Patellar Maltracking: No Longer Just a 2D Problem

Abstract

In order to correctly diagnose and treat pathological knee joint mechanics we must be able to non-invasively quantify the 3D in vivo kinematics of this joint. Unfortunately, the majority of clinical diagnoses, for this joint, are based upon static 2D imaging. This is due to the fact that currently there is a scarcity of noninvasive measurement techniques that acquire 3D in vivo data dynamically. Thus, in vivo patellofemoral (PF) kinematic measurements typically compress a 3D time-dependent joint attitude to a static 2D representation. The purpose of this study was to investigate if patellar maltracking is limited to two dimensions, as assumed clinically, or if it is a complete six-degree of freedom problem. To do this, we quantified the 3D patellofemoral and tibiofemoral (TF) kinematics in both healthy individuals and those with suspected patellofemoral maltracking using fast-phase contrast magnetic resonance imaging, a technique developed in our previous work. Our data suggest that variations in kinematics were not confined to the standard axial plane measures (e.g. patellar tilt, patellar subluxation), but variations are exhibited in all six degrees of freedom. Therefore, future clinical diagnoses and interventions along with future research will be most effective if the measures used are broadened to include all six-degrees of freedom.