Is the Caton-Deschamps Index a Valuable Ratio to Investigate Patellar Height in Children?

Thévenin-Lemoine, Camille; Ferrand, Michèle; Courvoisier, Aurélien; Damsin, Jean-Paul; Pointe, Hubert Ducou Le; Vialle, Raphaël

doi:10.2106/jbjs.j.00759

Cited by 123 publications

(86 citation statements)

References 13 publications

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“…[33][34][35][36][37] The Blackburne-Peel and Caton-Deschamps indices assess the patellar height in relation to the tibial plateau and are considered to be more reliable in children compared with the Insall-Salvati index, which is dependent on the ossification of the tibial tubercle. When used in children or adolescents, one has to account for growth and ossification pattern around the knee and their influence on these indices.…”

Section: Discussionmentioning

confidence: 99%

Does Medial Patellofemoral Ligament Reconstruction Decrease Patellar Height? A Preliminary Report

Lykissas

Eismann

et al. 2014

Journal of Pediatric Orthopaedics

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Section: Discussionmentioning

confidence: 99%

Does Medial Patellofemoral Ligament Reconstruction Decrease Patellar Height? A Preliminary Report

Lykissas

Eismann

et al. 2014

Journal of Pediatric Orthopaedics

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“…8,10 Patella alta was assessed on lateral radiographs using the Caton-Deschamps index and the Insall-Salvati index. 15,16 If the patient met the definition of patella alta based on either index (>1.2), then he/she was considered to have patella alta (i.e., did not require both). Skeletal maturity was evaluated based on the distal femoral and proximal tibial physes, using one of the following categories: open, closing, or closed.…”

Section: Radiographic Measurementsmentioning

confidence: 99%

First-Time Patellofemoral Dislocation: Risk Factors for Recurrent Instability

2015

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Patellofemoral instability is a complex problem, which can be difficult to manage. The purpose of this study was to describe the demographics of patients with a first-time patellofemoral dislocation, and identify risk factors for recurrent instability. This was a single institution, institutional review board-approved, retrospective review of >2,000 patients with a patellar dislocation between 1998 and 2010. Inclusion criteria are as follows: (1) no prior history of patellofemoral subluxation or dislocation of the affected knee; (2) X-rays within 4 weeks of the initial instability episode; and (3) a dislocated patella requiring reduction, or history/findings suggestive of acute patellar dislocation (effusion/hemarthrosis, tenderness along the medial parapatellar structures, and apprehension with lateral patellar translation). Clinical records and radiographs were reviewed. The Caton-Deschamps and Insall-Salvati indices were used to evaluate patella alta. Trochlear dysplasia was assessed using the Dejour classification system. Skeletal maturity was graded based on the distal femoral and proximal tibial physes, using one of the following categories: open, closing, or closed. Three hundred twenty-six knees (312 patients) met the aforementioned criteria. There were 145 females (46.5%) and 167 males (53.5%), with an average age of 19.6 years (range, 9-62 years). Thirty-five patients (10.7%) were treated with surgery after the initial dislocation. All others were initially managed nonoperatively. Of the 291 patients managed nonoperatively, 89 (30.6%) had recurrent instability, 44 (49.4%) of which eventually required surgery. Several risk factors for recurrent instability were identified, including younger age (p < 0.01), immature physes (p < 0.01), sports-related injuries (p < 0.01), patella alta (p = 0.02), and trochlear dysplasia (p < 0.01). Sixty-nine percent of patients with a first-time patellofemoral dislocation will stabilize with conservative treatment. However, patients younger than 25 years with trochlear dysplasia have a 60 to 70% risk of recurrence by 5 years. This information is helpful when counseling patients on their risk for recurrent instability and determining the most appropriate treatment plan. The clinical tool shown in Fig. 4 may be especially useful.

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“…Hence, in individuals who are still growing, the Caton-Deschamps index is preferred (length ratio of A. anterior proximal tibial plateau corner to most inferior point of patellar articular surface to B. length of patellar articular surface). Skeletal immaturity and trochlear dysplasia are the dominating factors for patellar instability, and a CD-index > 1.45 (patella alta) provides an important additional predictive factor 18,19 (Fig. 3).…”

Section: Anatomical Considerations and Predisposing Factorsmentioning

confidence: 99%

Patella instability in children and adolescents

Hasler

Studer

2016

EFORT Open Reviews

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Patellar instabilities are the most common knee pathologies during growth. Congenital dislocations are rare. Extensive, early soft tissue releases relocate the extensor mechanism and may enable normal development of the femoro-patellar anatomy.Conservative management is the preferred strategy after a ‘first-time’ traumatic dislocation. In cases with concomitant anatomical predisposing factors such as trochlear dysplasia, malalignment, malrotation or ligamentous laxity, surgical reconstruction must be considered. The same applies to recurrent dislocations with pain, a sense of instability or re-dislocations which may also lead to functional compensatory mechanisms (quadriceps-avoiding gait in knee extension) or cartilaginous lesions with subsequent patello-femoral osteoarthritis. The decision-making process guiding surgical re-alignment includes analysis with standard radiographs and MRI of the trochlear groove, joint cartilage and medial patello-femoral ligament (MPFL). Careful evaluation of dynamic and static stabilisers is essential: the medial patello-femoral ligament provides stability during the first 20° of flexion, and the trochlear groove thereafter.Excessive femoral anteversion, general ligamentous laxity with increased femoro-tibial rotation, patella alta and increased distance between the tibial tuberosity and the trochlear groove must also be taken into account and surgically corrected.In cases with ongoing dislocations during skeletal immaturity, soft tissue procedures must suffice: reconstruction of the medial patello-femoral ligament as a standalone procedure or in conjuction with more complex distal realignment of the quadriceps mechanism may lead to a permanent stable result, or at least buys time until a definitive bony procedure is performed.Cite this article: Hasler CC, Studer D. Patella instability in children and adolescents. EFORT Open Rev 2016;1:160-166. DOI: 10.1302/2058-5241.1.000018.

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Is the Caton-Deschamps Index a Valuable Ratio to Investigate Patellar Height in Children?

Cited by 123 publications

References 13 publications

Does Medial Patellofemoral Ligament Reconstruction Decrease Patellar Height? A Preliminary Report

Does Medial Patellofemoral Ligament Reconstruction Decrease Patellar Height? A Preliminary Report

First-Time Patellofemoral Dislocation: Risk Factors for Recurrent Instability

Patella instability in children and adolescents

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