Factors predisposing to patellar chondropathy and patellar apicitis in athletes

Kujala, Urho M.; Osterman, K; Kvist, M; Aalto, Teuvo; Friberg, O

doi:10.1007/bf00266208

Cited by 95 publications

(71 citation statements)

References 25 publications

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“…Patella alta has been reported to be associated with patella subluxation, episodic dislocation, and patellofemoral joint instability [18,31]. Patellofemoral malalignment associated with patella alta is believed to cause excessive wear of the cartilage, contributing to the development of patellofemoral pain and arthritis [13,15,27]. Biomechanical studies have shown that patella alta can result in decreased patellofemoral joint contact area and elevated contact stresses [26,30,32].…”

Section: Introductionmentioning

confidence: 99%

Does Patella Tendon Tenodesis Improve Tibial Tubercle Distalization in Treating Patella Alta? A Computational Study

Liao

Yang

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Patellofemoral malalignment associated with patella alta may cause pain and arthritis; because of this, the condition sometimes is treated surgically. Two common procedures are tibial tubercle distalization with or without patellar tendon tenodesis. However, the biomechanical consequences of these interventions for patella alta are not clearly understood. Questions/purposes We evaluated changes in patellofemoral joint contact mechanics after tibial tubercle distalization and tibial tubercle distalization combined with patella tendon tenodesis. Specifically, we asked: (1) Are there biomechanical differences between these two types of procedures? (2) Is there an ideal range to distalize the patella? Methods Subject-specific finite-element models were created for 10 individuals with patella alta (mean InsallSalvati ratio of 1.34 ± 0.05). Input parameters for the finite-element models included subject-specific joint geometry, quadriceps muscle forces, and weightbearing patellofemoral joint kinematics. Virtual operations were conducted to simulate the two procedures. For distalization, the tibial tubercle and patella were displaced distally 4 mm to 20 mm in 4-mm increments based on the original model. At each level of distalization, the patella tendon was attached back to its original insertion to simulate the additional tenodesis procedure. Cartilage stress, contact area, and contact forces were quantified and compared between procedures and distalization levels. Results Distalization and distalization + tenodesis reduced patellofemoral joint stress compared with the baseline of 1.02 ± 0.11 MPa. Distalization led to lower cartilage stress than distalization + tenodesis, and the effect size was relatively large (0.88 ± 0. Conclusions Cartilage stress appears lower using distalization as opposed to distalization + tenodesis in this finite-element analysis simulation. An Insall-Salvati ratio of 0.95 may be an ideal level for distalization; further distalization does not show additional benefits. Clinical Relevance This study suggests that distalization may result in less stress than distalization + tenodesis,

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Section: Introductionmentioning

confidence: 99%

Does Patella Tendon Tenodesis Improve Tibial Tubercle Distalization in Treating Patella Alta? A Computational Study

Liao

Yang

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…Furthermore, patella alta has been biomechanically and clinically linked to increased incidence of AKP [28][29][30][31] and present in 30 % of patients with PF disorders and in 0 % of controls [15,22]. There are also reports of a group of patients with 'potential patellar instability', in whom trochlear dysplasia and/or patella alta are present and causing AKP but with no history of patellar dislocation [15].…”

Section: Introductionmentioning

confidence: 99%

The incidence of trochlear dysplasia in anterior cruciate ligament tears

Ntagiopoulos¹,

Bonin²,

Sonnery‐Cottet

et al. 2014

International Orthopaedics (SICOT)

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Purpose The purpose of the present epidemiologic study is to record the radiographic presence of trochlear dysplasia and patella alta in patients who undergo anterior cruciate ligament (ACL) reconstruction as a potential underlying factor for postoperative anterior knee pain (AKP). Methods All consecutive cases of skeletally-mature ACLdeficient knees that would undergo ACL reconstruction in three different hospitals were prospectively included during a six-month period. Inclusion criteria were acute and subacute ACL injury with no previous ipsilateral knee operation. Patients with chronic ACL tears, prior-to-ACL-injury history of patellar instability or other PF disorders were excluded from the study. Results A total of 299 knees were included (mean age 32± ten years). Forty-four (14.7 %) knees had a positive 'crossing sign' in the lateral X-rays and 255 (85.3 %) had no sign of trochlear dysplasia (p<0.01). Among the cases with trochlear dysplasia, 41 (93 %) had type A trochlear dysplasia with the presence only of the 'crossing sign' and three (7 %) had type C trochlear dysplasia. Patellar height results included a mean Caton-Deschamps index of 1.0± 0.14 (0.5-1.4). Twenty (6.6 %) knees had an index of less than 0.8, and two (0.6 %) knees had an index less than 0.6. In contrast, 15 (5.0 %) knees had an abnormal value of more than 1.2, indicating patella alta. ConclusionsThe most important finding of the study is the increased prevalence of trochlear dysplasia and patella alta in patients with ACL injury, when compared to the incidence of trochlear dysplasia and patella alta in the general population in the literature. This finding could sound as an alert of a possible additional risk factor for post-operative anterior knee pain after ACL reconstruction.

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“…1,2 Several factors have been associated with anterior knee pain, including patella alta, [3][4][5] but the precise mechanism by which this leads to anterior knee pain remains poorly understood.…”

mentioning

confidence: 99%

Is there a biomechanical explanation for anterior knee pain in patients with patella alta?

Luyckx¹,

Didden²,

Vandenneucker³

et al. 2009

The Journal of Bone and Joint Surgery. British volume

146

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The purpose of this study was to test the hypothesis that patella alta leads to a less favourable situation in terms of patellofemoral contact force, contact area and contact pressure than the normal patellar position, and thereby gives rise to anterior knee pain.A dynamic knee simulator system based on the Oxford rig and allowing six degrees of freedom was adapted in order to simulate and record the dynamic loads during a knee squat from 30° to 120° flexion under physiological conditions. Five different configurations were studied, with variable predetermined patellar heights.The patellofemoral contact force increased with increasing knee flexion until contact occurred between the quadriceps tendon and the femoral trochlea, inducing load sharing. Patella alta caused a delay of this contact until deeper flexion. As a consequence, the maximal patellofemoral contact force and contact pressure increased significantly with increasing patellar height (p < 0.01). Patella alta was associated with the highest maximal patellofemoral contact force and contact pressure. When averaged across all flexion angles, a normal patellar position was associated with the lowest contact pressures.Our results indicate that there is a biomechanical reason for anterior knee pain in patients with patella alta.Anterior knee pain may be present in as many as 30% of physically active individuals.

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Factors predisposing to patellar chondropathy and patellar apicitis in athletes

Cited by 95 publications

References 25 publications

Does Patella Tendon Tenodesis Improve Tibial Tubercle Distalization in Treating Patella Alta? A Computational Study

Does Patella Tendon Tenodesis Improve Tibial Tubercle Distalization in Treating Patella Alta? A Computational Study

The incidence of trochlear dysplasia in anterior cruciate ligament tears

Is there a biomechanical explanation for anterior knee pain in patients with patella alta?

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