|
1
|
Murase F, Takegami Y, Tokutake K, Oyama H, Arakawa O, Takatsu T, Nakashima H, Mishima K, Imagama S. Fracture of the patella involving inferior pole is associated with postoperative patella baja - A retrospective multicenter study. J Orthop Sci 2025; 30:379-384. [PMID: 38561304 DOI: 10.1016/j.jos.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 03/16/2024] [Accepted: 03/21/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND The patella fracture involving of inferior pole fractures (IPF) may be associated with patella baja, However, the clinical impact of this condition remains unclear. This study aims to clarify 1) the incidence of patella baja following patellar fracture surgery, 2) the associated clinical outcomes with and without the presence of patella baja, and 3) the potential correlation between the detection of IPF on CT and the occurrence of patella baja. METHODS We conducted a retrospective multicenter study involving 251 patients who underwent surgical treatment for patellar fractures. Patients were divided into the patella baja (PB; n = 49) group and patella norma (PN; n = 202) group. Data collected included demographics, radiographic findings, surgical details, and postoperative complications. We compared these items between PB group and PN group. Logistic regression analyses were used to identify risk factors for patella baja. RESULTS Immediately following surgery, 36 (14.3%) patients presented with patella baja which increased to 49 cases (19.5%) at six months postoperatively. There is no statistically significant difference in the demographics, surgical details, clinical outcomes and complication between PB group and PN group. While, in the radiographical assessment, the prevalence of IPF on CT scan in the patella baja group was significantly higher than that in the patella norma group. By logistic regression analysis, IPFP on CT was identified as an independent risk factor for patella baja. (odds ratio 2.11, 95% confidence interval: 1.03-4.33, p = 0.042). CONCLUSION In patients with patellar fractures, the incidence of patella baja increased from 14.3% immediately post-surgery to 19.5% at the six-month check-up. No significant differences were observed in clinical outcomes between the patella baja group and the norma group. The patella fracture involving IPF on CT emerged as a predictive factor for patella baja.
Collapse
Affiliation(s)
- Fuminori Murase
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuhiko Takegami
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Katsuhiro Tokutake
- Department of Hand Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroki Oyama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Oki Arakawa
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tetsuro Takatsu
- Department of Orthopaedic Surgery, Gifu Prefecture Tajimi Hospital, Tajimi, Japan
| | - Hiroaki Nakashima
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kenichi Mishima
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| |
Collapse
|
|
2
|
Bi Z, Cai Y, Sun C, Shi X, Liao S, Liu J. Different Radiological Indices of Patellar Height Predict Patients' Diverse Outcomes Following Total Knee Arthroplasty. Clin Orthop Surg 2024; 16:741-750. [PMID: 39364107 PMCID: PMC11444939 DOI: 10.4055/cios23346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/28/2023] [Accepted: 01/29/2024] [Indexed: 10/05/2024] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) is a common surgical procedure for patients with knee osteoarthritis. The patellar component plays a crucial role in knee biomechanics and can influence postoperative outcomes. This study aimed to investigate the relationship between radiological indices of patellar height and patient outcomes following TKA. METHODS A retrospective analysis was conducted on patients who underwent TKA for osteoarthritis. Radiographic measurements of patellar height, including the Insall-Salvati (IS) ratio, modified Blackburne-Peel (mBP) ratio, Caton-Deschamps ratio, and plateau-patellar angle (PPA), were obtained. Clinical outcomes were assessed using the Knee Society Score (KSS) and the Forgotten Joint Score-12 (FJS-12). Patient satisfaction and postoperative complications were also evaluated. Statistical analyses, including correlation analysis and multiple regression models, were performed to determine the association between radiological indices and patient outcomes. RESULTS The study included 330 cases that met the inclusion criteria. The analysis revealed significant correlations between different radiological indices of patellar height and patient outcomes. Lower postoperative PPA was correlated with worse KSS and range of motion scores. A decreased mBP ratio was associated with poorer FJS-12 responses and higher risks of dissatisfaction and patellar clunk or crepitus. Increased IS ratio was linked to a lower likelihood of incidental giving way of the knee. Advanced age was associated with reduced dissatisfaction and incidental giving way probabilities. CONCLUSIONS The findings of this study demonstrate that radiological indices of patellar height can predict patient outcomes following TKA. Assessing patellar height using various radiographic measurements provides valuable information for surgical planning and prognostic evaluation. Understanding the impact of patellar height on clinical outcomes can aid in optimizing TKA procedures and improving patient satisfaction. These findings emphasize the importance of considering patellar height as a predictive factor in TKA and highlight its potential role in guiding postoperative management and rehabilitation strategies.
Collapse
Affiliation(s)
- Zhiguo Bi
- Department of Orthopaedic Surgery, Orthopaedic Center, The First Hospital of Jilin University, Changchun, China
| | - Yimeng Cai
- College of Basic Medical Sciences, Jilin University, Changchun, China
| | - Chao Sun
- Department of Orthopaedic Surgery, Orthopaedic Center, The First Hospital of Jilin University, Changchun, China
| | - Xiaotong Shi
- Department of Orthopaedic Surgery, Orthopaedic Center, The First Hospital of Jilin University, Changchun, China
| | - Shiyu Liao
- Department of Orthopaedic Surgery, Orthopaedic Center, The First Hospital of Jilin University, Changchun, China
| | - Jianguo Liu
- Department of Orthopaedic Surgery, Orthopaedic Center, The First Hospital of Jilin University, Changchun, China
| |
Collapse
|
|
3
|
Zaimovic N, Lorinson D, Lorinson K, Tichy A, Bockstahler B. Evaluation of the Tibial Plateau-Patella Angle (TPPA) in Dogs. Animals (Basel) 2024; 14:1798. [PMID: 38929417 PMCID: PMC11200802 DOI: 10.3390/ani14121798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 06/07/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024] Open
Abstract
Estimating a dog's patellar position involves various methods, which categorize it as norma, alta (high), or baja (low). However, they require various calculations. We aimed to evaluate the clinical applicability of a new method, the tibial plateau-patella angle (TPPA). This could aid in planning patella luxation surgery, estimating the patella position after TPLO and various osteotomies. We conducted a two-step study: first, on 15 stifles without pathologies from nine canine cadavers, and second, using 100 patient X-rays from the archive. Three stifle angle positions (45 ± 5°, 90 ± 5°, and 135 ± 5°) and three weight groups (S, M, and L) were evaluated in the first part of this study. Based on these results, the second part of this study was conducted using 100 pathology-free radiographs at the optimal stifle angle (90 ± 5°) from the archive. All radiographs were measured by three observers with varying levels of experience. Our results indicate that the stifle angle significantly impacted the TPPA, whereby lower values were detected with higher stifle angles, which remained consistent within the weight groups. High inter- and intra-observer agreement was achieved. The physiological TPPA values ranged from 26.7° to 48.8°, remaining consistent within the various weight groups. Observer 3 in Group S exhibited a 20% (insignificant) deviation, possibly due to challenges in determining the caudal point of the tibial plateau. In contrast with humans, TPPA values in dogs are negatively correlated with stifle angles, independent of weight. Our reliable and reproducible protocol suggests the potential benefits of training on small-breed dogs stifles.
Collapse
Affiliation(s)
- Nedim Zaimovic
- Small Animal Surgery, Department for Companion Animals and Horses, University of Veterinary Medicine, 1210 Vienna, Austria
| | - Dragan Lorinson
- Chirurgisches Zentrum für Kleintiere Dr. Lorinson, 2331 Vösendorf, Austria; (D.L.); (K.L.)
| | - Karin Lorinson
- Chirurgisches Zentrum für Kleintiere Dr. Lorinson, 2331 Vösendorf, Austria; (D.L.); (K.L.)
| | - Alexander Tichy
- Platform Bioinformatics and Biostatistics, Department for Biomedical Services, University of Veterinary Medicine, 1120 Vienna, Austria;
| | - Barbara Bockstahler
- Section of Physical Therapy, Small Animal Surgery, Department for Companion Animals and Horses, University of Veterinary Medicine, 1210 Vienna, Austria;
| |
Collapse
|
|
4
|
Mayne AI, Rajgor H, Munasinghe C, Agrawal Y, Pagkalos J, Davis ET, Sharma AD. The ROSA robotic-arm system reliably restores joint line height, patella height and posterior condylar offset in total knee arthroplasty. Knee 2024; 48:1-7. [PMID: 38461736 DOI: 10.1016/j.knee.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 12/26/2023] [Accepted: 02/18/2024] [Indexed: 03/12/2024]
Abstract
INTRODUCTION There is growing interest in the use of robotic TKA to improve accuracy of component positioning in Total Knee Arthroplasty (TKA). The aim of this study was to investigate the accuracy of implant component position using the ROSA® knee system with specific reference to Joint Line Height, Patella Height and Posterior Condylar Offset (PCO). METHODS This was a retrospective review of a prospectively-maintained database of the initial 100 consecutive TKAs performed by a high volume surgeon using the ROSA® knee system. Both the image-based and imageless workflow were used and two prosthesis types were implanted. To determine the accuracy of component positioning, the immediate post-operative radiograph was reviewed and compared with the immediate pre-operative radiograph with regards to Joint Line Height, Patella Height and Posterior Condylar Offset. RESULTS 100 consecutive patients undergoing TKA using the ROSA system were included; mean age 70 years (range 49-95 years). Mean change in joint line height was 0.2 mm, patella height (Insall-Salvati ratio) 0.01 and posterior condylar offset 0.02 mm; there was no statistically significant difference between the pre and post-operative values. No difference was demonstrated between image-based or imageless workflows, or between implant design (Persona versus Vanguard) regarding joint line height, patella height and PCO. CONCLUSION This study validates the use of the ROSA® knee system in accurately restoring Joint Line Height, Patella Height and Posterior Condylar Offset in TKA surgery. No significant differences were found between imageless and image-based groups, or between implant designs (Persona versus Vanguard).
Collapse
Affiliation(s)
- Alistair Iw Mayne
- Arthroplasty Department, Royal Orthopaedic Hospital, Bristol Road South, Birmingham B31 2AP, UK.
| | - Harshadkumar Rajgor
- Arthroplasty Department, Royal Orthopaedic Hospital, Bristol Road South, Birmingham B31 2AP, UK
| | - Chathura Munasinghe
- Arthroplasty Department, Royal Orthopaedic Hospital, Bristol Road South, Birmingham B31 2AP, UK
| | - Yuvraj Agrawal
- Arthroplasty Department, Royal Orthopaedic Hospital, Bristol Road South, Birmingham B31 2AP, UK
| | - Joseph Pagkalos
- Arthroplasty Department, Royal Orthopaedic Hospital, Bristol Road South, Birmingham B31 2AP, UK
| | - Edward T Davis
- Arthroplasty Department, Royal Orthopaedic Hospital, Bristol Road South, Birmingham B31 2AP, UK
| | - Akash D Sharma
- Arthroplasty Department, Royal Orthopaedic Hospital, Bristol Road South, Birmingham B31 2AP, UK
| |
Collapse
|
|
5
|
Kwolek K, Grzelecki D, Kwolek K, Marczak D, Kowalczewski J, Tyrakowski M. Automated patellar height assessment on high-resolution radiographs with a novel deep learning-based approach. World J Orthop 2023; 14:387-398. [PMID: 37377994 PMCID: PMC10292056 DOI: 10.5312/wjo.v14.i6.387] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/06/2023] [Accepted: 05/06/2023] [Indexed: 06/19/2023] Open
Abstract
BACKGROUND Artificial intelligence and deep learning have shown promising results in medical imaging and interpreting radiographs. Moreover, medical community shows a gaining interest in automating routine diagnostics issues and orthopedic measurements.
AIM To verify the accuracy of automated patellar height assessment using deep learning-based bone segmentation and detection approach on high resolution radiographs.
METHODS 218 Lateral knee radiographs were included in the analysis. 82 radiographs were utilized for training and 10 other radiographs for validation of a U-Net neural network to achieve required Dice score. 92 other radiographs were used for automatic (U-Net) and manual measurements of the patellar height, quantified by Caton-Deschamps (CD) and Blackburne-Peel (BP) indexes. The detection of required bones regions on high-resolution images was done using a You Only Look Once (YOLO) neural network. The agreement between manual and automatic measurements was calculated using the interclass correlation coefficient (ICC) and the standard error for single measurement (SEM). To check U-Net's generalization the segmentation accuracy on the test set was also calculated.
RESULTS Proximal tibia and patella was segmented with accuracy 95.9% (Dice score) by U-Net neural network on lateral knee subimages automatically detected by the YOLO network (mean Average Precision mAP greater than 0.96). The mean values of CD and BP indexes calculated by orthopedic surgeons (R#1 and R#2) was 0.93 (± 0.19) and 0.89 (± 0.19) for CD and 0.80 (± 0.17) and 0.78 (± 0.17) for BP. Automatic measurements performed by our algorithm for CD and BP indexes were 0.92 (± 0.21) and 0.75 (± 0.19), respectively. Excellent agreement between the orthopedic surgeons’ measurements and results of the algorithm has been achieved (ICC > 0.75, SEM < 0.014).
CONCLUSION Automatic patellar height assessment can be achieved on high-resolution radiographs with the required accuracy. Determining patellar end-points and the joint line-fitting to the proximal tibia joint surface allows for accurate CD and BP index calculations. The obtained results indicate that this approach can be valuable tool in a medical practice.
Collapse
Affiliation(s)
- Kamil Kwolek
- Department of Spine Disorders and Orthopaedics, Centre of Postgraduate Medical Education, Gruca Orthopaedic and Trauma Teaching Hospital, Otwock 05-400, Poland
| | - Dariusz Grzelecki
- Department of Orthopaedics and Rheumoorthopedics, Centre of Postgraduate Medical Education, Gruca Orthopaedic and Trauma Teaching Hospital, Otwock 05-400, Poland
| | - Konrad Kwolek
- Department of Orthopaedics and Traumatology, University Hospital, Krakow 30-663, Poland
| | - Dariusz Marczak
- Department of Orthopaedics and Rheumoorthopedics, Centre of Postgraduate Medical Education, Gruca Orthopaedic and Trauma Teaching Hospital, Otwock 05-400, Poland
| | - Jacek Kowalczewski
- Department of Orthopaedics and Rheumoorthopedics, Centre of Postgraduate Medical Education, Gruca Orthopaedic and Trauma Teaching Hospital, Otwock 05-400, Poland
| | - Marcin Tyrakowski
- Department of Spine Disorders and Orthopaedics, Centre of Postgraduate Medical Education, Gruca Orthopaedic and Trauma Teaching Hospital, Otwock 05-400, Poland
| |
Collapse
|
|
6
|
Schreiner AJ, Spiegel L, Yan SG, Konrads C, Erne F, Hemmann P, Schmidutz F. Evaluation of modified and newly applied patella height indices in primary total knee arthroplasty. Skeletal Radiol 2023; 52:73-82. [PMID: 35943544 PMCID: PMC9666313 DOI: 10.1007/s00256-022-04142-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/27/2022] [Accepted: 07/27/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aim of this radiological study was to compare several relevant modified and newly applied patella height indices (PHI) in navigated primary total knee arthroplasty (TKA) to determine intra- and interobserver reliability in order to give a recommendation for clinical application in measuring patella height (PH) in primary TKA. MATERIALS AND METHODS A retrospective data analysis assessing different PHI (modified Insall-Salvati index (mISI), Caton-Deschamps index (mCDI), Blackburne-Peel index (mBPI), Plateau-Patella Angle (mPPA); Miura-Kawaramura index (MKI), Knee-Triangular index (KTI)) on lateral knee radiographs was performed by two blinded observers using the same software three months pre- and postoperatively. Concordance correlation coefficient and Pearson's correlation respectively were determined for intra- and interobserver rating as well as a categorization according to Landis and Koch and Cohen. RESULTS A total of 337/291 patients of a 5-year period could be analyzed pre-/postoperatively. Excellent postoperative interrater results according to the categorization of Landis and Koch were achieved for the mBPI (Pearson 0.98) > mPPA (0.90) > KTI (0.86), good results for the MKI (0.79) and the mCDI (0.69), and moderate results for the mISI (0.52) with a predominantly strong Cohen correlation in almost all cases. Preoperatively, the mBPI and the KTI were the best interrated PHI. No PH changes could be found postoperatively for the mISI, KTI, MKI, and mPPA. CONCLUSION The mBPI, the mPPA, and the KTI can be recommended for PH assessment in TKA. The mPPA might be the easiest one to use in a daily clinical set-up.
Collapse
Affiliation(s)
- Anna Janine Schreiner
- Orthopaedic Clinic Markgroeningen, Markgroeningen, Germany ,grid.10392.390000 0001 2190 1447Department of Traumatology and Reconstructive Surgery, BG Unfallklinik Tuebingen, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Lena Spiegel
- grid.10392.390000 0001 2190 1447Department of Traumatology and Reconstructive Surgery, BG Unfallklinik Tuebingen, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Shuang Gen Yan
- grid.10392.390000 0001 2190 1447Department of Traumatology and Reconstructive Surgery, BG Unfallklinik Tuebingen, Eberhard Karls University of Tuebingen, Tuebingen, Germany ,grid.412679.f0000 0004 1771 3402Department of Orthopaedic Surgery, The First Affiliated Hospital of Anhui Medical University, No. 1 Baicao Road, Hefei, 230088 China
| | - Christian Konrads
- grid.10392.390000 0001 2190 1447Department of Orthopaedic Surgery, University of Tuebingen, Tuebingen, Germany
| | - Felix Erne
- grid.10392.390000 0001 2190 1447Department of Traumatology and Reconstructive Surgery, BG Unfallklinik Tuebingen, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Philipp Hemmann
- grid.10392.390000 0001 2190 1447Department of Traumatology and Reconstructive Surgery, BG Unfallklinik Tuebingen, Eberhard Karls University of Tuebingen, Tuebingen, Germany
| | - Florian Schmidutz
- grid.10392.390000 0001 2190 1447Department of Traumatology and Reconstructive Surgery, BG Unfallklinik Tuebingen, Eberhard Karls University of Tuebingen, Tuebingen, Germany ,grid.5252.00000 0004 1936 973XDepartment of Orthopaedic Surgery, Physical Medicine and Rehabilitation, University of Munich (LMU), Munich, Germany ,Orthopedic Surgery, Orthopedic Center Rosenheim, Rosenheim, Germany
| |
Collapse
|
|
7
|
OTAĞ İLHAN, ÇIMEN KAAN, TORUN YUNIS, PAZARCI ÖZHAN, AKKOYUN SERKAN, OTAĞ AYNUR, ÇIMEN MEHMET. MODELING OF PATELLA HEIGHT WITH DISTAL FEMUR AND PROXIMAL TIBIA REFERENCE POINTS WITH ARTIFICIAL NEURAL NETWORK. J MECH MED BIOL 2022. [DOI: 10.1142/s0219519422500154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The patellofemoral joint is one of the parts of the knee extension mechanism that plays a role in the stability of the knee by enlarging the force arm of the quadriceps muscle and changing the direction of the muscle strength. For the entire knee joint to perform its task painlessly and functionally, the positions and strength of the muscles, the strength of the ligaments, and their reaction to movement must be compatible. The Insall–Salvati (Ins-Sal) index is useful for showing changes in patellar height produced by repositioning the tibial plateau, in other words, showing changes in patellar tendon length. Patella height is an important value to be taken into account in knee prosthesis surgery, tibial osteotomy, and anterior cruciate ligament reconstruction. The morphometric relationship between the reference measurements of the distal femur and proximal tibia and the position of the patella will be useful in determining the natural anatomy. In this study, we aimed to determine the relationship between patella height and distal femur and proximal tibia reference areas by using the artificial neural network method as an alternative approach method. In order to assess the performance of the estimation of the Ins-Sal index, the four ANN model with six input combinations which included age, gender and the reference measurements for the right and left sides have been constructed and tested. The MSE and [Formula: see text] values are calculated for every four models for the training and test phase. The results show that the proposed approach for modeling of relation between reference measurements and the Ins-Sal index is a powerful approach.
Collapse
Affiliation(s)
- İLHAN OTAĞ
- Department of Anatomy, Faculty of Medicine, Sivas Cumhuriyet University, Sivas, Turkey
| | - KAAN ÇIMEN
- Department of Anatomy, Faculty of Medicine, Sivas Cumhuriyet University, Sivas, Turkey
| | - YUNIS TORUN
- Department of Electric-Electronics Engineering, Sivas Cumhuriyet University, Sivas, Turkey
- Artificial Intelligence Systems and Data Science Application and Research Center, Sivas Cumhuriyet University, Sivas, Turkey
| | - ÖZHAN PAZARCI
- Department of Orthopedics and Traumatology, Sivas Cumhuriyet University, Sivas, Turkey
| | - SERKAN AKKOYUN
- Artificial Intelligence Systems and Data Science Application and Research Center, Sivas Cumhuriyet University, Sivas, Turkey
- Department of Physics, Faculty of Sciences, Sivas Cumhuriyet University, Sivas, Turkey
| | - AYNUR OTAĞ
- Department of Physiotherapy, Faculty of Health Sciences, Sivas Cumhuriyet University, Sivas, Turkey
| | - MEHMET ÇIMEN
- Department of Anatomy, Faculty of Medicine, Sivas Cumhuriyet University, Sivas, Turkey
| |
Collapse
|
|
8
|
Aithal Padur A, Kumar N, Lewis MG, Sekaran VC. Morphometric analysis of patella and patellar ligament: a cadaveric study to aid patellar tendon grafts. Surg Radiol Anat 2021; 43:2039-2046. [PMID: 34570285 PMCID: PMC8536615 DOI: 10.1007/s00276-021-02837-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 09/09/2021] [Indexed: 10/25/2022]
Abstract
PURPOSE Morphometric analysis of the patella and the patellar ligament is crucial in diagnosing and surgical corrections of knee injuries and patellofemoral joint disorders. Dimensions of the patella and the patellar ligament are frequently used in implant design and ACL reconstruction. This study aims to obtain detailed morphometric data on the patellar ligament and its localization based on gross anatomical dissections in the adult cadavers. METHODS The present study consisted of 50 lower limbs from formalin-fixed male adult cadavers aged about 70 years (45-85) belonging to the South Indian population. Total length of the quadriceps tendon, patellar height, patellar ligament height, proximal width, distal width and thickness of the patellar ligament were measured meticulously. Mean, standard deviation, median scores of each parameter were computed for groups using SPSS 16.0. Level of significance was considered as p < 0.05. Wilcoxon signed-rank test was used to compare the various parameters on the right and left limbs. The relationships between all parameters were analyzed using Spearman's rank correlation test. RESULTS There was no statistically significant difference in the various measurements of the patella and patellar ligament between the right and left lower limbs. Patellar ligament length showed positive correlation with ligament thickness (r = 0.36; p = 0.078 for right limb and r = 0.33; p = 0.104 for left limb). Proximal width of ligament showed significant positive correlation with distal width (r = 0.41; p = 0.041 for right limb and r = 0.54; p = 0.006 for left limb). CONCLUSION This morphometric data and analysis might be fundamental in understanding various knee conditions in situ and necessary to orthopedic surgeons for successful planning and execution for ACL reconstruction using patellar ligament graft and other patellofemoral joint disorders. LEVEL OF EVIDENCE I.
Collapse
Affiliation(s)
- Ashwini Aithal Padur
- Department of Anatomy, Melaka Manipal Medical College (Manipal Campus), Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, 576104, India
| | - Naveen Kumar
- Department of Anatomy, Melaka Manipal Medical College (Manipal Campus), Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, 576104, India.
| | | | - Varalakshmi Chandra Sekaran
- Department of Community Medicine, Melaka Manipal Medical College (Manipal Campus), Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
| |
Collapse
|
|
9
|
Cui LK, Kang K, Zheng XZ, Jiang SG, Huang WT, Gao SJ. A Sagittal Patellar Angle Linear Equation Reflecting Patellofemoral Kinematics: Evaluation of Patellar Height at any Degree of Knee Flexion Angle. Orthop Surg 2021; 14:3-9. [PMID: 34783159 PMCID: PMC8755871 DOI: 10.1111/os.13166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 09/19/2021] [Accepted: 09/23/2021] [Indexed: 11/27/2022] Open
Abstract
Objective To confirm whether a novel sagittal patellar angle linear equation used for evaluating patellar height by calculating expected sagittal patellar angle (SPA) at any degree of knee flexion angle is suitable for patients older than 17 years and its reliability compared with other commonly used methods. Methods From September 2016 to September 2019, a total number of 202 consecutive outpatients' knee lateral X‐ray radiographs were retrospectively measured and evaluated using a recently proposed linear equation Y = 1.94 + 0.74 × knee flexion(KF) angle. Patients were divided by ages into ayounger group, whose ages were between 17–49 years, and an older group, whose ages were older than 49 years, which has not been validated in the original study. Parameters such as KF, SPA, patella and patella tendon length and so on were measured on computer with picture archiving and communication system by two independent observers at an interval of 1 month. Insall‐Salvati (IS) index, Caton‐Deschamps (CD) index and Y value, correlation coefficients were calculated and compared using SPSS 22.0 software. Results In the younger group, 143 patients (165 knees) were included, ages were 17–49 (31.62 ± 11.38) years, males/females were 70 (48.95%)/73 (51.05%), left knees/right knees were 83 (50.30%)/82 (49.70%), mean value of Y was 31.50° ± 10.07°, and SPA was 34.38° ± 12.38°, mean value of IS was 1.06 ± 0.17, mean value of CD was 1.04 ± 0.18. While in older group, 59 patients (78 knees) were included, ages were 50–60 (mean 54.61 ± 2.99) years, there were 32 males (54.24%) and 27 females (45.76%), 42 knees were left (53.85%) and 36 knees were right (46.15%), mean values of Y and SPA were 25.90° ± 11.55° and 29.36° ± 14.22°, mean IS index in older group was 1.06 ± 0.18, mean CD index was 1.00 ± 0.16. Intra‐ and inter‐observer reliabilities of Y in younger and older groups were 0.999, 0.999, 1.000 and 0.999, meaning high reliability and reproducibility, but low Pearson's correlation coefficients with IS and CD index were showed as −0.213 and − 0.216 in younger group and − 0.113 and − 0.316 in older group. Conclusions In patients older than 17 years, the linear equation Y = 1.94 + 0.74 × KF is a reliable and practical method to evaluate SPA regardless of age and knee flexion angle, but has weak correlation coefficients with the IS and CD index.
Collapse
Affiliation(s)
- Lu-Kuan Cui
- Department of Orthopedics, Third Hospital of Hebei Medical University, Shijiazhuang, China.,First Department of Traumatic Orthopedics, Cangzhou Hospital of Integrated Traditional and Western Medicine·Hebei Province, Cangzhou, China
| | - Kai Kang
- Department of Orthopedics, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xiao-Zuo Zheng
- Department of Orthopedics, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Shi-Gang Jiang
- Department of Orthopedics, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Wen-Tao Huang
- Department of Orthopedics, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Shi-Jun Gao
- Department of Orthopedics, Third Hospital of Hebei Medical University, Shijiazhuang, China.,Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, China
| |
Collapse
|
|
10
|
Graulich T, Gerhardy J, Omar Pacha T, Örgel M, Macke C, Krettek C, Omar M, Liodakis E. Patella baja after intramedullary nailing of tibial fractures, using an infrapatellar/transtendinous approach, predicts worse patient reported outcome. Eur J Trauma Emerg Surg 2021; 48:3669-3675. [PMID: 34727191 PMCID: PMC9532308 DOI: 10.1007/s00068-021-01807-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 10/07/2021] [Indexed: 11/24/2022]
Abstract
Purpose After intramedullary nailing of tibial shaft fractures using an infrapatellar/transtendinous approach, several patients suffer anterior knee pain. We suspect that the approach is associated with soft tissue scars and the development of a postoperative patella baja. The goal of the study is to investigate whether the development of patella baja is associated with worse subjective outcomes. Methods We retrospectively analyzed all patients in our orthopedic trauma department between 2011 and 2020 who underwent tibial fracture fixation via intramedullary nailing via an infrapatellar/transtendinous approach. Pre- and postoperative lateral knee x-rays were evaluated by measurement of the Insall-Salvati Index, and nail tip position. All patients were asked to answer the self-assessment Kujala questionnaire and Lysholm questionnaire. Results We included 78 patients (age: 44 ± 18 years) with a minimum follow-up of 12 months. Mean follow up was 59 ± 25 months. We included 50 male and 28 female patients. Patella baja detected by Insall-Salvati Index could be observed in 8 (10.3%) patients. Patients with patella baja showed significant worse function measured by the Kujala score 54 ± 18 vs. 80 ± 14 (p < 0.01). Likewise, Lysholm score did show significant differences between both groups (60 ± 24 vs. 86 ± 11; p < 0.01). Nail tip position was not associated with worse subjective function. Conclusions Patella baja in patients after tibial intramedullary nailing via an infrapatellar/transtendinous approach, is associated with worse subjective function and increased pain.
Collapse
Affiliation(s)
- Tilman Graulich
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany.
| | - Julius Gerhardy
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Tarek Omar Pacha
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Marcus Örgel
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Christian Macke
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Christian Krettek
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Mohamed Omar
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Emmanouil Liodakis
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| |
Collapse
|
|
11
|
Salem KH, Sheth MR. Variables affecting patellar height in patients undergoing primary total knee replacement. INTERNATIONAL ORTHOPAEDICS 2021; 45:1477-1482. [PMID: 33277664 PMCID: PMC8178142 DOI: 10.1007/s00264-020-04890-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 11/17/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND Alteration of patellar height is commonly encountered in total knee arthroplasty (TKA), and failure to address patella baja can result in suboptimal functional outcomes. It may therefore be prudent to evaluate pre-operative patellar height (PPH) and to seek risk factors for patella baja. METHODS Two hundred eighty-five patients who underwent TKA were included. Patient's age, gender, body mass index (BMI), and history of prior arthroscopy were recorded. PPH was measured using plateau-patella angle (PPA) as well as the Blackburn-Peel (BP), Caton-Deschamps (CD), and Insall-Salvati (IS) ratios. RESULTS The average patients' age was 71 years with a mean BMI of 30.45. There were 191 female and 94 male patients. One-fourth of the cases had at least one prior knee arthroscopy. Multivariate linear regression analysis identified gender and BMI as variables significantly affecting the IS ratio (p: < 0.05). Gender also had a significant correlation with PPA. Male patients were likely to have lower PPA (p: < 0.03). Though increasing age had a positive correlation with patellar height, this was not statistically significant. History of prior arthroscopy had no significant effect on any of the four PPH measurements. CONCLUSION Lower patellar height is significantly correlated to male gender and high BMI. We suggest that obese male patients be screened for pre-operative patella baja. This can help in surgical planning and optimizing results in TKA.
Collapse
Affiliation(s)
- Khaled Hamed Salem
- Department of Orthopaedic Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt.
- Department of Orthopaedic Surgery, RWTH University Aachen, Aachen, Germany.
| | | |
Collapse
|
|
12
|
Severino NR, Severino FR, de Camargo OPA, Guglielmetti LGB, de Oliveira VM, Cury RDPL. Update on Patellar Instability. Rev Bras Ortop 2020; 56:147-153. [PMID: 33935309 PMCID: PMC8075655 DOI: 10.1055/s-0040-1713389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 03/17/2020] [Indexed: 11/08/2022] Open
Abstract
Patellar instability is a multifactorial clinical condition that affects a significant number of patients and occurs due to morphological variations of the joint and patellofemoral alignment. The present literature review study aimed to identify and summarize current concepts on patellar instability, in relation to associated risk factors, diagnostic criteria, and the benefits and risks of conservative and surgical treatments. For this purpose, a search was conducted in the following electronic databases: MEDLINE (via Pubmed), LILACS and Cochrane Library. It is concluded that the accurate diagnosis depends on the detailed clinical evaluation, including the history and possible individual risk factors, as well as imaging exams. The initial treatment of patellar instability is still controversial, and requires the combination of conservative and surgical interventions, taking into consideration both soft tissues and bone structures, the latter being the most common reason for choosing surgical treatment, especially lateral patellar instability.
Collapse
Affiliation(s)
- Nilson Roberto Severino
- Grupo de Joelho, Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas, Irmandade da Santa Casa de Misericórdia de São Paulo, Santa Casa de São Paulo, São Paulo, Brasil
| | - Fabrício Roberto Severino
- Grupo de Joelho, Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas, Irmandade da Santa Casa de Misericórdia de São Paulo, Santa Casa de São Paulo, São Paulo, Brasil
| | - Osmar Pedro Arbix de Camargo
- Grupo de Joelho, Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas, Irmandade da Santa Casa de Misericórdia de São Paulo, Santa Casa de São Paulo, São Paulo, Brasil
| | - Luiz Gabriel Betoni Guglielmetti
- Grupo de Joelho, Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas, Irmandade da Santa Casa de Misericórdia de São Paulo, Santa Casa de São Paulo, São Paulo, Brasil
| | - Victor Marques de Oliveira
- Grupo de Joelho, Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas, Irmandade da Santa Casa de Misericórdia de São Paulo, Santa Casa de São Paulo, São Paulo, Brasil
| | - Ricardo de Paula Leite Cury
- Grupo de Joelho, Departamento de Ortopedia e Traumatologia, Faculdade de Ciências Médicas, Irmandade da Santa Casa de Misericórdia de São Paulo, Santa Casa de São Paulo, São Paulo, Brasil
| |
Collapse
|
|
13
|
Is the Clinician's Eye a Valid and Reproducible Tool for Diagnosing Patella Alta on a Lateral Knee Radiography? J Am Acad Orthop Surg Glob Res Rev 2020; 4:e2000098. [PMID: 32672723 PMCID: PMC7366395 DOI: 10.5435/jaaosglobal-d-20-00098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
|
14
|
Graulich T, Kranz C, Zhang D, Oergel M, Pacha TO, Haertle M, Omar M, Krettek C, Panzica M. Reduction of Patella-baja and Pseudo-patella-baja Does Not Improve Range of Motion in Patients After Mega-TKA. In Vivo 2020; 34:1153-1158. [PMID: 32354904 DOI: 10.21873/invivo.11887] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 01/29/2020] [Accepted: 02/03/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Patella baja (PB) and pseudo-patella baja (PPB) have been shown to negatively influence outcomes after total knee arthroplasty. We hypothesized that there is a high incidence of PB and PPB after megaprosthetic total knee arthroplasty (M-TKA), and that this is associated with reduced range of motion. PATIENTS AND METHODS We retrospectively analysed all patients in our Orthopaedic Trauma Department after distal femur or proximal tibia replacement. Preoperative and one-year postoperative follow-up included measurement of range of motion and detection of PB and PPB using radiological indices. RESULTS We included 44 patients (age: 73±19 years). Preoperative PB detected by ISI could be reduced from 13 (36%) to 11 (25%) (p<0.01). Preoperative vs. postoperative ISI was 0.88±0.23 vs. 1.06±0.45 (p=0.03). PPB was observed preoperatively in 23 (63%) patients vs. 24 (54%) postoperatively. Preoperative vs. postoperative CDI was 0.70±0.24 vs. 0.95±0.43 (p=0.002). Preoperative flexion was 91°±30° vs. 85°±24° postoperatively (p>0.05). CONCLUSION Both PB and PPB are frequently observed after M-TKA. A reduction in PB and PPB alone does not improve postoperative range of motion.
Collapse
Affiliation(s)
- Tilman Graulich
- Trauma Department, Hannover Medical School, Hannover, Germany
| | - Caroline Kranz
- Trauma Department, Hannover Medical School, Hannover, Germany
| | - Dafang Zhang
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, U.S.A.,Brigham and Women's Hospital, Boston, MA, U.S.A
| | - Marcus Oergel
- Trauma Department, Hannover Medical School, Hannover, Germany
| | | | - Marco Haertle
- Trauma Department, Hannover Medical School, Hannover, Germany
| | - Mohamed Omar
- Trauma Department, Hannover Medical School, Hannover, Germany
| | | | - Martin Panzica
- Trauma Department, Hannover Medical School, Hannover, Germany
| |
Collapse
|
|
15
|
Development of automatic measurement for patellar height based on deep learning and knee radiographs. Eur Radiol 2020; 30:4974-4984. [PMID: 32328760 DOI: 10.1007/s00330-020-06856-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 03/10/2020] [Accepted: 04/01/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To develop and evaluate the performance of a deep learning-based system for automatic patellar height measurements using knee radiographs. METHODS The deep learning-based algorithm was developed with a data set consisting of 1018 left knee radiographs for the prediction of patellar height parameters, specifically the Insall-Salvati index (ISI), Caton-Deschamps index (CDI), modified Caton-Deschamps index (MCDI), and Keerati index (KI). The performance and generalizability of the algorithm were tested with 200 left knee and 200 right knee radiographs, respectively. The intra-class correlation coefficient (ICC), Pearson correlation coefficient, mean absolute difference (MAD), root mean square (RMS), and Bland-Altman plots for predictions by the system were evaluated in comparison with manual measurements as the reference standard. RESULTS Compared with the reference standard, the deep learning-based algorithm showed high accuracy in predicting the ISI, CDI, and KI (left knee ICC = 0.91-0.95, r = 0.84-0.91, MAD = 0.02-0.05, RMS = 0.02-0.07; right knee ICC = 0.87-0.96, r = 0.78-0.92, MAD = 0.02-0.06, RMS = 0.02-0.10), but not the MCDI (left knee ICC = 0.65, r = 0.50, MAD = 0.14, RMS = 0.18; right knee ICC = 0.62, r = 0.47, MAD = 0.15, RMS = 0.20). The performance of the algorithm met or exceeded that of manual determination of ISI, CDI, and KI by radiologists. CONCLUSIONS In its current state, the developed system can predict the ISI, CDI, and KI for both left and right knee radiographs as accurately as radiologists. Training the system further with more data would increase its utility in helping radiologists measure patellar height in clinical practice. KEY POINTS • Objective and reliable measurement of patellar height parameters is important for clinical diagnosis and the development of a treatment strategy. • Deep learning can be used to create an automatic patellar height measurement system based on knee radiographs. • The deep learning-based patellar height measurement system achieves comparable performance to radiologists in measuring ISI, CDI, and KI.
Collapse
|
|
16
|
Abstract
Patella baja in total knee arthroplasty can result in impingement, pain, and decreased range of motion. Etiology can range from previous knee surgeries such as anterior cruciate ligament reconstruction, retrograde femoral nail, infrapatellar fat pad resection, and previous total knee arthroplasty. Diagnosis can be confirmed by one of a number of measurements of patellar height including Insall-Salvati and Blackburne-Peel ratios. It is important to differentiate between true patella baja and pseudopatella baja by patellar height ratio. Treatment includes correct identification of the underlying etiology and appropriate management. Surgical management strategies include tibial tubercle osteotomy, distal femoral augment and revision, proximalization of the patellar component, modification of the anterior tibial component, and/or Z-plasty of the patellar tendon. We review the outcomes for each of these procedures.
Collapse
|
|
17
|
Verhulst FV, van Sambeeck JDP, Olthuis GS, van der Ree J, Koëter S. Patellar height measurements: Insall-Salvati ratio is most reliable method. Knee Surg Sports Traumatol Arthrosc 2020; 28:869-875. [PMID: 31089790 DOI: 10.1007/s00167-019-05531-1] [Citation(s) in RCA: 101] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 05/02/2019] [Indexed: 01/26/2023]
Abstract
PURPOSE Patella alta is a risk factor for patellofemoral pain and instability. Several measurement methods and imaging modalities are in use to measure patellar height. The first aim of this study was to determine the intra- and interrater reliability of different patellar height measurement methods on conventional radiography (CR), CT and MRI. The second aim was to examine the applicability of patellar height measurement methods originally designed for CR on CT and MRI. METHODS Forty-eight patients who were treated for patellar instability were included. All patients had undergone a pre-operative conventional radiograph, CT scan and MRI. Five methods for measuring patellar height were performed on radiographs, CT and MRI by four observers. For each measurement, the intra- and interrater reliability was determined by calculating the intra-class correlation coefficient (ICC). A Bland-Altman analysis was performed for measurements with an ICC ≥ 0.70. RESULTS The Insall-Salvati (IS) ratio was the only measurement that showed good intra- and inter-observer reliability on CR, CT and MRI. The intra- and inter-observer reliability of the patellotrochlear index (PTI) for MRI was good to excellent for all observers. The IS ratio showed a moderate to good reliability for comparison of all three imaging modalities with the best agreement between radiography and MRI. The other patellar height measurements showed only poor to moderate inter-method agreement. CONCLUSION In this study, the Insall-Salvati ratio shows better intra- and inter-observer reliability than the Blackburne-Peel ratio, the Caton-Deschamps ratio and the modified Insall-Salvati ratio on all imaging modalities. Radiography and CT seem to have better reliability than MRI. The patellotrochlear index, however, shows good inter- and intra-observer reliability on MRI. Only for the IS method was there acceptable agreement between CR and MRI. This means that the established Insall-Salvati normal values could be used for MRI as well. This study shows that the most reliable method to measure patella height is the Insall-Salvati ratio measured on conventional radiographs or the patellotrochlear index on MRI. LEVEL OF EVIDENCE Level II diagnostic.
Collapse
Affiliation(s)
- Fleur V Verhulst
- Department of Orthopaedic Surgery, Canisius Wilhelmina Hospital, Postbus 9015, Nijmegen, 6500 GS, The Netherlands.
| | - Jordy D P van Sambeeck
- Department of Orthopaedic Surgery, Canisius Wilhelmina Hospital, Postbus 9015, Nijmegen, 6500 GS, The Netherlands
| | | | - Jasper van der Ree
- Department of Radiology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Sander Koëter
- Department of Orthopaedic Surgery, Canisius Wilhelmina Hospital, Postbus 9015, Nijmegen, 6500 GS, The Netherlands
| |
Collapse
|
|
18
|
Gao B, Dwivedi S, Fabricant PD, Cruz AI. Patterns in Outcomes Reporting of Operatively Managed Pediatric Patellofemoral Instability: A Systematic Review and Meta-analysis. Am J Sports Med 2019; 47:1516-1524. [PMID: 29630397 DOI: 10.1177/0363546518765152] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Traumatic patellofemoral dislocation is a common injury in pediatric patients, and surgical treatment is often recommended. Increasingly, it has been recognized that clinical studies need to report age-appropriate treatment outcomes. However, the variability and appropriateness of outcomes reporting in the youth patellar instability literature are unknown. PURPOSE To analyze the patterns of outcomes reporting in studies published in high-impact orthopaedic journals after operative management of pediatric patellar instability. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS Six high-impact orthopaedic journals were searched using PubMed and EMBASE to identify studies reporting outcomes of operative management of pediatric patellar instability. Studies containing adults were excluded. Clinical and radiographic outcomes were recorded from included articles. Descriptive statistics were calculated for overall instability recurrence rates, return-to-activity rates, and changes in Kujala and Tegner scores. RESULTS Of 545 identified articles, 8 studies met the inclusion criteria. These studies encompassed 213 patients and 230 knees (mean age, 13.2 years; range, 4.5-18.3 years). Seven of 8 studies reported patients' physeal status, but only 4 studies limited their outcomes reporting to patients with open physes. Two studies reported postoperative radiographic measures, and 5 studies reported preoperative radiographic findings. Six studies reported patient-reported outcome measures (PROMs). Seven unique PROMs were reported. All but one study reported complication rates and types of complications. The mean postoperative change in Tegner scores was -0.07 (range, -0.6 to 1.0). Among studies examining medial patellofemoral ligament reconstruction with adequate data, the mean return-to-activity rate was 86% (range, 81%-92%), the instability recurrence rate was 3% ± 20%, and the mean improvement in Kujala scores postoperatively was 22.1 (range, 19.9-26). CONCLUSION There is a need for more pediatric-specific outcomes studies regarding operatively managed traumatic patellofemoral instability. Of the outcomes reported, both radiographic outcomes and PROMs should be standardized. Among radiographic outcomes, there is a need for more studies that report tibial tubercle-trochlear groove distances and use Caton-Deschamps and/or Blackburne-Peel indices to assess patellar height. Among PROMs, there is a need for studies that use PROMs validated in pediatric populations, such as the International Knee Documentation Committee Pediatric Form or the Hospital for Special Surgery Pediatric Functional Activity Brief Scale.
Collapse
Affiliation(s)
- Burke Gao
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Shashank Dwivedi
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Peter D Fabricant
- Pediatric Orthopaedic Surgery Service, Hospital for Special Surgery, New York, New York, USA
| | - Aristides I Cruz
- Department of Orthopaedic Surgery, Hasbro Children's Hospital, Providence, Rhode Island, USA
| |
Collapse
|
|
19
|
Affiliation(s)
- Vasilios G Igoumenou
- First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | | | | |
Collapse
|
|
20
|
A novel method for determining sagittal pediatric patellar height with the Blumensaat-Epiphyseal Containment of the Knee Angle. J Pediatr Orthop B 2018; 27:510-515. [PMID: 29878975 DOI: 10.1097/bpb.0000000000000527] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
UNLABELLED Defining normal pediatric patellar height is complicated. Current methods use ratios calculated from lateral radiographs, but often provide inconsistent results and are time-consuming. It has been observed that the angle formed by Blumensaat's line and the distal femoral physis, when extended, form an area of patellar containment throughout a range of knee flexion. Deemed the Blumensaat-Epiphyseal Containment of the Knee (BECK) Angle, the objective of this study was to investigate this as a simple alternative to identify normal pediatric patellar height. Lateral radiographs were taken every 15° from 0° to 90° flexion on 10 fresh-frozen cadaveric knees. Patellar height was measured as the percentage of pole-to-pole patellar length contained within the BECK angle. The method was then applied to normal lateral radiographs of 105 pediatric knees, divided into age groups of 7-9, 10-12, and 13-16 years old. BECK angle patellar containment was compared with previously described methods. For cadaveric specimens, at least 50% patellar containment occurred between 0° and 71° flexion without quadriceps tension and between 21° and 81° flexion with 30 N of quadriceps tension. For pediatric radiographs, flexion ranged from 9° to 81°. At least 50% patellar containment occurred in 96% of knees in all three age groups. Knee flexion fell within a range of 15°-60° in 92 of the 105 pediatric knees. Limiting the analysis to this range, at least 50% patellar containment occurred in 99% of knees in all three age groups. On the basis of this study, normal pediatric knee lateral radiographs between 15° and 60° flexion should show at least 50% patellar containment within the BECK angle. LEVEL OF EVIDENCE Diagnostic Level II study.
Collapse
|
|
21
|
Ferner F, Lutter C, Dickschas J, Strecker W. Medial open wedge vs. lateral closed wedge high tibial osteotomy - Indications based on the findings of patellar height, leg length, torsional correction and clinical outcome in one hundred cases. INTERNATIONAL ORTHOPAEDICS 2018; 43:1379-1386. [DOI: 10.1007/s00264-018-4155-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 09/10/2018] [Indexed: 11/25/2022]
|
|
22
|
Stetzelberger V, Obertacke U, Jawhar A. Tourniquet application during TKA did not affect the accuracy of implant positioning: a randomized clinical trial. Knee Surg Sports Traumatol Arthrosc 2018; 26:1728-1736. [PMID: 29058023 DOI: 10.1007/s00167-017-4760-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 10/12/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE The accuracy of the identification of anatomical landmarks with versus without tourniquet application and its effect on implant positioning remained unknown. Therefore, the hypothesis of the present study was that tourniquet application did not affect the accuracy of the reconstruction of the mechanical leg alignment, the joint line level, and the patellar height. METHODS The prospective randomized monocentric trial (Clinical-Trials.gov NCT02475603) included a total of 86 patients scheduled to undergo primary TKA. The patients were allocated to receive TKA with (Group A, n = 43) or without tourniquet (Group B, n = 43). The mechanical leg alignment, the joint line level (modified Kawamura), and the patellar height (Plateau-patella angle, Insall Salvati index, and modified Insall Salvati index) were measured pre- and postoperatively on standardized calibrated digital radiographs. Mean, SEM, median, range, and p value were calculated for each parameter. RESULTS There was no statistical difference between the groups with regard to demographics, preoperative deformity, implant design, and surgical technique (n.s.). The mechanical leg alignment, the joint line level, and the patellar height revealed, in both groups, similar results pre- and postoperatively (n.s.). CONCLUSION The mechanical leg alignment, the joint line level, and the patellar height could be accurately reconstructed with and without tourniquet use. With respect to clinically relevant surrogate parameters of implant positioning, TKA can safely be performed without a tourniquet. Available data do not support a routine use of tourniquet during TKA and might justify a change of the clinical pathway. LEVEL OF EVIDENCE Level I.
Collapse
Affiliation(s)
- Vera Stetzelberger
- Department of Orthopaedics and Trauma Surgery, University Medical Center Mannheim of University Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Udo Obertacke
- Department of Orthopaedics and Trauma Surgery, University Medical Center Mannheim of University Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Ahmed Jawhar
- Department of Orthopaedics and Trauma Surgery, University Medical Center Mannheim of University Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| |
Collapse
|
|
23
|
Moghtadaei M, Otoukesh B, Bodduhi B, Ahmadi K, Yeganeh A. Evaluation of Patellar Position before and After Medial Opening Wedge High Tibial Osteotomy: Radiographic and Computed Tomography Findings. Med Arch 2018; 70:293-295. [PMID: 27703292 PMCID: PMC5034988 DOI: 10.5455/medarh.2016.70.293-295] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 07/05/2016] [Indexed: 12/03/2022] Open
Abstract
Introduction: Genovarum is a common orthopedic problem. Its optimal prompt treatment is an issue of importance. Aim: This study was conducted to determine the radiographic changes in patella bone before and after open wedge high tibial osteotomy. Material and Methods: In this quasi-experimental study, 43 patients were enrolled and underwent open wedge high tibial osteotomy and the radiographic and CT-scan indices including Q-Angle, Congruence Angle, Insall-Salvati index, and TTTG were measured and compared before and after surgery. Results: The result revealed that all indices including Q-Angle, Congruence Angle, Insull-Salvati index, and TTTG were not significantly differed across the study (P > 0.05). There was no difference between DLFA values before and after the operation (P> 0.05), while MPTA values were significantly different before and after operation (p <0.001). Conclusions: Totally it may be concluded that imaging indices are not differed after open wedge high tibial osteotomy and monitoring for them is not necessary and they would have no prognostic role.
Collapse
Affiliation(s)
- Mehdi Moghtadaei
- Department of Orthopedics, Rasool-e-akram Hospital, Iran University of Medical Science, Tehran, Iran
| | - Babak Otoukesh
- Department of Orthopedics, Rasool-e-akram Hospital, Iran University of Medical Science, Tehran, Iran
| | - Bahram Bodduhi
- Department of Orthopedics, Rasool-e-akram Hospital, Iran University of Medical Science, Tehran, Iran
| | - Keyvan Ahmadi
- Department of Orthopedics, Rasool-e-akram Hospital, Iran University of Medical Science, Tehran, Iran
| | - Ali Yeganeh
- Department of Orthopedics, Rasool-e-akram Hospital, Iran University of Medical Science, Tehran, Iran
| |
Collapse
|
|
24
|
Ihle C, Ahrend M, Grünwald L, Ateschrang A, Stöckle U, Schröter S. No change in patellar height following open wedge high tibial osteotomy using a novel femur-referenced measurement method. Knee 2017; 24:1118-1128. [PMID: 28673604 DOI: 10.1016/j.knee.2017.06.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Revised: 05/20/2017] [Accepted: 06/09/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Open wedge high tibial osteotomy (HTO) can influence the tibial slope and thereby the landmarks of currently used patellar height indices. The purpose of this retrospective study was to compare and validate a new femur-referenced patella height measurement method to currently used patellar height indices in a cohort of HTO patients. METHODS Patellar height (Caton-Deschamps, Blackburne-Peel and Insall-Salvati Indices and our newly developed Femoral Patellar Height Index) as well as tibial slope were analysed. Full-weight-bearing long-leg anteroposterior radiographs as well as anteroposterior and lateral radiographs of the knee in 0° of extension were used. Radiographs were performed preoperatively, and at six weeks, three, six, 12 and 18months postoperatively. Measurements were recorded twice by two observers. The second observation was performed after a delay of three months. RESULTS A total of 99 patients with a mean age of 46.2±8years were included. A statistically significant pre- to postoperative increase in tibial slope was found in all methods. Patellar height decreased according to Caton-Deschamps and Blackburne-Peel Indices. The Insall-Salvati Index as well as the novel Femoral Patellar Height Index remained unchanged. Intra-rater (interclass correlation coefficient (ICC) 0.914-0.998) and inter-rater (ICC 0.955-0.989) reliability were highest in the new index. CONCLUSION Detected changes of patellar height following open wedge HTO depend on the method used. Tibial slope increases following surgery. Our new index with a femoral reference for measuring patellar height was validated and good to excellent intra- and inter-rater reliability were demonstrated. Following HTO, the Femoral Patellar Height Index can be recommended as a standardized method to measure patellar height.
Collapse
Affiliation(s)
- C Ihle
- Department of Traumatology and Reconstructive Surgery, Eberhard Karls University Tübingen, BG, Trauma Center Tübingen, Germany
| | - M Ahrend
- Department of Traumatology and Reconstructive Surgery, Eberhard Karls University Tübingen, BG, Trauma Center Tübingen, Germany
| | - L Grünwald
- Department of Traumatology and Reconstructive Surgery, Eberhard Karls University Tübingen, BG, Trauma Center Tübingen, Germany
| | - A Ateschrang
- Department of Traumatology and Reconstructive Surgery, Eberhard Karls University Tübingen, BG, Trauma Center Tübingen, Germany
| | - U Stöckle
- Department of Traumatology and Reconstructive Surgery, Eberhard Karls University Tübingen, BG, Trauma Center Tübingen, Germany
| | - S Schröter
- Department of Traumatology and Reconstructive Surgery, Eberhard Karls University Tübingen, BG, Trauma Center Tübingen, Germany.
| |
Collapse
|
|
25
|
Bonadio MB, Helito CP, do Prado Torres JA, Gobbi RG, Pécora JR, Camanho GL, Demange MK. Plateau-patella angle: An option for the evaluation of patellar height in patients with patellar instability. Knee 2017; 24:340-344. [PMID: 28179061 DOI: 10.1016/j.knee.2017.01.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 12/28/2016] [Accepted: 01/06/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Patellar instability is a debilitating disease. An important factor related to recurrent dislocation is patellar height. A new method of patellar height measurement, the plateau-patella angle (PPA), was proposed in 2011. However, to date, there is no study evaluating the use of this method in patients with patellar instability. The aim of this study was to evaluate the PPA in patients with recurrent patellar dislocation. METHODS This was a retrospective evaluation of the radiographs of 78 knees with patellar instability. Patellar height was measured using the Insall-Salvati (I/S), Caton-Deschamps (C/D) and Blackburne-Peel (B/P) indices and the PPA. The qualitative and quantitative correlations between the various methods and between observers were calculated. RESULTS The PPA had a Pearson correlation of 0.76 (P<0.001) with the I/S index, 0.78 (P<0.001) with the C/D index and 0.90 (P<0.001) with the B/P index. In the qualitative correlation using the Spearman coefficient, the PPA had a correlation of 0.52 (P<0.001) with the I/S index, 0.72 (P<0.001) with the C/D index and 0.70 (P<0.001) with the B/P index. The correlations between the conventional methods were as follows: 0.57 (P<0.001) between the I/S and C/D indices; 0.61 (P<0.001) between the I/S and B/P indices; and 0.73 (P<0.001) between the C/D and B/P indices. CONCLUSION The determination of the PPA is a reproducible method that is consistent with the methods currently used to measure patellar height in patients with recurrent patellar dislocation.
Collapse
Affiliation(s)
- Marcelo Batista Bonadio
- Knee Surgery Division, Institute of Orthopedics and Traumatology, University o São Paulo, São Paulo, Brazil.
| | - Camilo Partezani Helito
- Knee Surgery Division, Institute of Orthopedics and Traumatology, University o São Paulo, São Paulo, Brazil
| | | | - Riccardo Gomes Gobbi
- Knee Surgery Division, Institute of Orthopedics and Traumatology, University o São Paulo, São Paulo, Brazil
| | - José Ricardo Pécora
- Knee Surgery Division, Institute of Orthopedics and Traumatology, University o São Paulo, São Paulo, Brazil
| | - Gilberto Luis Camanho
- Knee Surgery Division, Institute of Orthopedics and Traumatology, University o São Paulo, São Paulo, Brazil
| | - Marco Kawamura Demange
- Knee Surgery Division, Institute of Orthopedics and Traumatology, University o São Paulo, São Paulo, Brazil
| |
Collapse
|
|
26
|
BONADIO MARCELOBATISTA, TORRES JÚLIOAUGUSTODOPRADO, MAZZARO FILHO VICENTE, HELITO CAMILOPARTEZANI, GOBBI RICCARDOGOMES, DEMANGE MARCOKAWAMURA. PLATEAU-PATELLA ANGLE: AN OPTION FOR ASSESSING PATELLAR HEIGHT ON PROXIMAL TIBIA OSTEOTOMY. ACTA ORTOPEDICA BRASILEIRA 2016; 24:127-30. [PMID: 27217812 PMCID: PMC4863859 DOI: 10.1590/1413-785220162403158611] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To compare the plateau-patella angle method to the methods already established for patellar height measurement in patients undergoing high tibial osteotomy. METHODS This is a retrospective study of 13 patients undergoing medial opening tibial osteotomy. The patellar height was measured in pre and post-operative radiographs by the methods from Insall-Salvati, Caton-Deschamps, Blackburne-Peel and patella-plateau angle, as well as the tibial slope and length of the patellar tendon. Measurements were performed by two knee surgeons at two different times. RESULTS The mean age was 41.33 ± 01.09 years old. The average rates of Caton-Deschamps, Blackburne-Peel, Insall-Salvati and plateau-patella angle were, respectively, 1.00; 0.89; 1.10; and 23.15° preoperatively, and 0.89; 0.78; 1.11; and 20.46°, postoperatively. The correlation of Caton-Deschamps, Blackburne-Pell, and Insall-Salvati indexes and plateau-patellar angle interobserver was 0.72 (p <0.001), 0:54 (p <0.001), 0.65 (p <0.001), and 0.67 (w <0.001), respectively. CONCLUSION The plateau-patella angle method undergoes changes that are correlated with changes in tibial slope after osteotomy, unlike the classical methods. This fact may lead to overestimate the reduction of patellar height after osteotomy. Level of evidence IV. Case Series.
Collapse
|
|
27
|
Behrendt C, Zaluski A, E Albuquerque RP, de Sousa EB, Cavanellas N. Comparative evaluation of patellar height methods in the Brazilian population. Rev Bras Ortop 2016; 51:53-7. [PMID: 26962492 PMCID: PMC4767823 DOI: 10.1016/j.rboe.2015.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 02/19/2015] [Indexed: 11/16/2022] Open
Abstract
Objective The methods most used for patellar height measurement were compared with the plateau–patella angle method. Methods A cross-sectional study was conducted, in which lateral-view radiographs of the knee were evaluated using the three methods already established in the literature: Insall–Salvati (IS), Blackburne–Peel (BP) and Caton–Deschamps (CD). These were compared with the plateau–patella angle method. One hundred and ninety-six randomly selected patients were included in the sample. Results The data were initially evaluated using the chi-square test. This analysis was deemed to be positive with p < 0.0001. We compared the traditional methods with the plateau–patella angle measurement, using Fisher's exact test. In comparing the IS index with the plateau–patella angle, we did not find any statistically significant differences in relation to the proportion of altered cases between the two groups. The traditional methods were compared with the plateau–patella angle with regard to the proportions of cases of high and low patella, by means of Fisher's exact test. This analysis showed that the plateau–patella angle identified fewer cases of high patella than did the IS, BP and CD methods, but more cases of low patella. In comparing pairs, we found that the IS and CD indices were capable of identifying more cases of high patella than was the plateau–patella angle. In relation to the cases of low patella, the plateau–patella angle was capable of identifying more cases than were the other three methods. Conclusions The plateau–patella angle found more patients with low patella than did the classical methods and showed results that diverged from those of the other indices studied.
Collapse
Affiliation(s)
- Christian Behrendt
- Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, RJ, Brazil
| | - Alexandre Zaluski
- Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, RJ, Brazil
| | | | | | - Naasson Cavanellas
- Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, RJ, Brazil
| |
Collapse
|
|
28
|
Servodio Iammarrone C, Cadossi M, Sambri A, Grosso E, Corrado B, Servodio Iammarrone F. Is there a role of pulsed electromagnetic fields in management of patellofemoral pain syndrome? Randomized controlled study at one year follow-up. Bioelectromagnetics 2016; 37:81-8. [PMID: 26756278 DOI: 10.1002/bem.21953] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 12/12/2015] [Indexed: 12/30/2022]
Abstract
Patellofemoral pain syndrome (PFPS) is a common cause of recurrent or chronic knee pain in young adults, generally located in the retropatellar region. Etiology is controversial and includes several factors, such as anatomical defects, muscular imbalance, or joint overuse. Good results have been reported with exercise therapy, including home exercise program (HEP). Joint inflammation with increase of pro-inflammatory cytokines levels in the synovial fluid might be seen especially when chondromalacia becomes evident. Biophysical stimulation with pulsed electromagnetic fields (PEMFs) has shown anti-inflammatory effects and anabolic chondrocyte activity. The purpose of this randomized controlled study was to evaluate if the combination of HEP with PEMFs was more effective than HEP alone in PFPS treatment. Thirty-one PFPS patients were enrolled in this study. All patients were instructed to train with HEP. Patients in the PEMFs group associated HEP with PEMFs. Function and pain were assessed with Victorian Institute of Sport Assessment score (VISA), Visual Analog Scale (VAS), and Feller's Patella Score at baseline at 2, 6, and 12 months of follow-up. Drug assumption was also recorded. Increase in VISA score was significantly higher in PEMFs group compared to controls at 6 and 12 months, as well as the increase in the Feller's Patella Score at 12 months. VAS score became significantly lower in the PEMFs group with respect to control group since 6 month follow-up. Pain reduction obtained with PEMFs enhanced practicing therapeutic exercises leading to a better recovery process; this is extremely important in addressing the expectations of young patients, who wish to return to sporting activities.
Collapse
Affiliation(s)
| | | | | | - Eugenio Grosso
- Università degli Studi di Napoli "FEDERICO II" cattedra di Medicina Fisica e Riabilitativa, Napoli, Italy
| | - Bruno Corrado
- Università degli Studi di Napoli "FEDERICO II" cattedra di Medicina Fisica e Riabilitativa, Napoli, Italy
| | | |
Collapse
|
|
29
|
Behrendt C, Zaluski A, Albuquerque RPE, Sousa EBD, Cavanellas N. Avaliação comparativa de métodos da altura patelar na população brasileira. Rev Bras Ortop 2016; 51:53-57. [DOI: 10.1016/j.rbo.2015.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
|
|
30
|
Gracitelli GC, Pierami R, Tonelli TA, Falótico GG, Silva FD, Nakama GY, da Silveira Franciozi CE, de Queiroz AAB, Filho MC. ASSESSMENT OF PATELLAR HEIGHT MEASUREMENT METHODS FROM DIGITAL RADIOGRAPHY. Rev Bras Ortop 2015; 47:210-3. [PMID: 27042623 PMCID: PMC4799376 DOI: 10.1016/s2255-4971(15)30088-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Accepted: 08/04/2011] [Indexed: 01/16/2023] Open
Abstract
Objective: To analyze the most common methods for measuring patellar height and the impact of observer experience in correlations with the other observers using digital radiography. Methods: Sixty digital radiographs of the knee in lateral view were analyzed by four observers: a physician in the second year of medical residence in orthopedics (R2); a physician in the third year of medical residence in orthopedics (R3); an orthopedic surgeon who was a specialist in knee surgery (SK); and a radiologist who was a specialist in musculoskeletal radiology (SR). The indices used were: Insall-Salvati (IS), Blackburne-Peel (BP), Caton-Deschamps (CD) and modified Insall-Salvati (ISM). The interobserver agreement was calculated using the kappa coefficient (κ). Results: The highest correlation coefficients were found when using the IS method followed by the CD method. The worst correlation was observed in the ISM method. The highest interobserver agreement was found between the orthopedic surgeon specializing in knee surgery and the radiologist specializing in musculoskeletal radiology, for the four measurement methods used. Conclusion: Using digital radiography, the Insall-Salvati and Caton-Deschamps indexes presented the highest interobserver agreement, and this was also positively influenced by the observer's level of experience.
Collapse
Affiliation(s)
| | - Rafael Pierami
- Third-year Resident Physician in the Department of Orthopedics and Traumatology, EPM/UNIFESP, São Paulo, SP, Brazil
| | - Thomaz Antonio Tonelli
- Third-year Resident Physician in the Department of Orthopedics and Traumatology, EPM/UNIFESP, São Paulo, SP, Brazil
| | | | - Flavio Duarte Silva
- Radiologist in the Department of Imaging Diagnostics, EPM/UNIFESP, São Paulo, SP, Brazil
| | - Gilberto Yoshinobu Nakama
- Orthopedist in the Knee Group, Department of Orthopedics and Traumatology, EPM/UNIFESP, São Paulo, SP, Brazil
| | | | | | - Mario Carneiro Filho
- PhD; Affiliated Professor and Head of the Knee Group, Department of Orthopedics and Traumatology, EPM/UNIFESP, São Paulo, SP, Brazil
| |
Collapse
|
|
31
|
Vives-Barquiel MA, Torrents A, Lozano L, Martínez-Pastor JC, Maculé F, Segur JM, Popescu D. Proximalize osteotomy of tibial tuberosity (POTT) as a treatment for stiffness secondary to patella baja in total knee arthroplasty (TKA). Arch Orthop Trauma Surg 2015; 135:1445-51. [PMID: 26298563 DOI: 10.1007/s00402-015-2312-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Stiffness after a total knee arthroplasty (TKA) is one of the most common post-operative complications. The purpose of this study is the evaluation of the effectiveness of TT proximalization osteotomy of improving a lack of flexion and secondary pain in patella baja (infera) post-TKA. MATERIALS AND METHODS Between April 2007 and July 2012, TT proximalization osteotomy was performed on 21 patients. The average preoperative flexion was 70° (in a range of 60-80). Clinical pre- and post-operative evaluations were performed with Knee Society Score, Western Ontario and McMaster Universities Arthritis Index scales and a satisfaction survey. Modified Blackburn-Peel index and Portner angle were used to evaluate patellar height. RESULTS After an average follow-up of 35 months (range 18-48), an average flexion of 100° (range 90-100) and an overall satisfaction were obtained. Clinical scores improved significantly. The Blackburn-Peel index and Portner angle improved significantly from 0.3 (range 0.1-0.5) to 0.4 (0.3-0.5) and from 9 (3-15) to 12 (9-18), respectively. Three patients showed no signs of osteotomy consolidation. However, this was not linked to a lack of extension or an increase in local pain. CONCLUSION TT proximalization osteotomy provides satisfactory results in improving a lack of flexion and pain in patella baja post-TKR.
Collapse
Affiliation(s)
- M A Vives-Barquiel
- Resident Trauma and Orthopaedic Surgery Department, Hospital Clínic Barcelona, Villarroel 170, Barcelona, Spain.
| | | | - L Lozano
- Knee Unit, Hospital Clínic Barcelona, Villarroel 170, Barcelona, Spain
| | | | - F Maculé
- Knee Unit, Hospital Clínic Barcelona, Villarroel 170, Barcelona, Spain
| | - J M Segur
- Resident Trauma and Orthopaedic Surgery Department, Hospital Clínic Barcelona, Villarroel 170, Barcelona, Spain
| | - D Popescu
- Knee Unit, Hospital Clínic Barcelona, Villarroel 170, Barcelona, Spain
| |
Collapse
|
|
32
|
The reliability of four widely used patellar height ratios. INTERNATIONAL ORTHOPAEDICS 2015; 40:493-7. [DOI: 10.1007/s00264-015-2908-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 06/24/2015] [Indexed: 01/17/2023]
|
|
33
|
|
|
34
|
Portner O. High tibial valgus osteotomy: closing, opening or combined? Patellar height as a determining factor. Clin Orthop Relat Res 2014; 472:3432-40. [PMID: 25070919 PMCID: PMC4182389 DOI: 10.1007/s11999-014-3821-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 07/14/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND According to the literature, closing and opening wedge high tibial valgus osteotomies can raise or lower the patella, and diffèrent methods of patella height measurement show similarly conflicting results. Clarification of this was thought to be important because there is much literature describing morbidity secondary to patella alta or patella infera (baja). Effects on tibial slope and patellar tendon length are not well delineated and the influence of sex and age is unknown. QUESTIONS/PURPOSE A group of patients who underwent high tibial valgus osteotomy was investigated to determine how surgical technique influenced postoperative (1) patellar height and (2) tibial slope and patellar tendon length, and (3) whether age or gender independently influenced postoperative patellar height. To eliminate the often conflicting results seen when several ratio methods are used, patellar height was measured by one method, before and after surgery, shown previously to be reliable. METHODS Patellar height was measured on radiographs using the plateau-patella angle in a retrospective case series consisting of three cohorts: 18 patients with closing wedge osteotomies, 26 with opening wedge osteotomies, and 32 with combined osteotomies. The indication for surgery in all three cohorts was medial osteoarthritis with secondary varus. Before surgery there were no significant differences in patellar height, femorotibial angle, age, or gender among the three groups, and no patients were lost to followup during the 8-week study period after surgery. Seven of the 76 patients (9.2%), all in the opening wedge cohort, had concomitant ACL reconstruction at the time of the tibial osteotomy. No other surgery, except arthroscopy, was performed at the time of osteotomy. Patellar tendon length was assessed by the Insall-Salvati index and tibial slope by the angle between the posterior tibial cortex and the medial tibial joint line. Postoperative measurements were made between 6 and 8 weeks. The influence of sex and age was calculated using patellar height measurements made before any surgery. RESULTS All closing wedge osteotomies produced patellar ascent by an average of 13% (p<0.001), all opening wedges produced descent by an average of 21% (p<0.001), and the combined osteotomy mean showed minimal change (p=0.0034). The absolute consistency of the changes and their direction allow suggested guidelines for selection of osteotomy type. There were only slight changes in tibial slope. A significant change in patellar tendon length was seen in seven knees of the opening wedge cohort that had concomitant ACL reconstruction. All had a mean reduction of the Insall-Salvati index of 0.05 (approximately 5%), p=0.0002. New findings showed higher patellae in female and older patients, unrelated to the surgery. CONCLUSIONS If it is accepted that patella baja and patella alta should be avoided, then closing wedge osteotomies should be performed only when the patella is low riding, and opening wedge osteotomies should be done only for patients with preexisting patella alta. The combined osteotomy minimizes changes in patellar height. Patellar tendon contractures and tibial slope changes can be avoided. The plateau-patella angle should be measured preoperatively to help decide the type of osteotomy. LEVEL OF EVIDENCE Level III, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Oliver Portner
- Division of Orthopaedic Surgery, University of Ottawa, 75 Pond Street, Ottawa ON, K1L 8J1 Canada
| |
Collapse
|
|
35
|
Nizić D, Pervan M, Kovačević B. A new reference line in diagnosing a high-riding patella on routine digital lateral radiographs of the knee. Skeletal Radiol 2014; 43:1129-37. [PMID: 24570032 DOI: 10.1007/s00256-014-1825-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 01/07/2014] [Accepted: 01/11/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To propose a new reference line in diagnosing a high-riding patella (patella alta) on routine digital lateral radiographs of the knee. MATERIALS AND METHODS On 64 routine digital lateral radiographs of adult knees with no bone pathology or surgery and over the range of knee flexion between 1.6° and 79.1° (34.4°± 16.6°), the long axis of the superimposed egg-shaped femoral condyles was drawn and moved upward to pass through the point where the posterior contours of the femoral diaphysis and the femoral condyles meet-the posterior reference point-to become a new reference line. Any part of the patella crossing the new reference line indicated a high-riding patella. The new reference line was compared with the four most common patellar height ratios (Insall-Salvati, Grelsamer-Meadows or the modified Insall-Salvati, Caton Deschamps, and Blackburne-Peel) for the drawing time, accuracy, and reproducibility (intra- and interobserver agreement). RESULTS The new reference line required approximately one-third to one-half of the drawing time compared to the most common patellar height ratios, with equal accuracy and complete reproducibility. On the contrary, the reproducibility of the most common patellar height ratios ranged from poor to moderate, with the best results for the Insall-Salvati ratio. CONCLUSIONS The new reference line proved to be a very simple, accurate, and reproducible tool in diagnosing a high-riding patella. We believe that our preliminary results are an encouraging impetus to more complex research.
Collapse
Affiliation(s)
- Dinko Nizić
- Clinical Institute of Diagnostic and Interventional Radiology, Zagreb University Hospital Center, Kišpatićeva 12, 10000, Zagreb, Croatia,
| | | | | |
Collapse
|
|
36
|
Robin BN, Ellington MD, Jupiter DC, Allen BC. Plateau-patella angle in evaluation of patellar height after total knee arthroplasty. J Arthroplasty 2014; 29:1394-7. [PMID: 24612739 DOI: 10.1016/j.arth.2014.01.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 12/10/2013] [Accepted: 01/22/2014] [Indexed: 02/01/2023] Open
Abstract
The plateau-patella angle (PPA) has been proposed as a new and simpler method to describe patellar height. This method has not been used or validated in knees following total knee arthroplasty (TKA). A modified PPA (mPPA) was developed for use in this population. The method was validated by determining the interobserver and intraobserver reliability of the technique in 50 consecutive patients compared to three well-described methods of describing patellar height after TKA. Three observers then evaluated the mPPA of 297 post-operative radiographs to describe a normal range after TKA for a given technique and implant. The interobserver reliability was the highest for the mPPA compared to the other methods. The mean mPPA for the entire cohort was 21.06, 20.49, and 19.94 for the three observers. The modified plateau-patella angle is a reliable way to evaluate patellar height in patients who have undergone total knee arthroplasty.
Collapse
|
|
37
|
Ellington M, Robin B, Jupiter D, Allen B. Plateau-patella angle in evaluation of patellar height in osteoarthritis. Knee 2014; 21:699-702. [PMID: 24717261 DOI: 10.1016/j.knee.2014.02.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 02/11/2014] [Accepted: 02/26/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND The plateau-patella angle (PPA), recently introduced as a new and simpler method of measuring patellar height from the lateral radiograph, has the advantage of simplicity over previously described methods as it involves a single angular measurement without the need for calculations. The purpose of this study was to validate the use of the PPA as a measurement for patellar height in knees with moderate to severe osteoarthritis. METHODS A total of 331 patients who underwent total knee arthroplasty at our institution with radiographs prior to surgery were evaluated. Of those, 297 (89.2%) were felt to be adequate for review. Three observers with different levels of orthopedic training measured PPA, Insall-Salvati, Caton-Deschamps, and Blackburne-Peel indices on a subset of 50 consecutive patients. Interobserver agreement for each of the four measurements was calculated and correlation between each of the measurements within each observer was calculated. The measurement of the PPA was repeated. Intraobserver agreement for the PPA was determined and a normal range and distribution was defined for this population. RESULTS For the three observers, the mean PPA for the entire cohort was 25.55, 25.31, and 24.42. The intraclass correlation coefficient (ICC) was 0.81, The ICC and intraobserver assessment were the highest for the PPA compared with the other ratios. The PPA was found to correlate most strongly with the Blackburne-Peel method. CONCLUSIONS The plateau-patella angle is a reliable way to evaluate patellar height in the osteoarthritic population. The measurement demonstrated a higher interobserver reliability compared with previously described methods. LEVEL OF EVIDENCE Retrospective Level IV.
Collapse
Affiliation(s)
| | - Brett Robin
- Scott & White Healthcare, Temple, TX, United States
| | | | - Bryce Allen
- Scott & White Healthcare, Temple, TX, United States
| |
Collapse
|
|
38
|
Abstract
BACKGROUND The purpose of this study was to evaluate the hypothesis that medial patellofemoral ligament (MPFL) reconstruction for patellar instability decreases patellar height. METHODS Preoperative and postoperative lateral knee radiographs of 38 adolescents who underwent MPFL reconstruction between 2005 and 2011 were reviewed. The Insall-Salvati index, Blackburne-Peel index, Caton-Deschamps index, and plateau-patella angle were measured on all radiographs to identify differences in patellar height. These patellar height indices were also measured on lateral knee radiographs of 25 adolescents (control group) who were treated conservatively for osteochondritis dissecans of the knee. The 2 groups were compared to account for patellar height changes secondary to growth and ossification. Intrarater reliability was measured for all patellar height indices at 1-month interval. RESULTS Preoperatively, patients who underwent MPFL reconstruction had significantly greater patellar height on all indices compared with the control group before and after controlling for age and sex. The patients who underwent MPFL reconstruction showed a significantly greater decrease in patellar height on the Blackburne-Peel or Caton-Deschamps indices over time compared with the control group such that postoperatively there was no difference between groups in these patellar height indices. Furthermore, the change in patellar height indices after MPFL reconstruction did not differ between patients with less than or more than 1-year follow-up. All indices demonstrated good to excellent intrarater reliability. CONCLUSIONS The present study showed a decrease in patellar height in the postoperative period in patients after MPFL reconstruction for patellar instability. Further investigation is necessary to determine the long-term effects of MPFL reconstruction on patellar height. LEVEL OF EVIDENCE Level III--therapeutic, case series.
Collapse
|
|
39
|
Salvi M, Caputo F, Piu G, Sanna M, Sanna C, Marongiu G. The loss of extension test (LOE test): a new clinical sign for the anterior cruciate ligament insufficient knee. J Orthop Traumatol 2013; 14:185-91. [PMID: 23558793 PMCID: PMC3751350 DOI: 10.1007/s10195-013-0238-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Accepted: 03/11/2013] [Indexed: 12/03/2022] Open
Abstract
Background This prospective study was created to evaluate the reliability of a new clinical test, which we termed the “loss of extension test” (LOE test). The LOE test investigates the loss of normal maximum passive extension (MPE) of the knee due to an anterior cruciate ligament tear in comparison to the normal MPE of the healthy knee. Materials and methods The study was divided into two consecutive parts. Part 1 was designed to assess the side-to-side difference in normal MPE in a healthy population. In part 1, 100 healthy adults were enrolled. Part 2 was designed to evaluate the LOE test reliability in injured knees. In part 2, we included 196 selected patients. Results In part 1, the average side-to-side difference in MPE in the healthy population was not statistically significant. In part 2, the overall average side-to-side difference in MPE of the injured group was 10.1 mm ± 14.1 (min −20; max 60), which was not statistically significant (p = 0.52). An anterior cruciate ligament (ACL) tear was found in 121 knees among 196 patients. The average side-to-side difference in MPE in the ACL-insufficient group was 16.9 mm ± 13.4 (min −20; max 60), which was statistically significant (p < 0.0001). The accuracy of the loss of extension test was 83.7 %, its specificity was 93.3 %, its sensitivity was 77.7 %, its positive predictive value was 95 %, and its negative predictive value was 72.2 %. Conclusions The reliability of the LOE test is comparable to those reported in the literature for the Lachman test and dynamic tests, so the LOE test could represent a useful tool for the diagnosis of the anterior cruciate ligament insufficient knee.
Collapse
Affiliation(s)
- Massimiliano Salvi
- Department of Prosthetic and Sports Surgery, Casa di Cura Lay, Via S. Ignazio da Laconi, 34, 09123, Cagliari, Sardinia, Italy.
| | | | | | | | | | | |
Collapse
|
|
40
|
Nishizawa Y, Matsumoto T, Kubo S, Muratsu H, Matsushita T, Oka S, Ishida K, Matsuzaki T, Nishida K, Akisue T, Kuroda R, Kurosaka M. The influence of patella height on soft tissue balance in cruciate-retaining and posterior-stabilised total knee arthroplasty. INTERNATIONAL ORTHOPAEDICS 2012; 37:421-5. [PMID: 23275081 DOI: 10.1007/s00264-012-1749-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 12/03/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE Although the patella reduced or everted position has recently been recognised as an important factor influencing soft tissue balance during assessment in total knee arthroplasty (TKA), the influence of patella height on soft tissue balance has not been well addressed. Therefore, the relationship between soft tissue balance and patella height was investigated and differences between cruciate-retaining (CR) and posterior-stabilised (PS) TKA were compared. METHODS Forty consecutive patients blinded to the type of implant received, were randomised prospectively. Using lateral radiographs, pre-operative patella height was measured. Using an offset-type tensor designed to measure the soft tissue balance with a reduced patellofemoral (PF) joint and femoral component in place, soft tissue balance was intra-operatively assessed in CR TKA (n = 20) and PS TKA (n = 20) in osteoarthritic patients. The joint component gap and varus ligament balance at zero, ten, 45, 90 and 135° of knee flexion with the patella reduced were measured. RESULTS In PS TKA, the joint component gap positively correlated with patella height at 90 and 135° of knee flexion. However, there was no correlation between joint component gap and patella height at other flexion angles in PS TKA and any flexion angle in CR TKA. Varus ligament balance showed no significant correlation with patella height in either CR or PS TKA. CONCLUSION Analysis of soft tissue balance and patella height only showed a positive correlation in joint component gap at a high flexion angle (90 and 135°) in PS TKA but not in other parameters examined. Pre-operative measurement of patella height may be an important factor for predicting an intra-operative flexion gap in PS TKA.
Collapse
Affiliation(s)
- Yuichiro Nishizawa
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-cho, chuo-ku, Kobe, 650-0017, Japan
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
|
41
|
Sarmah SS, Patel S, Hossain FS, Haddad FS. The radiological assessment of total and unicompartmental knee replacements. ACTA ACUST UNITED AC 2012; 94:1321-9. [PMID: 23015555 DOI: 10.1302/0301-620x.94b10.29411] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Radiological assessment of total and unicompartmental knee replacement remains an essential part of routine care and follow-up. Appreciation of the various measurements that can be identified radiologically is important. It is likely that routine plain radiographs will continue to be used, although there has been a trend towards using newer technologies such as CT, especially in a failing knee, where it provides more detailed information, albeit with a higher radiation exposure. The purpose of this paper is to outline the radiological parameters used to evaluate knee replacements, describe how these are measured or classified, and review the current literature to determine their efficacy where possible.
Collapse
Affiliation(s)
- S S Sarmah
- University College London Hospital, 235 Euston Road, London NW1 2BU, UK.
| | | | | | | |
Collapse
|
|
42
|
The influence of patella height on intra-operative soft tissue balance in posterior-stabilized total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2012; 20:2191-6. [PMID: 22120839 DOI: 10.1007/s00167-011-1797-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2011] [Accepted: 11/15/2011] [Indexed: 10/15/2022]
Abstract
PURPOSE Although the patella reduced or everted position has recently been recognized as an important factor in influencing soft tissue balance during the assessment in total knee arthroplasty (TKA), the influence of patella height on soft tissue balance has not been well addressed. We therefore investigated the effect of patella height by comparing soft tissue balance between high [Insall-Salvati index (ISI) > 1] and low patella patients (ISI ≦ 1). METHODS Using a tensor designed to facilitate soft tissue balance measurements with a reduced patellofemoral joint and femoral component in place, we intra-operatively assessed the joint component gap and ligament balance of posterior-stabilized (PS) TKAs in 30 osteoarthritic patients performed at 0, 10, 45, 90, and 135° of flexion, with the patella reduced. RESULTS When comparing the two groups, the component gaps of the higher patella group showed a larger trend than those of the lower patella group, with significant differences at 90 and 135° of knee flexion. Moreover, the joint component gap positively correlated with ISI at 90 and 135° of knee flexion. CONCLUSION Patella higher group showed significant larger component gaps than patella lower group in high flexion angles (90 and 135°). Pre-operative measurement of patellar height can help predict intra-operative soft tissue balance in PS TKA. LEVEL OF EVIDENCE III.
Collapse
|