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Magnetic resonance imaging analysis of rotational alignment in patients with patellar dislocations

Magnetic resonance imaging analysis of rotational alignment in patients with patellar dislocations
Magnetic resonance imaging analysis of rotational alignment in patients with patellar dislocations
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.
0363-5465
51-57
Diederichs, Gerd
2fd977fb-4479-4bcf-8209-1dbc43847d77
Köhlitz, Torsten
6ebdd6bb-f54a-4bd3-b204-bcd7c42515cd
Kornaropoulos, Evgenios
03658abc-4cd3-43b6-ba96-643b03abf91d
Heller, Markus O.
3da19d2a-f34d-4ff1-8a34-9b5a7e695829
Vollnberg, Bernd
1ad7c67f-ae7e-432e-801b-d5ea549ed477
Scheffler, Sven
bfa91a9e-8287-430e-b234-624a3dcf33e5
Diederichs, Gerd
2fd977fb-4479-4bcf-8209-1dbc43847d77
Köhlitz, Torsten
6ebdd6bb-f54a-4bd3-b204-bcd7c42515cd
Kornaropoulos, Evgenios
03658abc-4cd3-43b6-ba96-643b03abf91d
Heller, Markus O.
3da19d2a-f34d-4ff1-8a34-9b5a7e695829
Vollnberg, Bernd
1ad7c67f-ae7e-432e-801b-d5ea549ed477
Scheffler, Sven
bfa91a9e-8287-430e-b234-624a3dcf33e5

Diederichs, Gerd, Köhlitz, Torsten, Kornaropoulos, Evgenios, Heller, Markus O., Vollnberg, Bernd and Scheffler, Sven (2013) Magnetic resonance imaging analysis of rotational alignment in patients with patellar dislocations. The American Journal of Sports Medicine, 41 (1), 51-57. (doi:10.1177/0363546512464691).

Record type: Article

Abstract

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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More information

Published date: January 2013
Organisations: Bioengineering Group

Identifiers

Local EPrints ID: 348544
URI: http://eprints.soton.ac.uk/id/eprint/348544
ISSN: 0363-5465
PURE UUID: 1afe3e66-0154-48d1-87a2-f3dcff9d2a3e
ORCID for Markus O. Heller: ORCID iD orcid.org/0000-0002-7879-1135

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Date deposited: 14 Feb 2013 09:57
Last modified: 15 Mar 2024 03:43

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Contributors

Author: Gerd Diederichs
Author: Torsten Köhlitz
Author: Evgenios Kornaropoulos
Author: Bernd Vollnberg
Author: Sven Scheffler

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