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Özel, Deniz. "The relationship between early-onset chondromalacia and the position of the patella." Acta Radiologica 61, no. 3 (2019): 370–75. http://dx.doi.org/10.1177/0284185119861901.
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Background There are many underlying accelerator factors for chondromalacia and one of the well-known factors is patellar malalignment. Purpose To evaluate the relationship between early-onset chondromalacia and patellar position; and, second, to evaluate the value of patellar malalignment criteria. Material and Methods Patients aged 18–40 years with advanced chondromalacia were included. For comparison, a control group was defined with the same number of individuals of the same mean age. The magnetic resonance imaging (MRI) sagittal view with the greatest patellar length was used to obtain the patellar height measurement with the Insall-Salvati index. For the remaining three indices—modified Insall-Salvati, Caton-Deschamps, and Blackburne-Pell—a sagittal view with the greatest patellar articular surface was used. Discordance was defined as contradiction with the measured index and the other three indices. Results Both patella alta and baja were found to be predisposing factors for chondromalacia. Modified Insall-Salvati index was the most concordant measurement to define patella alta. Conclusion Both patella alta and patella baja were found to predispose to chondromalacia. Patella baja is rare, which may explain why it is not often mentioned as a predisposing factor. The modified Insall-Salvati index ratio was the best patella alta indicator that showed chondral status, more than patellar placement, and was more concordant with the other indices. Blackburne-Pell had the second highest number and ratio of discordance. BP cannot be optimally calculated because deciding the location of the tibial plateau seems to be problematic since it is a three-dimensional and complicated structure.
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Korkmaz, Ozgur, and Melih Malkoc. "Effect of anterior cruciate ligament reconstruction with hamstring tendons on Insall-Salvati index and anterior knee pain." Srpski arhiv za celokupno lekarstvo 146, no. 3-4 (2018): 174–78. http://dx.doi.org/10.2298/sarh170530153k.
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Introduction/Objective. The aim of this study was to evaluate the relationship between anterior knee pain and Insall-Salvati ratio after anterior cruciate ligament (ACL) reconstruction with hamstring tendon. Methods. We have evaluate 39 patient that had an ACL reconstruction surgery with hamstring tendon retrospectively. 14 patient had anterior knee pain at the and of the first year of the surgery. All the patient were evaluated for Insall-Salvati ratio preoperatively and postoperatively. Patients were evaluated at the end of the first year after the surgery with Lysholm score and Tegner activity scale. Patients preoperative and postoperative measurements were analyzed by using the Wilcoxon test and differences between patients with anterior knee pain and without pain was analyzed by the Mann-Whitney U test. Results. Mean Insall-Salvati ratio was found preoperatively 0,91?0,1 and postoperatively 0,85?0,09 (p?0,05). Mean Tegner activity score was 8,56?1,04 and mean Lysholm score was 87,36?9,42 in the group without anterior knee pain. Mean Tegner activity score was 7,21?0,97 and mean Lysholm score was 74,43?9,94 in the group with anterior pain. There is an decrease in ?nsall-Salvati ratio as a result of the surgery. But patients with anterior knee pain had lower values of ?nsall-Salvati ratio preoperatively. Conclusion. Preoperatively low ?nsall-Salvati ratio can be premised indicator of anterior knee pain in the early period after ACL reconstruction with hamstring tendons. Mean Tegner activity score and mean Lysholm score have higher values in the group without anterior pain post operatively.
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Türkmen, İsmail, İrfan Esenkaya, Koray Ünay, Fatih Türkmensoy, and Afşar Timuçin Özkut. "Proximal Tibia Medial Biplanar Retrotubercle Open Wedge Osteotomy for Varus Knees with Medial Gonarthrosis." Orthopaedic Journal of Sports Medicine 2, no. 11_suppl3 (2014): 2325967114S0016. http://dx.doi.org/10.1177/2325967114s00161.
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Objectives: The purpose of this study is to evaluate the early results of proximal tibia medial biplanar retrotubercle open wedge osteotomy for varus gonarthrosis and compare the results with the literatüre. Methods: The results of proximal tibia medial biplanar retrotubercle open wedge osteotomy for 23 knees of 22 patients with medial gonarthrosis were evaluated clinically and radiologically. Results: Twenty of the patients were female and two were male. Mean age of the patients was 56.24; mean boy mass index was 31.95 and preoperative HSS (Hospital for Special Surgery) score was 68.7. Mean tibiofemoral axis was 186.39° and mean Insall-Salvatti index value was 1.04 preoperatively. Mean follow up period was 30.19 months. Mean HSS score was 86.48, femorotibial anatomic axis angle was 175° and Insall-Salvati index value 1.06 during the last follow-up. The improvement of the HSS score and the femorotibial anatomic axis angle was statistically significant. However, the change in Insall Salvati index values was statistically insignificant. Nonfatal pulmonary embolus in 1 patient, and deep vein thrombosis that occured one year after the procedure in 1 patient, rhabdomyolysis in 1 patient and loss of correction (relapse) in 1 patient were encountered as complications. Conclusion: Our results show that proximal tibia medial biplanar retrotubercle open wedge osteotomy improves the frontal and sagittal plane deformities without changing the patellar tendon length. Hence, possible patellofemoral problems are prevented and the clinical results are improved.
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Kumar, Martand, Chakraborty Nabanita, and Shaw Pooja. "Radio-Anatomical Study of the Patella with Special Reference to Patellar Height." International Journal of Pharmaceutical and Clinical Research 16, no. 5 (2024): 3150–52. https://doi.org/10.5281/zenodo.13972633.
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Patellar height is one of the important static factors for maintenance of patellar stability. Several radiological indices have been used to measure the height of the patella of which ‘Insall-Salvati index’ is the most frequently studied method so far. Aims and Objectives: To measure patellar height by ‘Insall- Salvati ratio’ from MRI and to evaluate different physiological factors, e.g., age, sex, side etc affecting ‘Insall-Salvati ratio’. Materials and Methods: After taking approval from institutional ethical committee, the study was conducted in the KPC Medical College and Hospital over 1 year period of time. Detailed history was taken from 93 patients admitted in the Department of Orthopaedics in whom examinations of both the lower limbs were possible irrespective of their chief complaints and clinical features. 186 knee joints, i.e., both knee joints of all the 93 patients were subjected to radiological investigation (MRI). The data obtained by the examination was analysed to see variation of Patellar Height by ‘Insall-Salvati ratio’ with sex, age and laterality and also to see the distribution of patients with respect of knee pain. Results: The clinical method which was newly attempted in this study, showed no statistically significant difference (p< 0.05) from ther radiological one both on the right and left sides. The scenario was similar for both the age groups and for male as well as female patients. Conclusion: The clinical method could not yield any significant difference from radiological method within subjects of comparable age groups on either side in either sex.
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Giovagnorio, Francesco, Matteo Olive, Alice Casinelli, et al. "Comparative US-MRI evaluation of the Insall–Salvati index." La radiologia medica 122, no. 10 (2017): 761–65. http://dx.doi.org/10.1007/s11547-017-0781-3.
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Djuricic, Goran, Filip Milanovic, Sinisa Ducic, et al. "Morphometric Parameters and MRI Morphological Changes of the Knee and Patella in Physically Active Adolescents." Medicina 59, no. 2 (2023): 213. http://dx.doi.org/10.3390/medicina59020213.
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Background and Objectives: The immature skeleton in a pediatric population exposed to frequent physical activity might be extremely prone to injuries, with possible consequences later in adulthood. The main aim of this study is to present specific morphometric parameters and magnetic resonance imaging (MRI) morphological changes of the knee and patella in a physically active pediatric population. Additionally, we wanted to investigate the morphological risk factors for patellar instability. Materials and Methods: The study included the MRI findings of 193 physically active pediatric patients with knee pain. The participants underwent sports activities for 5 to 8 h per week. Two divisions were performed: by age and by patellar type. We evaluated three age groups: group 1 (age 11–14), group 2 (age 15–17), and group 3 (age 18–21 years). In addition, participants were divided by the patellar type (according to Wiberg) into three groups. The following morphometric parameters were calculated: lateral trochlear inclination (LTI), the tibial tubercle–trochlear groove distance (TT-TG), trochlear facet asymmetry (TFA), Insall–Salvati index, modified Insall–Salvati index, Caton–Deschamps index, articular overlap, morphology ratio and contact surface ratio. Results: We found a statistically significant association between patellar type groups in LTI (p < 0.001), TFA (p < 0.001), Insal–Salvati (p = 0.001) index, and Caton–Deschamps index (p = 0.018). According to age groups, we found statistical significance in the Caton–Deschamps index (p = 0.039). The most frequent knee injury parameter, according to Wiberg, in physically active pediatric patients was patella type 2 in boys and type 3 in girls. Conclusions: The MRI morphometric parameters observed in our study might be factors of prediction of knee injury in physically active children. In addition, it might be very useful in sports programs to improve the biomechanics of the knee in order to reduce the injury rate in sports-active children.
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Rhatomy, Sholahuddin, Kurniawan Silalahi, Anggaditya Putra, and Nolli Kresonni. "Characteristics of Patellofemoral Measurement in Indonesian Population Using Magnetic Resonance Imaging." Open Access Macedonian Journal of Medical Sciences 9, A (2021): 47–51. http://dx.doi.org/10.3889/oamjms.2021.5602.
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BACKGROUND: The patellofemoral join is a unique complex joint formed by articulation of the patella and the femoral trochlea. Normal measures for patellofemoral parameters have been published.
 AIM: This study aimed to describe the characteristics of patellofemoral measurements in Indonesian population using magnetic resonance imaging (MRI).
 METHODS: This descriptive total sampling study was conducted from May 2019 to August 2020. The parameters of the measurements in this study include Insall-Salvati ratio, Caton-Deschamps index, trochlear angle, lateral trochlear inclination, TT (tibia tubercle) – TG (trochlear groove) distance, and trochlear depth. The mean results of the measurements were compared with the normal value measurements that are internationally used.
 RESULTS: A total of 100 normal knees MRI scan from patients consisting of 54 (54%) males and 46 (46%) females, with an average age of 35.09 ± 12.77 (19–60) years old. The average body mass index (BMI) was 28.07 ± 3.0 (22–34). Based on ethnicity, subjects were mostly Javanese (66%), Sundanese (12%), Madura (4%), Minangkabau (7%), and the others (11%). The mean of Insall-Salvati ratio was 1.09 ± 0.17 (0.49–1.60). The mean of Caton-Deschamps index was 0.97 ± 0.16 (0.62–1.64). The mean of trochlear angle was 138.97° ± 119.7 (122°–160°). The mean of lateral trochlear inclination was 20.37° ± 4.56 (11.0°–30.6°). The mean of TT-TG distance was 13.76 ± 5.86 (4.9–41), and the mean of trochlear depth was 5.18 ± 1.87 (1.05–8.6). Those values were within normal range of international values. There were no significant differences between comparison of males and females.
 CONCLUSION: The means of Insall-Salvati ratio, Caton-Deschamps index, trochlear angle, lateral trochlear inclination, and TT-TG trochlear depth of the Indonesian people were within the international normal range, and higher than other countries’ published measurements.
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White, Alex E., Peters T. Otlans, Dylan P. Horan, et al. "Radiologic Measurements in the Assessment of Patellar Instability: A Systematic Review and Meta-analysis." Orthopaedic Journal of Sports Medicine 9, no. 5 (2021): 232596712199317. http://dx.doi.org/10.1177/2325967121993179.
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Background: Numerous diagnostic imaging measurements related to patellar instability have been evaluated in the literature; however, little has been done to compare these findings across multiple studies. Purpose: To review the different imaging measurements used to evaluate patellar instability and to assess the prevalence of each measure and its utility in predicting instability. We focused on reliability across imaging modalities and between patients with and without patellar instability. Study Design: Systematic review; Level of evidence, 4. Methods: We performed a systematic review of the literature using the PubMed, SCOPUS, and Cochrane databases. Each database was searched for variations of the terms “patellar instability,” “patellar dislocation,” “trochlear dysplasia,” “radiographic measures,” “computed tomography,” and “magnetic resonance imaging.” Studies were included if they were published after May 1, 2009, and before May 1, 2019. A meta-analysis using a random effects model was performed on several measurements, comparing instability and control groups to generate pooled values. Results: A total of 813 articles were identified, and 96 articles comprising 7912 patients and 106 unique metrics were included in the analysis. The mean patient age was 23.1 years (95% CI, 21.1-24.5), and 41% were male. The tibial tubercle–trochlear groove (TT-TG) distance was the most frequently included metric (59 studies), followed by the Insall-Salvati ratio and Caton-Deschamps index (both 26 studies). The interobserver intraclass correlation coefficients were excellent or good for the TT-TG distance and Insall-Salvati ratio in 100% of studies reporting them; however, for the Caton-Deschamps index and Blackburne-Peel ratio, they were excellent or good in only 43% and 40% of studies. Pooled magnetic resonance imaging values for TT-TG distance ( P < .01), Insall-Salvati ratio ( P = .01), and femoral sulcus angle ( P = .02) were significantly different between the instability and control groups. Values for tibial tubercle–posterior cruciate ligament distance ( P = .36) and Caton-Deschamps index ( P = .09) were not significantly different between groups. Conclusion: The most commonly reported measurements for evaluating patellar instability assessed patellar tracking and trochlear morphology. The TT-TG distance was the most common measurement and was greater in the patellar instability group as compared with the control group. In addition, the TT-TG, tibial tubercle–posterior cruciate ligament, and patellar tendon–trochlear groove distances were highly reproducible measurements for patellar tracking, and the Insall-Salvati ratio had superior reproducibility for assessing patellar height.
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Park, Hoon, Hyun Woo Kim, Jin Hwa Kam, and Dong Hoon Lee. "Open Wedge High Tibial Osteotomy with Distal Tubercle Osteotomy Lessens Change in Patellar Position." BioMed Research International 2017 (2017): 1–10. http://dx.doi.org/10.1155/2017/4636809.
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The purpose of this study was to investigate the change in patellar position after open wedge high tibial osteotomy (OWHTO) with distal tubercle osteotomy (DTO), comparing outcomes of conventional OWHTO in young adults with proximal tibia varus deformity but no arthritic manifestations. Thirty-three patients (mean age, 31.8 years) subjected to OWHTO/DTO were matched with 30 patients (mean age, 33.5 years) undergoing conventional OWHTO. Patellar position, as measured in pre- and postoperative standing lateral radiographs, was compared. Patellar height was assessed via Insall-Salvati ratio, modified Insall-Salvati ratio, Blackburne-Peel (BP) index, Caton-Deschamps (CD) index, and modified Miura-Kawamura index. Computed tomography was used to measure lateral patellar tilt and shift. In the OWHTO group, all patellar height indices decreased significantly following surgery. Although mean values of BP and CD indices decreased significantly in the OWHTO/DTO group, other determinants of patellar height showed no significant postoperative differences. Significant postoperative declines in average lateral patellar tilt were also evident in both groups, but pre- and postoperative lateral patellar shift did not differ significantly. OWHTO/DTO can be performed without significant changes in patellar height. The results obtained support that OWHTO/DTO is suitable for relatively young patients with proximal tibia vara but no arthritic change.
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Kňazovický, Dávid, Valent Ledecký, Marián Hluchý, and Marek Ďurej. "Use of the modified Insall Salvati method for determination of vertical patellar position in dogs with and without cranial cruciate ligament rupture considering the morphology of the cranio-proximal tibia." Acta Veterinaria Brno 81, no. 4 (2012): 403–7. http://dx.doi.org/10.2754/avb201281040403.
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The aim of this study was to evaluate if the modified Insall Salvati (IS) method can be applied for the canine patient despite differences of proximal tibial morphology, and if such potential differences are also seen in dogs with cranial cruciate ligament rupture. Insall Salvati method is a simple and convenient method for determination of the vertical position of patella, by dividing the length of patella by length of the patellar ligament. The influence of the variable proximal tibial morphology on the modified (IS) index was measured and the value of modified IS index in healthy dogs (n = 25) was compared with dogs with cranial cruciate ligament rupture (n = 26). Medio-lateral radiographs of 102 stifles were evaluated. Patellar ligament length (PLL), patellar length (PL), modified IS ratio and the height of insertion point of patellar ligament on tibial tuberosity were measured. Data of the IS ratio were compared with the value of the height of the insertion point with no significant difference (P = 0.36). There was no significant difference (P = 0.07) in the PLL:PL ratio between dogs affected or unaffected with cranial cruciate ligament rupture. Based on the results of this study we can conclude that the morphology of the cranio-proximal tibia and the height of insertion point of the patellar ligament do not have an influence on the value of the modified IS index both in healthy dogs and in dogs with cranial cruciate ligament rupture.
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Bhingraj, Mahmoud, Subramanyam Maripuri, and Kyle James. "RECURRENT POST-TRAUMATIC PATELLAR INSTABILITY IN ADOLESCENTS: IS TIBIAL TUBERCLE OSTEOTOMY THE KEY TO ADDITIONAL STABILITY?" Orthopaedic Proceedings 107-B, SUPP_3 (2025): 19. https://doi.org/10.1302/1358-992x.2025.3.019.
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IntroductionPatellar dislocation is a common injury in adolescents with a reported recurrence rate of 15 to 44% following conservative management. Surgery is offered in cases with re-dislocations and recurrent patellar instability. Addition of tibial tubercle osteotomy may be required in cases with significant instability, patella alta and abnormal TT:TG distance.PurposeThe purpose of this study is analyse the outcome in patients who underwent MPFL reconstruction, with or without tibial tubercle osteotomy.MethodsData was collected retrospectively for all patients until 2014, for 31 patients which included pre-operative Insall-Salvati Index, Caton-Deschamps Index, TT:TG distance, pre- and post-operative Kujala scoring. Patient satisfaction following the surgery was also noted at the final follow-up.Results31 patients underwent MPFL reconstructions, and 10 (31%) patients had bilateral surgeries making it a total of 41 knees. The mean pre-op Insall-Salvati and Caton-Deschamps Index were 1.36±0.98 and 1.34±0.94 respectively. The mean TT:TG distance was 16.63±21 mm ranging from 7 mm to 28 mm and the average pre-operative Kujala score was 47.11.4 knees (~10%) underwent a re-operation which included wound debridement, implant removals and a tibial tubercle osteotomy. The post-operative Caton-Deschamps Index was 1.04±0.6 following tibial tubercle osteotomy which indicated improvement in the patellar height. The mean post-op Kujala score was 94 and patient satisfaction at final follow-up was 96%.ConclusionAddition of a tibial tubercle osteotomy improves the patellar height and alignment, providing greater stability and better clinical outcome with no recurrence in patellar dislocations.
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GÜVEN, Necip, Sezai ÖZKAN, Tulin TURKOZU, et al. "Insall–Salvati index is associated with anterior cruciate ligament tears in men: A Case-controlled study." Journal of Orthopaedic Surgery 30, no. 1 (2022): 230949902110696. http://dx.doi.org/10.1177/23094990211069692.
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Purpose Many factors in the etiology of anterior cruciate ligament (ACL) tears, predisposing factors related to knee morphology have also been reported. This study aimed to determine whether the Insall–Salvati (IS) index, which measures patella height, is a predisposing risk factor for ACL tears. Methods The IS index, patellar length (PL), and patellar tendon length (PTL) values of patients (study group) that underwent arthroscopic reconstruction for ACL tears obtained by preoperative magnetic resonance imaging (MRI) were compared with the index values in the preoperative MRIs of patients that underwent knee arthroscopy for reasons besides ACL tears. In addition, the anterior tibial translation (ATT) of both groups was also measured and compared on MRI images. The MRI findings of the subjects included in both study groups were arthroscopically confirmed. Results The mean ages of the study group (n = 120) and control group (n = 90) were 29.1 ± 8.2 years and 31.8 ± 9.8 years, respectively. There was a statistically significant difference between the study and control groups in terms of the PL and PTL values ( p = 0.016 and p = 0.001, respectively). The IS index was statistically significantly higher in the study group with ACL tears ( p = 0.009). The ATT was 8.61 ± 4.68 mm in the study group and 3.80 ± 1.92 mm in the control group. The ATT results of both groups were evaluated, and it was found that the study group was significantly higher than the control group ( p = 0.001) Conclusions As a result of our current study, we observed higher IS index values in patients with ACL tears than in patients without ACL tears. It should be kept in mind that patella alta, which is associated with a high IS index as one of the factors of knee morphology associated with ACL tears, may play a role in the etiology of ACL tears.
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Sagradyan, Artur Stepanovich, A. A. Gritsyuk, Yu M. Stoyko, et al. "Patellar Articular Surface Replacement in Total Hip Arthroplasty." N.N. Priorov Journal of Traumatology and Orthopedics 18, no. 3 (2011): 47–53. http://dx.doi.org/10.17816/vto201118347-53.
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Examination of 249 patients with unilateral coxarthrosis was performed after total knee arthroplasty with (group 1) and without (group 2) patellar resurfacing performed at orthopaedic department of National Medical Surgical Center named after N.I. Pirogov. Total arthroplasty outcomes were assessed using knee-specific Oxford Knee Score (OKS), general questionnaire Medical Outcome Study 36-item Short-Form Health Survey (MOS Sf-36) and patellofemoral-specific questionnaire (PFQ). The following indications to patellar resurfacing were determined: body weight over 95 kg, patellar lateral shift ratio over 9%, 3rd and 4th degree of patellar chondromalacia by Outerbridge. Outcomes of patellar resurfacing were independent of patellar tilt angle (б), Insall-Salvati index, patient's height, body mass index, 1st and 2nd degree of patellar chondromalacia by Outerbridge.
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Yu, Hang, Hui Dong, Binjia Ruan, Xiaohang Xu, Yongxiang Wang, and Le Hu. "Clinical Effect of Suture Anchor and Double-Pulley Technique in the Treatment of Inferior Patellar Fracture." Computational and Mathematical Methods in Medicine 2021 (December 31, 2021): 1–8. http://dx.doi.org/10.1155/2021/4964195.
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Objective. To evaluate the efficacy of suture anchor combined with double-pulley technique for subpatellar comminuted fractures compared with wire vertical suture and Krachow in the treatment of subpatellar fractures. Methods. Retrospectively selected 48 patients with subpatellar pole comminuted fracture admitted in our hospital from February 2013 to July 2019, 25 patients with double-pulley technique (group A), and 23 patients with vertical wire suture with Krachow suture. Patient age, gender, AT/OTA typing, injury mechanism, follow-up time, surgical time, bleeding volume, mean fracture healing time, and postoperative complications were recorded. The Insall-Salvati index immediately and 6 weeks after surgery. Bostman scores and knee activity were recorded at each follow-up, and month 12 was taken as the final result. Results. Time of surgery in group A (46.52 min) was significantly shorter than in group B (76.30 min). Intraoperative bleeding in group 15.1 ml, B, group 15.9 ml. Both incisions healed in stage I, averaging clinical healing of patella fracture within 10 weeks. There was no significant difference in mean Bostman score and knee activity at month 12 (group A: 28.4, 124.8°; group B: 28.1, 125.7°). There was no significant statistical difference in the Insall-Salvati index immediately or 6 weeks between the two groups. Group B patients had two wire fractures, fracture healing and the wire removed one year after surgery, and the remaining patients had no complications such as internal fixation loosening, fracture, delayed healing, or nonhealing of fracture. Conclusion. Compared with the treatment of subpatellar fracture with wire vertical suture and Krachow method, suture anchor with double-pulley technique has short operation time, reliable fixation, and less complications. Patients can have early functional exercise and good knee function recovery without secondary surgery. It can be considered as an alternative therapy for this fracture and deserves clinical adoption and promotion.
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Ocal, Mehmet K., Deniz Seyrek-Intas, and Soner Cagatay. "Comparison of Insall–Salvati Index and Its Modification in Normal Dogs from Four Different Body Weight Groups." Veterinary and Comparative Orthopaedics and Traumatology 33, no. 02 (2019): 110–15. http://dx.doi.org/10.1055/s-0039-3400232.
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Abstract Objective The objectives of this study were to record the values of Insall-Salvati (IS) index and its modification in dogs classified into four different body weight groups and to determine whether these index values were influenced by sex. Study Design Bilateral mediolateral radiographs of 86 dogs were obtained. The dogs were classified into four different body weight groups: small, medium, large and giant. The patellar length (PL), caudal and cranial patellar ligament lengths (LLca and LLcr), stifle angle and superimposition of the femoral condyles were measured on the radiographs. The IS index and its modification (LLcr:PL) were calculated by dividing LLca or LLcr by the PL respectively. Spearman's correlation test and analysis of variance were used for statistical analyses. Results The sex of the dog and the presence of enthesophytes at the apex of the patella were two influential factors for the IS and LLcr:PL values. The mean IS values were 1.60 ± 0.28 in small dogs, 1.73 ± 0.27 in medium dogs, 1.82 ± 0.21 in large dogs and 1.97 ± 0.13 in giant dogs. The mean LLcr:PL for the same groups were 2.05 ± 0.23, 2.13 ± 0.19, 2.23 ± 0.21 and 2.27 ± 0.16 respectively. Conclusion The reference intervals for the IS index were 1.04 to 2.16 in the small dogs, 1.19 to 2.27 in the medium dogs, 1.40 to 2.24 in the large dogs and 1.71 to 2.23 in the giant dogs. The reference intervals for the LLcr:PL index were 1.59 to 2.51 in the small dogs, 1.75 to 2.51 in the medium dogs, 1.81 to 2.65 in the large dogs and 1.95 to 2.59 in the giant dogs. Dogs with values exceeding these reference intervals have patella alta and those with values below these intervals have patella baja.
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Hong, Hyoung-Taek, Yong-Gon Koh, Ji-Hoon Nam, Paul Shinil Kim, Yoon Hae Kwak, and Kyoung-Tak Kang. "Gender Differences in Patellar Positions among the Korean Population." Applied Sciences 10, no. 24 (2020): 8842. http://dx.doi.org/10.3390/app10248842.
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The various factors related to the morphometric characteristics of patella make it difficult to produce a standard interpretation of their respective values. A total of 1423 patients participated in this work. The distribution of Insall–Salvati ratios was investigated, and the upper and lower limits of two standard deviations were used to define the patellar alta and baja. An additional method was used, where 2.5% at each end of the distribution was defined as patellar alta and baja. Ratios in the females and males were 0.92 ± 0.14 and 0.87 ± 0.14, respectively. The ratios were considerably higher in females than in males (p < 0.05). Ratios defined for patellar alta and baja were 1.19 and 0.68 for females and 1.13 and 0.58 for males, respectively, when two standard deviations were used. Ratios defined for patellar alta and baja were 1.22 and 0.66 for females and 1.15 and 0.59 for males, respectively, when the extreme 2.5% method was used. No considerable differences in the patellar alta and baja were observed between the two methods. Patellar alta and baja were determined in ratios of more than 1.20 and less than 0.64, respectively. No significant differences in the patellar alta and baja were observed between the genders in the Korean population. Additionally, two standard deviations of the Insall–Salvati index are recommended for defining patellar alta and baja for the Korean population. However, we recommended analyzing the histogram distribution for the population, followed by an analysis of the patellar alta and baja.
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Zehir, Sinan, and Taner Alic. "The effects on joint functions of biplanar distal tubercle open-wedge high tibial osteotomy: A prospective study." Medicine 102, no. 36 (2023): e34980. http://dx.doi.org/10.1097/md.0000000000034980.
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Distal tubercle biplanar open-wedge high tibial osteotomy (DT-BOWHTO) is a method frequently applied in the treatment of knee joint medial osteoarthritis. The aim of this study was to evaluate the radiological, clinical, and functional results of patients at 5 years after DT-BOWHTO surgery. The study included a total of 41 patients who underwent DT-BOWHTO, comprising 19 (46.3%) males and 22 (53.7%) females with a mean age of 55.54 ± 4.17 (45–63) years and mean follow-up of 66.76 ± 6.29 (60–81) months. Statistical comparisons were made of the preoperative and postoperative body mass index (BMI), modified Insall-Salvati index, Blackburn-Peel index, Kelgren-Lawrence classification (KLC), tibial slope angle, American Knee Society Functional Score (AKSFS), Clinical American Knee Society Score (CAKSS), visual analog scale (VAS) pain score, Tegner Functional Activity Score (TFAS), total corrected angular measurements (TCA), and the tibio-femoral varus angle. Compared to the preoperative values, no statistically significant difference was determined in the postoperative modified Insall-Salvati index, Blackburn-Peel index, and tibial slope angle values (P > .05), and a statistically significant difference was determined in the BMI, AKSFS, CAKSS, VAS, KLC, tibio-femoral varus angle, and TFAS values (P ≤ .001). When the preoperative and postoperative BMI values were compared in 3 groups of normal, overweight, and obese, there was found to be a statistically significant difference (P = .014). No significant correlation was determined between the BMI values and the VAS and KLC values (P > .05). No significant correlation was determined between the total corrected angular and the preoperative and postoperative pain, and clinical and functional knee scores (VAS, AKSFS, CAKSS, TFAS) (P > .05). DT-BOWHTO was seen to provide extremely good 5-year results in the knee clinical findings, pain severity, and functional results. As the patella height and tibial slope angle were not changed, this did not cause the development of osteoarthritis in the patellofemoral and tibiofemoral joints. Grafting and fixation of the tibial tubercle with additional screws in the application of DT-BOWHTO were not seen to make any additional contribution to the healing of the osteotomy line. There was no relationship between increased BMI, reduced pain, and increase in knee functions in patients who underwent DT-BOWHTO.
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Allahabadi, Sachin, and Nirav K. Pandya. "CLINICAL OUTCOMES AFTER MEDIAL PATELLOFEMORAL LIGAMENT RECONSTRUCTION UTILIZING ALLOGRAFT TISSUE IN PEDIATRIC AND ADOLESCENT PATIENTS: MINIMUM 2-YEAR FOLLOW-UP." Orthopaedic Journal of Sports Medicine 9, no. 7_suppl3 (2021): 2325967121S0010. http://dx.doi.org/10.1177/2325967121s00103.
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Background: Medial patellofemoral ligament (MPFL) reconstruction has gained popularity as a tool to manage recurrent patellar instability. The use of allograft for reconstruction includes benefits of quicker surgical time and obviating donor-site morbidity. In anterior cruciate ligament (ACL) reconstruction hesitancy exists to use allograft in younger patients based on data demonstrating higher graft failure rates. However, a similar trend of allograft failure has not been demonstrated for reconstruction of the MPFL, which has a lower tensile strength than that of the ACL. Hypothesis/Purpose: The purpose of this study is to evaluate outcomes including recurrent instability after MPFL reconstruction utilizing allograft tissue in pediatric and adolescent patients. Methods: A retrospective review was performed to identify patients of a single surgeon with MPFL reconstructions with allograft for recurrent patellar instability with minimum two-year follow-up. Surgical management was recommended after minimum six weeks of nonoperative management including bracing, physical therapy, and activity modification. Pre-operative x-rays were evaluated to assess physeal closure, lower extremity alignment and trochlear morphology, and Insall-Salvati and Caton-Deschamps ratios. MRIs were reviewed to evaluate the MPFL, trochlear morphology, and tibial tubercle trochlear groove distance (TT-TG). The allograft was fixed with a bioabsorbable screw. Descriptive statistics were used to characterize data. The primary outcome was recurrent instability. Results: 20 patients (23 knees) 14 females (17 knees) with average age 15.8 years (range: 11.5-19.6 years) underwent MPFL reconstruction with allograft with average follow-up of 3.6 years (range: 2.2-5.9 years). Physes were open in 8 knees. Average Insall-Salvati ratio was 1.08 ± 0.16 and Caton-Deschamps index was 1.18 ± 0.15. Eighteen patients were noted to have trochlear dysplasia pre-operatively and TT-TG was 15.4 ± 3.9 mm. The three knees (13.0%) with complications had open physes – two (8.7%) had recurrent instability requiring subsequent operation and one sustained a patella fracture requiring open reduction internal fixation. The average Insall-Salvati of these three patients was 1.26 ± 0.21, Caton-Deschamps was 1.18 ± 0.21, and TT-TG was 18.3 ± 3.5mm. There were no growth disturbances noted post-operatively. Conclusion: MPFL reconstruction using allograft tissue may be performed safely in the pediatric and adolescent population with good outcomes at mid-term follow-up with few complications and low rate of recurrent instability. Anatomic factors for may contribute to recurrent instability and complications post-operatively, though larger numbers are needed for statistical analyses. Further prospective and randomized evaluation comparing autograft to allograft reconstruction is warranted to understand graft failure rates.
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Falkowski, Anna L., Carlo Camathias, Jon A. Jacobson, and Olaf Magerkurth. "Increased Magnetic Resonance Imaging Signal of the Lateral Patellar Facet Cartilage: A Functional Marker for Patellar Instability?" American Journal of Sports Medicine 45, no. 10 (2017): 2276–83. http://dx.doi.org/10.1177/0363546517705634.
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Background: In the knee joint, predisposition for patellar instability can be assessed by an abnormal Insall-Salvati index, tibial tuberosity–trochlear groove (TTTG) distance, and abnormal shape of patella and trochlea. Given the complex anatomic features of the knee joint with varying positions of the patella during motion, the presence of a single or even a combination of these factors does not inevitably result in patellar instability. After trocheoplasty in patients with trochlear dysplasia, assessment of trochlear cartilage and subchondral bone is limited due to postoperative artifacts. Identification of presence of edema in the patellar cartilage may be helpful to identify patellar instability before and after surgery in these patients. Purpose: To determine whether increased signal intensity of the lateral patellar facet cartilage or measurements of abnormal patellofemoral articulation are associated with patellar instability before and after trochleoplasty. Study Design: Case series; Level of evidence, 4. Methods: Twenty-two patients with clinical diagnosis of patellar instability who underwent trochleoplasty, with magnetic resonance imaging (MRI) of the knee before and after surgery, were identified. The following observations and measurements were obtained in preoperative imaging: Insall-Salvati ratio, tibial tuberosity–trochlear groove (TTTG) distance, patellar shape (Wiberg), trochlear shape (Hepp), and edema in the lateral patellar facet cartilage. At 3 to 12 months after surgery, the presence or absence of edema in the cartilage of the lateral facet of the patella, the trochlear shape, and TTTG distance were reassessed. Wilcoxon matched-pairs signed rank test and Student t test were used. Interreader agreement was calculated as the Cohen κ or paired Student t test. Results: Increased cartilage signal was present in 20 patients before trochleoplasty and in 4 after trochleoplasty. Insall-Salvati ratio was greater than 1.20 in 20 patients. Patellar shape was greater than type 2 in 18 patients. Trochlear shape was greater than type 2 in 21 patients before and 7 after trochleoplasty. Mean TTTG distance was 14 mm before and 10 mm after surgery. When results before and after surgery were compared, a significant difference was found for cartilage signal, TTTG distance, and trochlear shape. Agreement for observations was moderate to substantial, and no significant differences were found for interreader agreement ( P > .05). Conclusion: Patellar cartilage at the lateral facet of the patella can be assessed after trochleoplasty despite postoperative artifacts in the trochlea. A decrease of patellar edema seems to be associated with improved femoropatellar articulation. Moreover, patellar edema may be used as a functional criterion of patellofemoral instability. This would provide additional information compared to morphologic criteria which just describe predisposing factors for femoropatellar instability.
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Ambra, Luiz Felipe, Betina B. Hinckel, Elizabeth A. Arendt, Jack Farr, and Andreas H. Gomoll. "Anatomic Risk Factors for Focal Cartilage Lesions in the Patella and Trochlea: A Case-Control Study." American Journal of Sports Medicine 47, no. 10 (2019): 2444–53. http://dx.doi.org/10.1177/0363546519859320.
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Background:Focal cartilage lesions in the patellofemoral (PF) joint are common. Several studies correlated PF risk factors with PF instability, anterior knee pain, and PF arthritis; however, there is a lack of evidence correlating those factors to PF focal cartilage lesions.Purpose:To evaluate the influence of the anatomic PF risk factors in patients with isolated focal PF cartilage lesions.Study Design:Cross-sectional study; Level of evidence, 3.Methods:Patients with isolated PF focal cartilage lesions were included in the cartilage lesion group, and patients with other pathologies and normal PF cartilage were included in the control group. Multiple PF risk factors were accessed on magnetic resonance imaging scans: patellar morphology (patellar width, patellar thickness, and patellar angle), trochlear morphology (trochlear sulcus angle, lateral condyle index, and trochlear sulcus depth), patellar height (Insall-Salvati ratio and Caton-Deschamps index), axial patellar positioning (patellar tilt, angle of Fulkerson), and quadriceps vector (tibial tuberosity–trochlear groove distance).Results:A total of 135 patients were included in the cartilage lesion group and 100 in the control group. As compared with the control group, the cartilage lesion group had a higher sulcus angle ( P = .0007), lower trochlear sulcus depth ( P < .0001), lower angle of Fulkerson ( P < .0001), lower patellar width ( P = .0003), and higher Insall-Salvati ratio ( P < .0001). From the patients in the cartilage lesion group, 36% had trochlear dysplasia; 27.6%, patella alta; and 24.7%, abnormal patellar tilt. These parameters were more frequent in the cartilage lesion group ( P < .0001). Trochlear lesions were more frequent in men, presented at an older age, and had fewer associated anatomic risk factors. Patellar lesions, conversely, were more frequent in women, presented at younger age, and were more closely associated with anatomic risk factors.Conclusion:PF anatomic abnormalities are significantly more common in patients with full-thickness PF cartilage lesions. Trochlear dysplasia, patella alta, and excessive lateral patellar tilt are the most common correlated factors, especially in patellar lesions.
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Otlans, Peters, Juliana Heimur, John Hayden Sonnier, Devyn Gibby, and Kevin B. Freedman. "The Utility of MRI in Evaluating Ruptures of the Patellar Tendon." Orthopaedic Journal of Sports Medicine 11, no. 1 (2023): 232596712211449. http://dx.doi.org/10.1177/23259671221144980.
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Background: Although the identification of patellar tendon rupture is a clinical diagnosis aided by standard radiography, magnetic resonance imaging (MRI) may aid in identifying the location of the rupture and concomitant pathology. Purpose: To evaluate the characteristics of patellar tendon tears needing surgical repair and to determine whether patient or injury factors were predictive of tear location. Study Design: Case series; Level of evidence, 4. Methods: Consecutive patients who underwent primary patellar tendon repair for rupture between May 15, 2017, and April 10, 2020, were reviewed retrospectively. Exclusion criteria included age <18 years, surgical treatment of multiligamentous knee injury, laceration injury, and knee arthroplasty. Radiographs, MRI scans, MRI reports, clinic notes, and operative notes were evaluated. Statistical analysis was performed to determine factors associated with tear location, complications, and reoperation. Results: In total, 147 patients and 156 tendon tears were included; 82.1% of the tears were patellar avulsions, 14.7% were midsubstance or complex tears, and 3.2% were tibial avulsions. Patient and injury characteristics (body mass index, race, medical comorbidities, presence of patellar tendinitis, mechanism of injury, Insall-Salvati ratio, and the presence of infrapatellar bone fragments) were not predictive of tear location ( P > .05). Patellar tendon ruptures were able to be clinically diagnosed correctly in >99% of cases. MRI was used to evaluate 77 (49.4%) knees. Patients who underwent MRI before surgery were more likely to have a history of preexisting tendinitis ( P = .015) and a lower preoperative Insall-Salvati ratio (1.68 vs 1.52; P = .017). Conclusion: Patient and injury factors were not predictive of tear location. The majority of patellar tendon tears were avulsion-type injuries from the inferior patella. MRI was not necessary to aid in the diagnosis of patellar tendon rupture, as 99.4% of tears were able to be diagnosed clinically without advanced imaging.
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Allberg, Clara M., and James Miles. "Measurement of Patellar Proximodistal Positioning with Limited Joint-Angle Sensitivity." Veterinary and Comparative Orthopaedics and Traumatology 33, no. 02 (2020): 096–101. http://dx.doi.org/10.1055/s-0039-3400230.
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Abstract Objective Patellar luxation can be associated with abnormal proximodistal positioning of the patella. The current gold standard index (Insall–Salvati) for referencing this position is poorly suited to postoperative use, if the tibial tuberosity is moved surgically, but has the advantage of changing minimally with altered joint angles. The aim of this study was to identify an alternative index, which was simple to use, joint-angle insensitive and suitable for postoperative use. Study Design Candidate indices based on the angle between stifle joint landmarks were screened across a wide range of joint angles for insensitivity to joint angle changes using vulpine and canine stifle radiographs. Intraobserver and interobserver agreements were assessed for a single candidate index using canine radiographs. Results An angular index based on the caudal aspect of the femoral and tibial condyles and the apex of the patella was largely insensitive to joint angle variation. Intra- and interobserver agreements appeared suitable for clinical use, with low within-subject standard deviations (<1.3°) and coefficients of variations (<2.2%), and high intraclass correlation coefficients (>0.89). Conclusion Patellar proximodistal position can be acceptably assessed at a variety of caudal joint angles using the described angular index. Further work is required to define reference intervals across a range of canine breeds.
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Lal, A. K., A. Nugur, and S. Santhanam. "PATELLAR HEIGHT IN CHILDREN: ARE THE INDICES USED IN ADULTS APPROPRIATE IN THE PAEDIATRIC POPULATION?" Orthopaedic Proceedings 106-B, SUPP_14 (2024): 13. http://dx.doi.org/10.1302/1358-992x.2024.14.013.
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Abnormal patella height has been found to be one of the main reasons for abnormal contact between patella and trochlear groove leading to patellar instability in children. Many methods have been described to diagnose patellar instability but most of them are justified only in adults. The reason being incomplete ossification in the paediatric population. These methods have been divided into direct and indirect methods. We analysed the MRI scan of knee of 57 children between 12–14 years of age with no previous diagnosis of patellar instability. Patients with a diagnosis of patellar instability, previous surgery on the knee or trauma and poor MRI scan were excluded from the study. We used Insall -Salvati Index (ISI), Caton-Deschamp Index (CDI) and Patella-Trochlear Index (PTI) and compared the results. We found that 40% of measurements by CDI and 41% by ISI showed patella alta in patients with normal patella height. 10% of patients in PTI readings had value suggestive of abnormal patella height.We concluded that PTI is a more reliable index to be used in children as it uses the length of articular surface and does not rely on bony landmarks. Studies done show PTI is a more reliable and accurate method of measuring patella height.
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McEwen, Peter, Sergio Barroso Rosa, Kaushik Hazratwala, Matthew Wilkinson, Brent Matthews, and Zaid Bahho. "The quadriceps active ratio: A dynamic MRI based assessment of patellar height." Orthopaedic Journal of Sports Medicine 5, no. 5_suppl5 (2017): 2325967117S0019. http://dx.doi.org/10.1177/2325967117s00193.
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Objective: Precise and accurate surgical correction of Patella Alta (PA) requires both a diagnosis of the condition and a target for correction. The radiographic ratios widely used for assessing patella height are flawed for a number of reasons. The Patellotrochlear Index (PTI) addresses some of these deficiencies but is done under passive conditions and in Bierdet’s paper was not related to the diagnosis of PFI. We describe a quadriceps active modification of the PTI, the quads active ratio (Q+R) and assess its reliability and accuracy as a test for the diagnosis of PFI due to PA. Methods: One hundred patients undergoing a clinically indicated knee MRI scan were recruited into the study. Participants had an additional sagittal T1 sequence acquired with maximal static quadriceps contraction. Six scans were technically inadequate. The remaining 94 scans were screened for trochlear dysplasia and 16 scans were subsequently discarded so PFI could be assessed solely in terms of PA. There were 9 cases of PFI in the remaining 78 scans. In 56 of these scans a lateral radiograph was also available. The PTI and Q+R were calculated from MRI scans and the Insall Salvati (IS), Modified Insall-Salvati (MIS), Blackburn Peel (BP) and Caton-Deschamp (CD) ratios from lateral radiographs by 3 surgeons at 3 times points. The inter- and intra-rater reliability of the measures were calculated using intra-class correlation coefficient. Receiver operator curves were constructed to determine the ideal cut-off for each MRI based test for the diagnosis of PFI. Sensitivity and specificity of the MRI based tests for PFI was compared to the IS, MIS, BP and CD ratios using their previously published cut-offs. Results: A main effect of time was found for the PTI (P < 0.01) but not for the Q+R (P = 0.052). A time x surgeon interaction effect was shown for both the PTI and the Q+R (P < 0.01, respectively). However, one-way ANOVA at time point 3 showed no main effect of surgeons for either the PTI (p=0.05) or Q+R (p = 0.09). The Intra-class Correlation Coefficient between surgeons for the PTI and the Q+R ranged from 0.65-0.75 and 0.69-0.83 respectively. The coefficient of variation between surgeons for the PTI and the Q+R ranged from 0.88-9.88% and 2.24-4.85% respectively. According to the area under the receiver operator characteristics curve, the Q+R (AUC, 0.76; SE, 0.06; 95%CI, 0.87-0.64; P < 0.01) was more accurate to detect PFI than the PTI (AUC, 0.74; SE, 0.06; 95%CI, 0.86-0.62; P < 0.05). The Q+R and PTI cut-off scores of 0.12 and 0.36 gave sensitivities of 79.2% and specificities of 55.0% and 50.0% respectively. Of the widely used radiographic indices the Insall-Salvati ratio was the most accurate. Conclusion: The Q+R is more accurate than the PTI for the diagnosis of patella alta causing PFI and addresses many of the deficiencies in other assessment methods. In the absence of trochlear dysplasia a Q+R cut-off of 0.12 may be a reasonable target for correction of Patella Alta.
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KESKİN, Zeynep, Muhammet Zeki GÜLTEKİN, and Suat KESKİN. "Investigation of the Effectiveness of Radiography, Computer Tomography and Magnetic Resonance Imaging Using the Insall-Salvati Index in Evaluation of Patellar Tendon Height: A Retrospective Study." Turkiye Klinikleri Journal of Medical Sciences 43, no. 1 (2023): 90–95. http://dx.doi.org/10.5336/medsci.2022-92158.
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DOĞAN, Özgür, Batuhan GENCER, and İhsaniye SÜER DOĞAN. "The Effectiveness of Anterior Cruciate Ligament Reconstruction on the Patellofemoral Stability and Patellar Height." Archives of Current Medical Research 4, no. 2 (2023): 94–101. http://dx.doi.org/10.47482/acmr.1261764.
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Background: Considering the critical role the anterior cruciate ligament (ACL) plays in knee biomechanics, it is a logical hypothesis that ACL reconstruction (ACLR) will have positive effects on knee kinematics, and stability. Our objective was to investigate the effect of single-bundle ACLR on patellar height, and patellofemoral balance radiologically and clinically.
 Methods: In this prospective study, 87 patients operated with hamstring autograft-used single-bundle ACLR were analyzed. History of dislocation, stability-related physical examination findings, Tegner-Lysholm Knee Scoring Scale, and Kujala Anterior Knee Pain Scale were used for functional assessment. All patients underwent pre-and post-operative magnetic resonance imaging and Insall-Salvati (IS) Index, Caton Deschamps Index, Blackburne-Peel Index, and Patella-patellar tendon (P-PT) angles were measured on T1-weighted sagittal section images. 
 Results: A total of 79 patients (90.8%) achieved excellent or good result, according to Tegner-Lysholm Knee Scoring Scale, and the patients' postoperative 1st year mean Kujala Anterior Knee Pain Score was calculated as 90.4 (Range: 79.1 – 96.4). On physical examination, increased passive patellar translation was observed in 2 patients (2.3%), but the J sign was appeared to be negative in all the patients. While all patellar height indices decreased after reconstruction, only the decrease in IS index was statistically significant (p=0.007). Moreover, the P-PT angle was found to be significantly lower after ACLR (p
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Sieroń, Dominik, Izabella Jabłońska, Dawid Lukoszek, et al. "Knee Diameter and Cross-Section Area Measurements in MRI as New Promising Methods of Chondromalacia Diagnosis-Pilot Study." Medicina 58, no. 9 (2022): 1142. http://dx.doi.org/10.3390/medicina58091142.
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Background and Objectives: Chondromalacia often affects the knee joint. Risk factors for the development of cartilage degenerative changes include overweight, female sex and age. The use of radiological parameters to assess the knee joint is rarely reported in the literature. Materials and Methods: The study involved 324 patients, including 159 (49%) women and 165 (51%) men, with an age range between 8–87 years (mean: 45.1 ± 20.9). The studied group had a body mass index (BMI) in the range of 14.3–47.3 (mean: 27.7 ± 5.02). A 1.5 Tesla and 3.0 Tesla (T) MRI scanner was used to assess the cartilage of the knee joint using the Outerbridge scale. The radiological parameters analyzed were the Insall–Salvati index, knee surface area, knee AP (antero-posterior) maximal diameter and knee SD (sinistro-dexter) maximal diameter. Results: Parameters such as the knee surface area, knee AP maximal diameter and knee SD maximal diameter showed a significant correlation with Outerbridge Scale (p < 0.014). The age of the patients showed a significant correlation with each knee parameter (p < 0.004). Results of knee AP and SD maximal diameter measurements strongly depended on BMI level. Conclusions: A significant relationship was found between the knee surface area, knee AP maximal diameter and knee SD maximal diameter and the advancement of chondromalacic changes in the knee joint, age and BMI.
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Gheni Abd Ali, Zuhair. "High Tibial Osteotomy Open Wedge Osteotomy versus Close Wedge Osteotomy in Relation to Patella Baja as Asequale to this Osteotomy." AL-QADISIYAH MEDICAL JOURNAL 11, no. 20 (2017): 50–53. http://dx.doi.org/10.28922/qmj.2015.11.20.50-53.
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Study design :Our study is aretrospective study to asses the level of the patella after valgus high tibial osteotomy in 2 groups of patients group A perform to them open wedge valgus high tibial osteotomy and groupB perform to them close wedge valgus high tibial osteotomy.material and method :Our study include 18 patients perform to them valgus high tibial osteotomy from January 2004 – October 2008 in multi center in Baghdad and alnajaf cities ,age between 40-60 years average 45 years 9 of them perform to them open wedge valgus high tibial osteotomy and 9 of them perform to them close wedge high tibial osteotomy.Result:The mechanical hip-knee-ankle angle improved from average 168 degree to average184 degree . patella baja observed in both groups of patients but it is more sever in group A than in group B i.e it is more sever in patients with open wedge valgus high tibial osteotomy than in close wedge valgus high tibial osteotomy .conclusion :Patella baja is common after valgus high tibial osteotomy , it is more sever in patient with open wedge valgus high tibial osteotomy than close wedge valgus high tibial osteotomy ,according to the blackburne – peel index and insall salvati index , this effect the function of the joint according to the severity of the patella baja in both groups of patients .
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Ginting, M.D, Florensius, Dwikora Novembri Utomo, M.D, and Rosy Setiawati, M.D.D. "Comparative analysis of patellofemoral anthropometry by gender using magnetic resonance imaging." Edelweiss Applied Science and Technology 8, no. 6 (2024): 5050–56. https://doi.org/10.55214/25768484.v8i6.3110.
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Patellofemoral instability affects women more often than men. Anatomical differences between the sexes lead to disturbances in patellofemoral alignment. Some of the key structural factors that contribute to patellar instability include trochlear dysplasia, patella alta, an increased tibial tuberosity-trochlear groove (TT-TG) distance, and lateral tilt of the patella. The study was conducted at a tertiary hospital. Patients with a history of patellar instability, history of fracture in the knee area, lower extremity deformity, history of knee ligament surgery and hyperlaxity were excluded. A total of 86 knee MRIs (45 men and 41 women) performed measurements of trochlear profile, patellar position, lateralization of the tibial tuberosity and patellar profile. Data were analyzed using descriptive and analytical analysis in the form of an Independent T-Test with the alternative Mann Whitney U-Test. The results of the study show significant differences between groups. There were differences in facet asymmetry (p<0.02), the depth of the trochlea (p<0.03), the Insall Salvati Index (p<0.01), the Caton Deshcamp Index (p<0.01), the bisection of the index (p<0.01), the Tibial Tuberosity-Posterior Cruciate Ligament (TT-PCL) (p<0.016), and the profile of the patella (Cranio Caudal Length, Transverse Length, Anteroposterior Length, Circumference, and Patellar Area) (p<0.001). Patellofemoral anthropometry shows significant gender differences. In women, a shallower trochlear groove, wider lateral facets, a higher and more lateral patellar position, and a smaller patellar profile are observed. These factors may contribute to the higher susceptibility of women to patellofemoral instability.
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Valianatos, Panagiotis, Evgenia Papadakou, Dimitrios Erginoussakis, Dimitrios Kampras, Nikitas Schizas, and Anastasios Kouzoupis. "Treatment of Chronic Patellar Tendon Rupture with Hamstrings Tendon Autograft." Journal of Knee Surgery 33, no. 08 (2019): 792–97. http://dx.doi.org/10.1055/s-0039-1688499.
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AbstractWe describe a new simple reconstruction for neglected chronic ruptures of patellar tendon using ipsilateral hamstrings tendon autograft. This has been validated in thirteen patients with mean follow up six years resulting in favorable outcome. Thirteen patients with mean age 58.2 years (range 30–64 years) presented with chronic patellar tendon rupture. They all underwent patellar tendon reconstruction using ipsilateral hamstrings tendon autograft. The average time from injury was 10 months (range 3–20 months). The cause of rupture was fall from height or after TKA and the preoperative Lysholm score was 65 (range 50–80). Postoperatively with a mean follow up of six years (range 5–7 years), all patients had a stable knee with mean flexion of 123°, extension lag 0°, and Insall-Salvati index 1.2. Quadriceps power was regained in 8 cases to 5/5 and in 5 cases to 4/5. No complications were inspected. The postoperative Lysholm score was 93 (range 89–95). Patellar tendon reconstruction using ipsilateral hamstrings as free autograft, consists an effective treatment option for chronic neglected patellar tendon ruptures. Our technique has favorable clinical outcome, complications are not expected, and consist a simple and anatomic reconstruction with a powerful graft, without the requirement for allograft or implants.
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Li, Junran, Chuanjie Chen, Hongyan Zhou, Jingxiu Zhai, Hongbo Zhao, and Ligeng Li. "Anatomic Risk Factors for Osteochondral Fracture of Acute First-Time Patellar Dislocation in Adolescents: A Retrospective Magnetic Resonance Imaging Study." Evidence-Based Complementary and Alternative Medicine 2022 (August 8, 2022): 1–6. http://dx.doi.org/10.1155/2022/6723326.
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Objective. To analyze the risk factors for osteochondral fracture (OCF) of first-time acute patellar dislocation (APD) through measurements of patellofemoral anatomy in adolescents. Methods. In this prospective study, all patients were divided into two groups according to whether OCF was detected on magnetic resonance imaging (MRI): Group A (associated with OCF) and Group B (without OCF). Patellofemoral anatomy was evaluated with four aspects including trochlear/patellar dysplasia, patella location, patellofemoral matching, and morphologic classification. On MRI scans, trochlear facet asymmetry ratio (TFAR), lateral trochlear inclination (LTI), sulcus angle (SA), trochlear depth (TD), and patellar depth (PD) were measured to assess trochlear/patellar dysplasia. Insall–Salvati index (ISI), Caton–Deschamps index (CDI), Blackburne–Peel index (BPI), lateral patellofemoral angle (LPFA), patellar tilt angle (PTA), and lateral patellar displacement (LPD) were measured to show the location of patella. Patellofemoral matching was analyzed through the measurements of patellofemoral congruence angle (PFCA), patellofemoral index (PFI), and patellotrochlear index (PTI). Results. A total of ninety-four adolescents from 49 boys and 45 girls (mean age, 15 years; range, 10–18 years) with first-time APD were recruited and included in Group A (65) and Group B (29). The PFI (2.62 ± 0.51 vs. 2.10 ± 0.44) and PTI (0.28 ± 0.05 vs. 0.22 ± 0.07) were significantly higher in Group B than Group A P < 0.05 . There were no significant differences in other quantitative outcomes of the two groups P > 0.05 . The distribution of Dejour/Wiberg classification was statistically similar between the two groups P > 0.05 . Conclusions. Adolescent patients with first-time APD complicating OCF have closer morphologic features of patellofemoral dysplasia and patella location when compared to adolescents without OCF. Abnormal patellofemoral matching increases the risk of OCF after first-time APD in adolescents.
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Grimm, Nathan L., Benjamin M. Wooster, David M. Tainter, Beau J. Kildow, Jaewhan Kim, and Dean C. Taylor. "Anatomic Magnetic Resonance Imaging Measurements in First-Time Patellar Dislocators by Sex and Age." Journal of Athletic Training 54, no. 8 (2019): 901–5. http://dx.doi.org/10.4085/1062-6050-280-18.
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Context Anatomic differences of the knee in first-time patellar dislocators have not been clearly elucidated. Objective To compare structural differences of the knee in those who have sustained an acute first-time patellar dislocation resulting in a medial patellofemoral ligament (MPFL) tear by sex and age (≤17 years old, ≥18 years old). Design Case series. Setting Retrospective magnetic resonance imaging analysis. Patients or Other Participants Thirty-five acute first-time patellar dislocators with an associated MPFL tear. Main Outcome Measure(s) Patellar height using 3 methods, patellar alignment using congruency angles, and trochlear morphology using the sulcus angle. We compared the means of these variables by sex and age. The intraclass correlation coefficient was then calculated to assess the agreement of the independent reviewers. Results A total of 21 left and 14 right knees were analyzed. The MPFL tear location did not differ by sex (P = .34) or age (P = .43). Patellar height did not differ as measured by the Caton-Deschamps ratio (P = .29 for sex, P = .49 for age), Insall-Salvati index (P = .15 for sex, P = .33 for age), or patellotrochlear index (P = .67 for sex, P = .49 for age). The congruence angle (P = .81 for sex, P = .06 for age) and trochlear morphology as measured by the sulcus angle (P = .64 for sex, P = .45 for age) were similar between groups. Conclusions Patellar height and trochlear morphology did not differ by sex or age among patients whose first-time patellar dislocations resulted in an MPFL tear. In addition, the location of the tear did not appear to vary by sex or age.
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Kotel’nikov, G. P., Yu V. Lartsev, A. K. Povelihin, et al. "Personalized preoperative planning in children with recurrent patellar dislocation severe." N.N. Priorov Journal of Traumatology and Orthopedics 26, no. 3 (2019): 31–36. http://dx.doi.org/10.17116/vto201903131.
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The aim of the study: was to improve the results of treatment in children with recurrent severe patellar dislocation, through the development of a differentiated approach to preoperative planning. Material and Methods. In SLLP Clinics Samara state medical University from 2014 to 2018 was observed 54 patients with this disease. In 37 patients recurrent severe dislocation. The average age of patients is 14.2 years. The patients underwent postural radiography of the lower extremities, radiography of the knee joint in the lateral projection, computed tomography of the knee joints, computed tomography of the hip joints. Research patients measured parameters, confirming mnohopocetny dysplastic changes of the joint angle Q, the index Insall-Salvati, the congruence angle on Merchant and anticarsia of the femoral head. Because of the severe degree of the disease, bone plastic surgery is indicated. Patients underwent corrective supracondylar derotation-dialysisa osteotomy of the femur in combination with medialization and distalization of the tibial tuberosity. During this operation, it is possible to perform a correction in all three planes. Results. In the postoperative period, 32 patients have no complications, 1 patient has relapse, 4 patients have contracture. In the long-term postoperative period 86.5% of positive results and 13.5% of unsatisfactory results, which is much lower than 36.1% - the percentage of complications according to the medical literature. Conclusion. The proposed personalized approach in preoperative planning for recurrent dislocation of the patella of severe degree, allows you to choose the best option for surgery.
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Oliva, Francesco, Mario Ronga, Umile Giuseppe Longo, Vittorino Testa, Giovanni Capasso, and Nicola Maffulli. "The 3-in-1 Procedure for Recurrent Dislocation of the Patella in Skeletally Immature Children and Adolescents." American Journal of Sports Medicine 37, no. 9 (2009): 1814–20. http://dx.doi.org/10.1177/0363546509333480.
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Background Recurrent patellar dislocations are common injuries in children and adolescents. The subjective and functional results of soft tissue surgical management in a population that was skeletally immature at the time of surgery have not been reported. Hypothesis The 3-in-1 procedure is an effective treatment for recurrent patellar dislocation in skeletally immature patients. Study Design Case series; Level of evidence, 4. Methods Twenty-five skeletally immature patients (age at operation, 13.5 ± 3.8 years) who were practicing sports and suffering from recurrent unilateral patellar dislocation were included in the study and followed until skeletal maturation. Clinical evaluation included the modified Cincinnati rating system and the Kujala score, anthropometry, plain radiography, and isokinetic dynamometry. Results The average follow-up was 3.8 years (range, 2.5-6 years). The mean modified Cincinnati score increased from 51.7 ± 12.6 preoperatively to 94.3 ± 10.8 (P < .02), while the mean Kujala scores increased from 52.4 ± 12.7 preoperatively to 93.8 ± 14.2 (P < .02). The Insall-Salvati index remained essentially unchanged, being 1.04 ± 0.2 preoperatively and 1.02 ± 0.3 at latest follow-up. Significant differences were found between the operated and the contralateral limb in the various isokinetic strength variables at all angular velocities measured at the latest follow-up (.05 < P < .0042). Conclusion The 3-in-1 procedure is a safe, reliable management option for recurrent patellar dislocation in skeletally immature patients. Side-to-side differences in isokinetic strength and in anthropometric indices persist despite subjective success of the procedure.
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Ronga, Mario, Francesco Oliva, Umile Giuseppe Longo, Vittorino Testa, Giovanni Capasso, and Nicola Maffulli. "Isolated Medial Patellofemoral Ligament Reconstruction for Recurrent Patellar Dislocation." American Journal of Sports Medicine 37, no. 9 (2009): 1735–42. http://dx.doi.org/10.1177/0363546509333482.
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Background Several medial patellofemoral ligament reconstruction procedures have been proposed to manage recurrent patellar dislocation. Hypothesis Reconstruction of the medial patellofemoral ligament using a hamstring graft with a 2 transverse patellar tunnels technique is an effective treatment for recurrent patellar dislocation in patients without any evident predisposing factors. Study Design Case series; Level of evidence, 4. Methods Twenty-eight patients with chronic patellar instability without any anatomic predisposing factors, experiencing recurrent unilateral patellar dislocation, were included in the study. Evaluation included the modified Cincinnati and the Kujala scores, anthropometry, plain radiography, and isokinetic dynamometry. Results The average follow-up was 3.1 years (range, 2.5-4 years). The mean modified Cincinnati score increased from 52 preoperatively to 89 (P = .001). The mean Kujala scores increased from 45 preoperatively to 83 (P = .03). The muscle volume of the thigh of the operated limb increased with time, but remained less well developed than the nonoperated limb (P = .04). The mean Insall-Salvati index was 1.1 (range, 0.9-1.2) preoperatively and remained within normal range (1.1 [range, 0.9 to 1.2]) (P = .07), at latest follow-up. Significant isokinetic strength differences were found between the operated and the contralateral limbs (.05 < P < .006), even at the latest follow-up. Three patients experienced a new patellar dislocation. Conclusion Medial patellofemoral ligament reconstruction using hamstring tendon passed through a double patellar transverse bony tunnel technique is a safe, reliable management option for recurrent patellar dislocation in patients without any predisposing anatomic factors.
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Seyfettinoğlu, Fırat, Özkan Köse, Hasan Ulaş Oğur, Ümit Tuhanioğlu, Hakan Çiçek, and Baver Acar. "Is There a Relationship between Patellofemoral Alignment and Osgood–Schlatter Disease? A Case-Control Study." Journal of Knee Surgery 33, no. 01 (2018): 067–72. http://dx.doi.org/10.1055/s-0038-1676523.
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AbstractThis study was aimed to investigate the role of anatomic variations in patellofemoral alignment in patients with or without Osgood-Schlatter disease (OSD) and to determine the potential anatomic risk factors that may play role in the etiology. This prospective observational case-control study was conducted on two groups of adolescent patients. Group 1 comprised patients who were diagnosed as having OSD and group 2 consisted of an equal number of age-matched patients who presented to the outpatient clinic with traumatic knee injury and underwent knee radiographic examination but without a diagnosis of OSD. Age, height, weight, body mass index (BMI), dominant side, and level of sporting activity were recorded. Quadriceps (Q) angles were measured using a long-arm goniometer with patients lying in the supine position with their knees in full extension and contracting the Q muscles. On anteroposterior, lateral knee, and tangential patella (Merchant and Laurin views) radiographs, the following measurements were performed: Insall–Salvati (IS), Caton–Deschamps (CD), and Blackburne–Peel (BP) indexes, congruence angles, lateral patellofemoral angles, sulcus angles, and patella type according to Grelsamer's morphology classification. Both groups were similar in respect of age (p = 0.160), sex (p = 0.311), height (p = 0.326), weight (p = 0.596), BMI (p = 0.153), and dominancy (p = 0.500). The rate of patients engaged in sports activities was significantly greater in the OSD group (p = 0.003). No significant difference was determined between the groups in respect to IS index, CD index, BP index, sulcus angle, lateral patellofemoral angle, and congruence angle (p–values: 0.358, 0.995, 0.912, 0.802, 1.000, and 0.907, respectively). The mean Q angle was measured as 15.6 ± 2.2 degrees in the OSD group and 14.3 ± 2.5 degrees in the control group (p = 0.014). Despite the difference being statistically significant, it was clinically insignificant because the difference was only 1.3 degrees. The principle etiologic factor seems to be increased physical activity rather than subtle variations is patellofemoral anatomy and alignment of extensor mechanism.
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Özdemir, Uğur, Bekir Murat Çinar, Mehmet Türker, et al. "Ellipsoidal patellar bone tunnel fixation with Toggleloc suspension system for medial patellofemoral ligament reconstruction: A 5 years follow-up." Medicine 103, no. 26 (2024): e38379. http://dx.doi.org/10.1097/md.0000000000038379.
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Background: This study aimed to evaluate the clinical and radiological features of the patella fixation technique using Toggleloc suspension system in a single ellipsoidal blind patellar tunnel during medial patellofemoral ligament (MPFL) reconstruction. Methods: This study included 52 patients (25 men, 27 women) who underwent MPFL reconstruction using a semitendinosus tendon graft. The graft was fixed to the ellipsoidal single blind tunnel opened on the medial side of the patella with an endobutton and was fixed to the femoral tunnel by using bioabsorbable screw. Clinical scores (Kujala score, Lysholm score, Tegner activity score and the visual analog scale [VAS] score) were evaluated preoperatively and at the end-follow up. Preoperative and postoperative radiological measurements (trochlea depth, sulcus angle, patellar height, patellar congruence angle, patellar tilt angle and lateral patellofemoral angle) were evaluated with X-ray (Merchant X-ray, anteroposterior and lateral radiography) and computed tomography (CT) of the knee. Results: Postoperative patellar redislocation or subluxation was not observed in any patient. Patellar congruence angle, patellar tilt angle and lateral patellofemoral angle mean values were found to return to normal values in the postoperative period and the results were statistically significant. Also statistically significant improvement in all clinical scores postoperatively. According to the Insall-Salvati index (ISI) and Caton-Deschamps index (CDI) on lateral radiography of the knee at 30° flexion, patellar height decreased in the postoperative period statistically significant. The CDI was above 1.3 in 17 (%32) of our patients. Thirteen of these values decreased to normal values. No radiological progression of patellofemoral osteoarthritis was observed in all patients at the final follow-up evaluation. Conclusion: In cases of patellofemoral instability, fixation of the tendon graft in blind ellipsoid tunnel using the Toggleloc suspension system provides satisfactory patellar graft fixation strength, significant functional improvement and a low failure rate.
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Mitani, Genya, Takashi Maeda, Tomonori Takagaki, et al. "Modified Elmslie–Trillat Procedure for Recurrent Dislocation of the Patella." Journal of Knee Surgery 30, no. 05 (2016): 493–500. http://dx.doi.org/10.1055/s-0036-1593363.
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AbstractMany groups have reported good to excellent clinical outcomes of the Elmslie–Trillat (ET) procedure for recurrent dislocation of the patella. However, the mean follow-up period of these studies was no more than 5 years. We hypothesized that the long-term postoperative outcomes of the modified ET procedure for recurrent dislocation of the patella would be acceptable compared with those of other procedures. The long-term postoperative outcomes of patients treated with the modified ET procedure were examined. A total of 31 knees in 27 patients with recurrent dislocation of the patella who underwent a modified ET procedure (without medial capsular plication) were evaluated. The mean follow-up period was 13.0 years. Pre- and postoperative radiographs were examined to determine the Q-angle, tilting angle, lateral shift ratio, sulcus angle, congruence angle, and Insall–Salvati index. Clinical outcomes were evaluated based on the Fulkerson patellofemoral joint evaluation score, Kujala score, and the presence of the apprehension sign. Radiological evaluation revealed significant postoperative improvements in the Q-angle, tilting angle, lateral shift ratio, congruence angle, Kujala score, and Fulkerson score (p < 0.001). Sixty-eight percent of all patients had a “good” or “excellent” Fulkerson score. The apprehension sign continued to be shown for six knees. Progression of osteoarthritic changes was observed in three knees, and one knee was symptomatic. The modified ET procedure provided satisfactory outcomes based on radiological and clinical evaluations. These results show the long-term effectiveness and safety of the modified ET procedure for recurrent patellar dislocation.
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Feucht, Matthias J., Patricia M. Lutz, Conrad Ketzer, et al. "Preoperative patellofemoral anatomy affects failure rate after isolated patellofemoral inlay arthroplasty." Archives of Orthopaedic and Trauma Surgery 140, no. 12 (2020): 2029–39. http://dx.doi.org/10.1007/s00402-020-03651-9.
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Abstract Purpose To analyze whether preoperative patellofemoral anatomy is associated with clinical improvement and failure rate after isolated patellofemoral arthroplasty (PFA) using a modern inlay-type trochlear implant. Methods Prospectively collected 24 months data of patients treated with isolated inlay PFA (HemiCAP® Wave, Arthrosurface, Franklin, MA, USA) between 2009 and 2016, and available digitalized preoperative imaging (plain radiographs in three planes and MRI) were retrospectively analyzed. All patients were evaluated using the WOMAC score, Lysholm score, and VAS pain. Patients revised to TKA or not achieving the minimal clinically important difference (MCID) for the total WOMAC score or VAS pain were considered failures. Preoperative imaging was analyzed regarding the following aspects: Tibiofemoral OA, patellofemoral OA, trochlear dysplasia (Dejour classification), patellar height (Insall–Salvati index [ISI]; Patellotrochlear index [PTI]), and position of the tibial tuberosity (TT–TG and TT–PCL distance). Results A total of 41 patients (61% female) with a mean age of 48 ± 13 years could be included. Fifteen patients (37%) were considered failures, with 5 patients (12%) revised to TKA and 10 patients (24%) not achieving MCID for WOMAC total or VAS pain. Failures had a significantly higher ISI, and a significantly lower PTI. Furthermore, the proportion of patients with a pathologic ISI (> 1.2), a pathologic PTI (< 0.28), and without trochlear dysplasia were significantly higher in failures. Significantly greater improvements in clinical outcome scores were observed in patients with a higher preoperative grade of patellofemoral OA, ISI ≤ 1.2, PTI ≥ 0.28, TT–PCL distance ≤ 21 mm, and a dysplastic trochlea. Conclusion Preoperative patellofemoral anatomy is significantly associated with clinical improvement and failure rate after isolated inlay PFA. Less improvement and a higher failure rate must be expected in patients with patella alta (ISI > 1.2 and PTI < 0.28), absence of trochlear dysplasia, and a lateralized position of the tibial tuberosity (TT–PCL distance > 21 mm). Concomitant procedures such as tibial tuberosity transfer may, therefore, be considered in such patients. Level of evidence Level III, retrospective analysis of prospectively collected data.
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Luceri, Francesco, Julien Roger, Pietro Simone Randelli, Sébastien Lustig, and Elvire Servien. "How Does Isolated Medial Patellofemoral Ligament Reconstruction Influence Patellar Height?" American Journal of Sports Medicine 48, no. 4 (2020): 895–900. http://dx.doi.org/10.1177/0363546520902132.
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Background: Reconstruction of the medial patellofemoral ligament (MPFL) is the gold standard treatment for recurrent patellar dislocation. Patella alta has been reported in about half of patients with recurrent patellofemoral instability. Hypothesis: MPFL reconstruction (MPFLr) has a beneficial role in the correction of patellar height in patients with mild patella alta (Caton-Deschamps index [CDI] between 1.20 and 1.40). Study Design: Case series; Level of evidence, 4. Methods: Skeletally mature patients, with no history of previous or concomitant knee surgical procedures, who underwent isolated MPFLr using hamstring autograft for recurrent patellar instability between 2005 and 2018, were included in this study. The authors calculated CDI, modified Insall-Salvati index (MISI), and Blackburne-Peel index (BPI) ratios. Measurements done by 2 independent observers were calculated and used to compare pre- and postoperative patellar height (patella alta: CDI >1.20). Results: A total of 89 patients (95 knees) were included in the study, with a mean age of 25.0 years (range, 15.0-45.0 years). There were 70% women and 30% men. We found patella alta in 35.8% of cases preoperatively. Among them, 79.4% had reduced patellar height indices, within normal limits, postoperatively (mean follow-up, 18.4 ± 12.0 months). All the ratios showed a significant reduction in patellar height after surgery (CDI: 0.19 [range, –0.05, 0.60]; MISI: 0.22 [–0.14, 0.76]; BPI: 0.18 [–0.08, 0.59]; P < .00001). The CDI of 79.4% of the study knees was reduced to within normal limits postoperatively. The CDI was maintained within normal limits postoperatively in 93.4% of the knees with normal patellar height and reduced to normal in 50% of the knees with severe patella alta before surgery . No patient reported patella infera before surgery, whereas this condition was found in 8.2% of study patients postoperatively. A moderate correlation was reported between preoperative radiographic indices and their reduction after surgery (CDI: P < .001, ρ = 0.39; MISI: P < .001, ρ = 0.39; BPI: P < .001, ρ = 0.48). Conclusion: The higher the preoperative patellar height, the more important is the lowering effect of MPFLr using the hamstring for patellar instability. Bony procedures should not be indicated in patients with patellar instability and a CDI between 1.20 and 1.40.
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Diederichs, Gerd, Torsten Köhlitz, Evgenios Kornaropoulos, Markus O. Heller, Bernd Vollnberg, and Sven Scheffler. "Magnetic Resonance Imaging Analysis of Rotational Alignment in Patients With Patellar Dislocations." American Journal of Sports Medicine 41, no. 1 (2012): 51–57. http://dx.doi.org/10.1177/0363546512464691.
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Background: The role of anatomic risk factors in patellofemoral instability is not yet fully understood, as they have been observed in patients either alone or in combination and in different degrees of severity. Purpose: To prospectively analyze rotational limb alignment in patients with patellofemoral instability and in controls using magnetic resonance imaging (MRI). Study Design: Cross-sectional study; Level of evidence, 3. Methods: Thirty patients (mean age, 22.9 y; range, 12-41 y) with a history of patellar dislocation and 30 age- and sex-matched controls (mean age, 25.2 y; range, 16-37 y) were investigated. The patients underwent MRI of the leg at 1.5 T using a peripheral angiography coil and a T2-weighted half-Fourier acquisition single-shot turbo spin echo (HASTE) sequence for measuring femoral antetorsion, tibial torsion, knee rotation, and mechanical axis deviation (MAD). The mean values of these parameters were compared between patients and controls. In addition, the patients underwent an assessment to determine the influence of rotational limb alignment on lateral trochlear inclination, trochlear facet asymmetry, trochlear depth, Insall-Salvati index, and tibial tuberosity–trochlear groove distance. Results: Patients had 1.56-fold higher mean femoral antetorsion (20.3° ± 10.4° vs 13.0° ± 8.4°; P < .01) and 1.6-fold higher knee rotation (9.4° ± 5.0° vs 5.7° ± 4.3°; P < .01) compared with controls. Moreover, patients had 2.9 times higher MAD (0.81 ± 0.75 mm vs −0.28 ± 0.87 mm; P < .01). Differences in tibial torsion were not significant. Also, there were no significant correlations between parameters of rotational alignment and standard anatomic risk factors. Conclusion: Our results suggest that some patients with nontraumatic patellar instability have greater internal femoral rotation, greater knee rotation, and a tendency for genu valgum compared with healthy controls. Rotational malalignment may be a primary risk factor in patellar dislocation that has so far been underestimated.
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Laddha, Mukesh, Anshul Pancholiya, and Sahu Gaura. "Clinical outcome of Patella stability after fixation of Osteochondral fracture in Acute Primary Traumatic Patella Dislocation without MPFL Repair or Reconstruction." Journal of Clinical Orthopaedics 7, no. 1 (2022): 110–15. http://dx.doi.org/10.13107/jcorth.2022.v07i01.489.
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Introduction: Conservative management is advisable for acute primary traumatic patella dislocation (PTPD). Surgical treatment is reserved for osteochondral fractures (OCF), medial patello femoral ligament (MPFL) avulsion/tear, compound injuries, and any underlying bony abnormalities requiring correction. MPFL repair (at avulsed site) or reconstruction along with underlying bony correction in PTPD is controversial. The purpose of this study is to evaluate patella stability after fixation of OCF in PTPD without performing MPFL repair or reconstruction, even in the presence of any underlying bony abnormalities. Material and Methods: This is a retrospective study of eight patients who had PTPD with OCF along with MPFL injury who presented between 2016 and 2019. Pre-operative X-rays and MRI were done to assess the status of MPFL, identify the presence of OCF and to calculate Insall-Salvati index, Tibial Tuberosity-Trochlear groove distance and Trochlear dysplasia. All patients underwent surgery by open approach and OCF fixation by bioabsorbable pins or suture material. MPFL was neither repaired at avulsed site nor reconstructed and even no bony corrections were done. Results: Average size of OCF fragments is 15*7 mm and all involving medial facet of patella. Lysholm score improved significantly from 32.8 to 94.8 and Kujala score from 49.1 to 96 at the end of 6 months. None of the patient had patella instability till latest follow-up, average follow-up period is 4.5 years (3–6 years). Clinically, apprehension test was negative in all cases with full ROM. Post-operative imaging including X-ray and MRI showed complete healing of the OCF along with complete healing/regeneration of MPFL with same pre-existing bony abnormalities if present preoperatively. Conclusion: This study shows excellent patella stability and full knee function along with complete union of OCF and complete healing/regeneration of MPFL in PTPD even in the presence of underlying bony abnormality. Hence, in PTPD with OCF, there is no need to repair/reconstruct MPFL or to correct underlying bony pathology, only OCF fixation is required.
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Zhu, Zhaohua, Weiyu Han, Ming Lu, et al. "Effects of infrapatellar fat pad preservation versus resection on clinical outcomes after total knee arthroplasty in patients with knee osteoarthritis (IPAKA): study protocol for a multicentre, randomised, controlled clinical trial." BMJ Open 10, no. 10 (2020): e043088. http://dx.doi.org/10.1136/bmjopen-2020-043088.
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IntroductionThe infrapatellar fat pad (IPFP) is commonly resected during total knee arthroplasty (TKA) for better exposure. However, our previous studies have suggested that IPFP size was protective against, while IPFP signal intensity alteration was detrimental on knee symptoms and structural abnormalities. We hypothesise that an IPFP with normal qualities, rather than abnormal qualities, should be preserved during TKA. The aim of this study is to compare, over a 1-year period, the postoperative clinical outcomes of IPFP preservation versus resection after TKA in patients with normal or abnormal IPFP signal intensity alteration on MRI.Methods and analysisThree hundred and sixty people with end-stage knee osteoarthritis and on the waiting list for TKA will be recruited and identified as normal IPFP quality (signal intensity alteration score ≤1) or abnormal IPFP quality (signal intensity alteration score ≥2). Patients in each hospital will then be randomly allocated to IPFP resection group or preservation group. The primary outcomes are the summed score of self-reported Knee Injury and Osteoarthritis Outcome Score (KOOS), KOOS subscales assessing function in daily activities and function in sport and recreation. Secondary endpoints will be included: KOOS subscales (pain, symptoms and quality of life), Knee Society Score, 100 mm Visual Analogue Scale (VAS) Pain, timed up-and-go test, patellar tendon shortening, 100 mm VAS self-reported efficacy of reduced pain and increased quality of life, and Insall-Salvati index assessed on plain X-ray. Adverse events will be recorded. Intention-to-treat analyses will be used.Ethics and disseminationThe study is approved by the local Medical Ethics Committee (Zhujiang Hospital Ethics Committee, reference number 2017-GJGBK-001) and will be conducted according to the principle of the Declaration of Helsinki (64th, 2013) and the Good Clinical Practice standard, and in compliance with the Medical Research Involving Human Subjects Act . Data will be published in peer-reviewed journals and presented at conferences, both nationally and internationally.Trial registration numberThis trial was registered at Clinicaltrial.gov website on 19 October 2018 with identify number NCT03763448.
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Cernat, Eduard M., Alina Dima, Claudiu Popescu, et al. "Anterior Intercondylar Notch Geometry in Relation to the Native Anterior Cruciate Ligament Size." Journal of Clinical Medicine 13, no. 2 (2024): 309. http://dx.doi.org/10.3390/jcm13020309.
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Background: The intercondylar notch (ICN) and the anterior cruciate ligament (ACL) are important structures in knee morphometry, with key roles in stabilizing the knee. Aim: To determine the associations between the specific shape of the ICN (A-, W-, or U-shape) and the ACL size in patients with intact ACLs. Methods: Magnetic resonance imaging (MRI) scans were independently analyzed by two experts: one orthopedic surgeon and one imaging physician. In all cases, the following measurements were taken based on the existing definitions: ACL area, anterior ICN (aICN) area, ICN width, lateral trochlear inclination (LTI), and Insall–Salvati index. Results: A total of 65 cases (50.8% male; 33.8 ± 10.2 years mean age at inclusion) were included in the study. The ACL and aICN areas were significantly larger in patients with U-shaped compared with A-shaped and W-shaped ICNs: 0.50 (0.20–0.80) vs. 0.40 (0.20–0.80) vs. 0.40 (0.30–0.80), p = 0.011 and 1.16 (0.57–3.60) vs. 0.47 (0.15–0.95) vs. 0.37 (0.15–0.81), p < 0.001, respectively. Internal meniscal lesions were more common in cases with U-shaped ICNs (64.0%), while external ones were more common in W-shaped ICN cases (35.3%). None of the A-shaped cases had external chondral or meniscal lesions. The ACL area was significantly larger in males and internal meniscal injuries, with no differences between chondral lesions, external meniscal injuries, patellar chondral lesions, patella alta, or trochlear dysplasia. Conclusion: The specific shape of the intercondylar notch was associated with the anterior cruciate ligament–anterior intercondylar notch (ACL–aICN) area size correlation, with a strong correlation between ACL and aICN area when the intercondylar notch was A-shaped or W-shaped, and a low correlation when the notch was U- shaped. The specific shape of the intercondylar notch (A-, W-, or U-shape) was associated with the occurrence of both internal and external meniscal injuries, with the U-shaped intercondylar notch morphometry being more frequent in cases with internal meniscal injuries and the W-shape being more common in cases with external meniscal injuries.
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Albiero, William, Melanie A. Morscher, John Elias, Pat Riley, Mark Adamczyk, and Kerwyn Jones. "INCREASED LIKELIHOOD OF PEDIATRIC RECURRENT PATELLAR DISLOCATIONS BASED ON SEVERITY OF RADIOGRAPHIC MEASURES." Orthopaedic Journal of Sports Medicine 7, no. 3_suppl (2019): 2325967119S0004. http://dx.doi.org/10.1177/2325967119s00045.
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Background: The etiology for recurrent patellar dislocations in children with patellofemoral instability (PFI) is not always apparent. Radiographic and other imaging measures help guide the clinician. However, the imaging parameters for pathologic pediatric PFI and the significance of these measures based on severity are not clearly defined. This study compares common imaging measures for PFI in a non-pathologic and known patellar dislocation pediatric population and determines the likelihood of symptoms based on the severity of each individual measure. Methods: An IRB-approved retrospective review of knee MRIs and radiographs at a single pediatric institution identified 108 limbs (102 patients) meeting inclusion criteria. Sixty-nine limbs had no known patellar pathology (control group) and 39 had surgery for recurrent patellar dislocations (surgical group). MRI measures included tibial tuberosity-trochlear groove distance (TT-TG), tibial tuberosity-posterior cruciate ligament distance (TT-PCL), and lateral trochlear inclination (LTI). Radiographic measures included the Caton-Deschamps Index (CDI) and Insall-Salvati Index (ISI). These measures are representative of PFI risk factors, specifically patellar tendon malalignment, trochlear dysplasia, and patella alta. Binomial logistic regression was used to relate the anatomical parameters to the probability of PFI. Results: The surgical and control groups were similar in terms of age, height and weight. The logistic regression analysis indicated that the TT-TG (p=0.001) and LTI (p<0.001) were correlated with PFI. The odds ratio (95% confidence interval) was 1.19 (1.07 -1.31) for TT-TG, giving the increased probability of a knee to experience PFI for each 1 mm increase. The odds ratio was 0.85 (0.77-0.93) for LTI, showing a decrease in the probability of instability with each 1° increase. Neither CDI nor ISI measures significantly correlated with probability of PFI (p=0.30 and p=0.18, respectively). The two parameters of TT-TG and LTI accounted for 42% (Nagelkerke R2) of the variance between the control and surgical groups. Conclusion/Significance: Comparing pediatric patients with recurrent patellar dislocations to controls, logistic regression analysis suggests the likelihood of PFI correlates with the severity of specific radiographic measures, specifically those representing the degree of patellar tendon alignment (TT-TG) and trochlear dysplasia (LTI). Knowing this correlation can help guide the treatment of PFI in pediatric patients by providing physicians and families with a continuum on which to base their decisions.
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Singh, Chander Mohan, Hrishikesh Pande, Prashant Pratim Padhi, Anjan Prabhakara, Vivek Mathew Philip, and Yogesh Sharma. "Incidence of patella baja following patellar eversion in total knee arthroplasty." International Journal of Research in Orthopaedics 3, no. 2 (2017): 247. http://dx.doi.org/10.18203/issn.2455-4510.intjresorthop20170782.
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<p class="abstract"><strong>Background:</strong> Patella baja is a rare complication of total knee arthroplasty (TKA) leading to decreased mechanical advantage of the extensor mechanism, decreased knee range of motion, anterior knee pain and increased wear of the tibial and patellar polyethylene. There exists a lack of evidence on whether patellar eversion leads to shortening of the patellar tendon. The present study aims to determine if eversion of patella during TKA leads to patella baja.</p><p class="abstract"><strong>Methods:</strong> Between August 2014 and August 2016, 55 knees undergoing primary TKA with a standard medial parapatellar arthrotomy and eversion of patella were included in this two point cross sectional study. Preoperative X-rays were taken to assess the length of the patellar tendon and Insall Salvati ratio (ISR). Postoperatively the Blackburne Peel Index (BPI), ISR and patellar tendon lengths were assessed on lateral X-rays to look for any incidence of patella baja.<strong></strong></p><p class="abstract"><strong>Results:</strong> The postoperative change in the length of the patellar tendon was unpredictable; though most of them decreased. The pre and post op difference in the length of patellar tendon was statistically significant in females (4.43±0.20 cm vs. 4.35±0.24 cm; p value-0.005). Significant decrease in length of patellar tendon was seen in patients aged 66-70 years (p= 0.024) and patients with BMI &gt;30 kg/m<sup>2</sup>. No case of true patella baja was found postoperatively. No significant correlation could be established between ISR and age, sex or BMI of the patients.</p><p><strong>Conclusions:</strong> The different risk factors for post TKA shortening of patellar tendon include female gender and higher BMI (&gt;30 Kg/m²). However eversion of patella during TKA may not lead to an increased incidence of true patella baja.</p>
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Li, Jia, Mao Yuan, Lanyu Qiu, et al. "The SP-ET index is a new index for assessing the vertical position of patella." Insights into Imaging 13, no. 1 (2022). http://dx.doi.org/10.1186/s13244-022-01289-2.
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Abstract Background Some parameters in previous studies did not better reflect the vertical position of the patella relative to the femoral trochlear. This study aimed to assess the value of the most superior point of patella-entrance of femoral trochlea distance ratio (SP-ET index) as a newer index in defining the vertical position of patella relative to the trochlea, correlate it with the Insall–Salvati ratio, and investigate the effect of the new index on patellar cartilage lesions. Methods A total of 99 knees of 77 patients with patellar cartilage lesions were retrospectively analyzed using magnetic resonance imaging (MRI) data. The Insall–Salvati ratio and SP-ET index were measured on MR images. Ninety-nine knees just with meniscus rupture were enrolled as the control group. The two parameters of the patellar cartilage lesions were compared with those of the control group. Results The Insall–Salvati ratio and SP-ET index in the patellar cartilage lesions group were significantly higher than those in the control group (p < 0.001). The SP-ET index showed a moderate positive correlation with the Insall–Salvati ratio (r = 0.307, p < 0.001). Receiver operating characteristic (ROC) analysis showed that the diagnostic efficiency of the SP-ET index was better than that of the Insall–Salvati ratio in patients with patellar cartilage lesions. Conclusion The SP-ET index may be a useful complement parameter to define the vertical position of the patella relative to the femoral trochlear. Increased SP-ET index may be an important risk factor for patellar cartilage lesions.
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Jin, Xixin, Xujin Wu, Wei Xu, Chang She, Liubing Li, and Yongtao Mao. "Gender differences in the impact of anatomical factors on non-contact anterior cruciate ligament injuries: a magnetic resonance study." BMC Musculoskeletal Disorders 25, no. 1 (2024). http://dx.doi.org/10.1186/s12891-024-07390-5.
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Abstract Purpose To identify MRI-detected anatomical risk factors for non-contact anterior cruciate ligament (ACL) injuries across genders. Methods A retrospective analysis was performed on 141 ACL-reconstructed patients (35 females, 106 males) and 142 controls (37 females, 105 males) from January 2020 to April 2022. Inclusion criteria were primary non-contact ACL injuries. The tibial plateau slope, lateral femoral condyle index, Insall-Salvati index, and patellar tendon angle were measured, using binary logistic regression for gender-specific risk evaluation. Results Increased lateral tibial plateau slope, reduced intercondylar notch width index, lateral femoral condyle index, and patellar tendon angle correlated with ACL injuries in both genders. The Insall-Salvati index was a significant risk factor in females but not in males. Conclusion This study identifies the lateral tibial plateau slope, notch width index, lateral femoral condyle index, and patellar tendon angle at near-extension as risk factors for ACL injuries in both genders, with the Insall-Salvati index also implicated in females.
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Pontoh, Ega, Muhammad Zufar, Irfan Fathurrahman, et al. "The Influence of Anterior Translation of the Tibia with Patellar Height Measurements in Anterior Cruciate Ligament Insufficient Knee." Orthopaedic Journal of Sports Medicine 12, no. 10_suppl3 (2024). http://dx.doi.org/10.1177/2325967124s00412.
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Introduction and Objectives: Anterior cruciate ligament (ACL) injury is one of the most common knee injuries in sport activities. Diagnosis of ACL injury relies on examining primary and secondary signs through magnetic resonance imaging (MRI) and definitively through arthroscopy. Anterior translation of the tibia (ATT) of ≧7 mm has been an established secondary sign of ACL injury visualised in MRI. Furthermore, patellar malalignment was associated with ACL injury which can be detected through several patellar height measurements. The present study aimed to examine the differences in patellar height measurements between ACL insufficient knees with ATT ≧7 mm and <7 mm, and the association between ATT and patellar height measurements. Materials and Methods: A total of 133 study participants with ACL injury were included in this study. Study participants were examined clinically and radiologically. Furthermore, all study participants underwent arthroscopic ACL reconstruction surgery. Age, gender, and BMI were recorded during admission. All study participants underwent MRI scan to assess ATT and patellar height measurements which include Insall-Salvati ratio, Modified Insall-Salvati ratio, Caton-Deschamps index, and Blackburne-Peel ratio. Independent sample T-test was carried out to compare parameters between ATT values. Linear regression was done to examine the association between ATT and patellar height measurements. Results: There were significant differences between those with ≧7 mm and <7 mm of ATT in patellar tendon length [42.14 (4.95) vs 43.98 (5.33), p=0.045] and Insall-Salvati ratio [1.04 (0.16) vs 1.11 (0.16), p=0.017]. Every increase in ATT was negatively associated with Insall-Salvati ratio (regression coefficient -5.71, 95%CI -8.67, -2.75, p<0.001) and Caton-Deschamps index (regression coefficient -2.90, 95%CI -5.75, -0.04, p=0.047) after adjusting to age, sex, and BMI. Conclusion: Greater anterior translation of the tibia was associated with a reduction in Insall-Salvati ratio and Caton-Deschamps index. Lower value of patellar tendon length and Insall-Salvati ratio was observed in subjects with ATT ≧7 mm. The findings in this study signify the role of ACL injury in demonstrating patellar malalignment secondary to increased ATT.
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Lyu, Liangjing, Yongliang Li, Jingyu Zhong, and Weiwu Yao. "Association among peripatellar fat pad edema and related patellofemoral maltracking parameters: a case-control magnetic resonance imaging study." BMC Musculoskeletal Disorders 24, no. 1 (2023). http://dx.doi.org/10.1186/s12891-023-06827-7.
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Abstract Background The peripatellar fat pads are critical for protective cushioning during movement, and their endocrine function has been shown to affect osteoarthritis. Magnetic resonance imaging (MRI) is frequently used to visualize edema of the peripatellar fat pads due to injury. In this study, we aimed to assess the relationship between peripatellar fat pad edema and patellofemoral maltracking MRI parameters and investigate the association among cases of peripatellar fat pad edema. Methods Age- and sex-matched peripatellar fat pad edema cases were identified and divided into superolateral Hoffa, quadriceps, and prefemoral groups. Images were assessed according to tibial tuberosity lateralization, trochlear dysplasia, patellar alta, patellar tilt, and bisect offset. McNemar’s test or paired t-tests and Spearman’s correlation were used for statistical analysis. Interobserver agreement was assessed with the intraclass correlation coefficient. Results Of 1210 MRI scans, 50, 68, and 42 cases were in the superolateral Hoffa, quadriceps, and prefemoral groups, respectively. Subjects with superolateral Hoffa fat pad edema had a lower lateral trochlear inclination (p = 0.028), higher Insall-Salvati (p < 0.001) and modified Insall-Salvati (p = 0.021) ratios, and lower patellotrochlear index (p < 0.001) than controls. The prefemoral group had a lower lateral trochlear inclination (p = 0.014) and higher Insall-Salvati (p < 0.001) and modified Insall-Salvati (p = 0.004) ratios compared with the control group. In contrast, the patellotrochlear index (p = 0.001) was lower. Mean patellar tilt angle (p = 0.019) and mean bisect offset (p = 0.005) were significantly different between cases and controls. The quadriceps group showed no association. Superolateral Hoffa was positively correlated with prefemoral (p < 0.001, r = 0.408) and negatively correlated with quadriceps (p < 0.001, r = -0.500) fat pad edema. Conclusions Superolateral Hoffa and prefemoral fat pad edemas were associated with patellar maltracking parameters. Quadriceps fat pad edema and maltracking parameters were not associated. Superolateral Hoffa fat pad edema was positively correlated with prefemoral and negatively correlated with quadriceps fat pad edema.