci Sports Exerc 40:606–611CrossRefPubMed
28.
Zurück zum Zitat Smith TO, Donell ST, Clark A, Chester R, Cross J, Kader DF, Arendt EA (2014) The development, validation and internal consistency of the Norwich patellar instability (NPI) score. Knee Surg Sports Traumatol Arthrosc 22:324–335CrossRefPubMed Smith TO, Donell ST, Clark A, Chester R, Cross J, Kader DF, Arendt EA (2014) The development, validation and internal consistency of the Norwich patellar instability (NPI) score. Knee Surg Sports Traumatol Arthrosc 22:324–335CrossRefPubMed
29.
Zurück zum Zitat Smith TO, Hunt NJ, Donell ST (2008) The reliability and validity of the Q-angle: a systematic review. Knee Surg Sports Traumatol Arthrosc 16:1068–1079CrossRefPubMed Smith TO, Hunt NJ, Donell ST (2008) The reliability and validity of the Q-angle: a systematic review. Knee Surg Sports Traumatol Arthrosc 16:1068–1079CrossRefPubMed
30.
Zurück zum Zitat Tsujimoto K, Kurosaka M, Yoshiya S, Mizuno K (2000) Radiographic and computed tomographic analysis of the position of the tibial tubercle in recurrent dislocation and subluxation of the patella. Am J Knee Surg 213:83–88 Tsujimoto K, Kurosaka M, Yoshiya S, Mizuno K (2000) Radiographic and computed tomographic analysis of the position of the tibial tubercle in recurrent dislocation and subluxation of the patella. Am J Knee Surg 213:83–88
31.
Zurück zum Zitat Utting MR, Mulford JS, Eldridge JD (2008) A prospective evaluation of trochleoplasty for the treatment of patellofemoral dislocation and instability. J Bone Joint Surg Br 90:180–185CrossRefPubMed Utting MR, Mulford JS, Eldridge JD (2008) A prospective evaluation of trochleoplasty for the treatment of patellofemoral dislocation and instability. J Bone Joint Surg Br 90:180–185CrossRefPubMed
32.
Zurück zum Zitat Wittstein JR, Bartlett EC, Easterbrook J, Byrd JC (2006) Magnetic resonance imaging evaluation of patellofemoral malalignment. Arthroscopy 22:643–649CrossRefPubMed Wittstein JR, Bartlett EC, Easterbrook J, Byrd JC (2006) Magnetic resonance imaging evaluation of patellofemoral malalignment. Arthroscopy 22:643–649CrossRefPubMed
33.
Zurück zum Zitat Zaffagnini S, Dejour D, Grassi A, Bonanzinga T, Marcheggiani Muccioli GM, Colle F, Raggi F, Benzi A, Marcacci M (2013) Patellofemoral anatomy and biomechanics: current concepts. Joints 1:15–20PubMedPubMedCentral Zaffagnini S, Dejour D, Grassi A, Bonanzinga T, Marcheggiani Muccioli GM, Colle F, Raggi F, Benzi A, Marcacci M (2013) Patellofemoral anatomy and biomechanics: current concepts. Joints 1:15–20PubMedPubMedCentral
Metadaten
Titel
Patellar instability: CT and MRI measurements and their correlation with internal derangement findings
verfasst von
Rashmi S. Thakkar
Filippo Del Grande
Vibhor Wadhwa
Majid Chalian
Gustav Andreisek
John A. Carrino
John Eng
Avneesh Chhabra
Publikationsdatum
05.05.2015
Verlag
Springer Berlin Heidelberg
Erschienen in
Knee Surgery, Sports Traumatology, Arthroscopy / Ausgabe 9/2016
Print ISSN: 0942-2056
Elektronische ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-015-3614-8

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