Imaging of Patellofemoral Instability

McCrum, Erin; Cooper, Kyle; Wittstein, Jocelyn; French, Robert J.

doi:10.1016/j.csm.2021.05.007

Cited by 18 publications

(10 citation statements)

References 68 publications

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“…24 In instances when an avulsion fracture fragment is identified on the radiograph, an MRI should be considered for further evaluation. 25 MRIs can also be used to identify osteochondral lesions and lateral femoral condyle bone bruising. When necessary, CT scans are utilized to evaluate femoral anteversion, tibial rotation, and TT-TG distance.…”

Section: Discussionmentioning

confidence: 99%

Differences in Outcomes between Patellar Dislocations Managed in Emergent versus Non-Emergent Care Settings

et al. 2022

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Patellar dislocations occur at a much higher rate in military than civilian populations. Past population-level studies have shown that surgical management is as good as or superior to conservative care and may reduce future reoccurrences. Although in acute cases and in civilian clinics, patellar dislocations are usually managed first in an emergent care setting, previous work suggests this can lead to increased costs. This study compared differences in downstream care type and intensity of services based on whether initial care occurred in emergent or non-emergent care settings. In our sample of 1,523 Military Health System (MHS) beneficiaries with patellar dislocation and 2-year follow-up, we found non-significant differences in costs, intensity of services, and rates of surgical repair regardless of whether the patient was initially seen in an emergent versus non-emergent care setting. Although we found significant increases in the use of imaging, patellar dislocation-related medical visits, and frequency of closed treatment approaches in emergent care settings, these values were very small and likely not clinically significant. These findings, which included all the patellar dislocations reported across the entire MHS in a 24-month period, suggest that neither emergent nor non-emergent care settings are likely to influence the long-term care received by the individual.

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Section: Discussionmentioning

confidence: 99%

Differences in Outcomes between Patellar Dislocations Managed in Emergent versus Non-Emergent Care Settings

et al. 2022

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“…Studies have shown that 30% of these avulsion fractures are only likely to be recognized on the dedicated patellar view; therefore, including a sunrise view in cases of traumatic knee injuries is essential[ 3 ]. Moreover, in the case of radiographic avulsion fracture, further evaluation of additional stigmata of previous patellar dislocation by magnetic resonance imaging (MRI) is recommended[ 4 ].…”

Section: To the Editormentioning

confidence: 99%

Radiological evaluation of patellofemoral instability and possible causes of assessment errors: Letter to the editor

Mesregah¹

2022

WJM

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“…Assessment of patellofemoral congruence is performed in routine practice in cases of patellofemoral instability [ 1 , 2 ], painful patellar syndrome [ 3 ], or patellofemoral osteoarthritis [ 4 ]. In these cases, the analysis of patellofemoral congruence makes it possible to justify a surgical treatment choice in case of chronic instability or chronic patellofemoral pain (tibial tuberosity osteotomy, external patellar release, axial correction and/or derotation osteotomy, medial patellofemoral ligament reconstruction) [ 5 – 8 ].…”

Section: Introductionmentioning

confidence: 99%

Radiographic measurement of the congruence angle according to Merchant: validity, reproducibility, and limits

Severyns

Mallet²,

Santoni³

et al. 2023

Knee Surg & Relat Res

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Purpose The objective of this study was to analyze the intra- and interobserver variability of this measurement according to a strict methodology and on a representative sample of the general population, as well as to identify the possible difficulties of measurement in case of patellar or trochlear dysplasia. Methods This observational study involved radiographic analysis by three independent observers of a total of 50 patients who had a loaded patellofemoral X-ray taken with the knee flexed to 45°. An initial reading was taken to measure the angle of the trochlear sulcus, the Merchant angle, and to classify the knees according to a possible trochlear dysplasia and/or patellar dysplasia according to Wiberg. A second measurement was then performed to analyze intraobserver agreement. Interobserver agreement was measured on all radiographic measurements (n = 100). Results The Merchant patellofemoral congruence angle showed good intraobserver concordance ranging from 0.925 (95% CI 0.868–0.957) to 0.942 (95% CI 0.898–0.967), as well as interobserver concordance ranging from 0.795 (95% CI 0.695–0.862) to 0.914 (95% CI 0.872–0.942). Poor results were found in terms of interobserver concordance on the measurement of the Merchant angle in case of stage 3 Wiberg patella ranging from 0.282 (95% CI −0.920 to 0.731) to 0.611 (95% CI 0.226–0.892). Conclusion Congruence angle is one of most commonly used measurements for patellar tracking. However, the convexity of the patellar surface makes it difficult to identify the patellar apex on its intraarticular facet, making the measurement of the Merchant congruence angle unreliable and not very reproducible in cases of stage 3 Wiberg patella. Registration N°IRB 2021/139

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Imaging of Patellofemoral Instability

Cited by 18 publications

References 68 publications

Differences in Outcomes between Patellar Dislocations Managed in Emergent versus Non-Emergent Care Settings

Differences in Outcomes between Patellar Dislocations Managed in Emergent versus Non-Emergent Care Settings

Radiological evaluation of patellofemoral instability and possible causes of assessment errors: Letter to the editor

Radiographic measurement of the congruence angle according to Merchant: validity, reproducibility, and limits

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