Trochlear Dysplasia as Shown by Increased Sulcus Angle Is Associated With Osteochondral Damage in Patients With Patellar Instability

Fones, Lilah; Jimenez, Andrew E.; Cheng, Chris; Chevalier, Nicole; Brimacombe, Michael; Cohen, Andrew D.; Pace, J. Lee

doi:10.1016/j.arthro.2021.04.054

Cited by 18 publications

(36 citation statements)

References 38 publications

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“…None of the previous studies investigating the causes of OCF in APD have evaluated the presence of joint hypermobility. [14][15][16][17] Joint hypermobility is seen in patients with hyperlaxity due to ligament and connective tissue laxity. Therefore, joint subluxations and dislocations may occur even in minor traumas in these patients.…”

Section: Discussionmentioning

confidence: 99%

“…Studies on this subject have started to be conducted in recent years, but the results are contradictory, and no consensus has been reached. [14][15][16][17] When evaluating risk factors for OCF, it is necessary to consider not only intra-articular anatomic risk factors but also patient-related factors such as trauma mechanism and joint hypermobility. Therefore, the aim of this study was to investigate the risk factors for osteochondral fracture by evaluating patients with and without OCF after first-time APD.…”

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confidence: 99%

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Patellar Lateralization, Absence of Joint Hypermobility, and the Mechanism of Injury Are Associated With Osteochondral Fracture After First-time Acute Lateral Patellar Dislocation in Adolescents: An MRI-based Evaluation

İğrek,

Şahbat,

Koç

et al. 2024

Journal of Pediatric Orthopaedics

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Background: Although the risk factors for patellofemoral dislocation are clearly defined, risk factors for osteochondral fracture (OCF) after patellar dislocation are not as well defined. The aim of this study was to investigate the risk factors for OCF by evaluating patients with and without OCF after first-time acute patellar dislocation. Methods: This multicenter study was conducted as a retrospective examination of the radiologic measurements on the magnetic resonance imaging of 306 patients. The patients were divided into the OCF group and non-OCF group, and OCFs were grouped according to whether the fracture was in the patella or femur. Patellar height, patellar lateralization, trochlear morphology, patellofemoral matching, and patella types were evaluated on patient magnetic resonance imaging. The presence of joint hypermobility in the patients was determined according to the Beighton scale score. The injury mechanisms of the patients were grouped as sports-related injuries, injuries resulting from simple falls, and injuries during daily activities. Results: A total of 120 OCFs were detected in 108 (35.2%) patients, of which 96 (80%) were in the patella and 24 (20%) in the femur. The rate of OCF after sports-related injuries was found to be significantly higher than in other injury mechanisms (P=0.001). More joint hypermobility was detected in patients without OCF (P=0.041). The measurements of tibial tubercle–trochlear groove, tibial tubercle–posterior cruciate ligament distance and lateral patellar displacement were statistically higher in cases with OCF (P=0.001). In patients with normal joint mobility, the rate of OCF localization in the patella was significantly higher (P=0.035). No correlation was found between any other parameters and OCF (P>0.05). The absence of joint hypermobility and the measurements of tibial tubercle–trochlear groove distance, tibial tubercle–posterior cruciate ligament distance, and lateral patellar displacement were independent risk factors for the incidence of OCF according to the logistic regression analysis. Conclusions: The absence of joint hypermobility and patellar lateralization are independent risk factors for the occurrence of OCF after first-time patellar dislocation. Sports-related injury is a nonindependent risk factor for the presence of OCF. In patients with normal joint mobility, the incidence of OCF in the patella is higher than in the femur. These important factors should be considered when evaluating patients and starting their treatment. Level of Evidence: Level III—retrospective cohort study.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Patellar Lateralization, Absence of Joint Hypermobility, and the Mechanism of Injury Are Associated With Osteochondral Fracture After First-time Acute Lateral Patellar Dislocation in Adolescents: An MRI-based Evaluation

İğrek,

Şahbat,

Koç

et al. 2024

Journal of Pediatric Orthopaedics

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“…This study showed that 74% of the knees had an abnormal sulcus angle, and these patients have an increased risk of recurrent dislocation in the future. Furthermore, Fones et al found a statistically significant correlation between an abnormal sulcus angle and the incidence of associated osteochondral pathology [ 25 ]. This is similar to the findings in our study, where 14 (82%) knees with associated osteochondral pathology had an increased sulcus angle > 145 degrees.…”

Section: Discussionmentioning

confidence: 99%

Patterns of Associated Knee Ligament and Chondral Injuries in First-Time Traumatic Patellar Dislocation: A Retrospective Magnetic Resonance Imaging (MRI) -Based Study

Anazor¹,

Evangelou²

2022

Cureus

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First-time acute traumatic patellar dislocation, when managed without a knee magnetic resonance imaging (MRI) scan, may lead to missed diagnoses of important associated knee injuries. The aim of this study was to ascertain the incidence of associated ligamentous and cartilaginous injuries in first-time traumatic patella dislocation. MethodsThis was a five-year retrospective study on patients aged 16-45 who had knee MRI scans showing the characteristic bone bruise patterns seen in traumatic lateral patellar dislocation. Anonymized data from the hospital picture archiving and communication system (PACS) was obtained with each scan reviewed by a consultant radiologist, a fellowship-trained orthopaedic knee specialist, and an orthopaedic registrar or resident. ResultsA total of 200 knee MRI scans were screened. 61 eligible knee MRI scans were included in the study. The patients' ages ranged from 16 to 42 years old, with a mean of 25 years. 73.8% were male. A medial patellofemoral ligament (MPFL) tear or rupture occurred in 58 of 61 knees (95%) with MPFL attenuation in three (5%) injured knees. Meniscal injuries were identified in 5 of 61 knees (8.2%), medial collateral ligament (MCL) injuries in 11 of 61 knees (18%), osteochondral injuries and loose bodies in 17 of 61 knees (27.9%), and anterior cruciate ligament (ACL) injury in one knee (1.6%). ConclusionsThis single-centre MRI-based study has provided information on the incidence of associated chondral and ligamentous injuries in patients with first-time acute traumatic patellar dislocation. This information will be useful for clinicians when counselling patients and will add to the available literature on this injury. An MRI scan should be obtained in cases of suspected first-time traumatic patellar dislocations, especially in active young patients, due to the incidence of other associated traumatic knee lesions that might need surgical treatment and lead to persisting knee symptoms if neglected.

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“…3) and trochlear depth may also be evaluated on Merchant and lateral radiographs, respectively, with sulcus angles >145° and trochlear depths ≤4 mm indicating trochlear dysplasia 5 . Higher sulcus angles have a risk of osteochondral pathologies, including acute fracture 27 . The congruence angle can also be demonstrated on the Merchant view by measuring the angle between a line bisecting the sulcus angle and a line from the deepest point of the sulcus to the median ridge of the patella.…”

Section: Imagingmentioning

confidence: 99%

Patellar Instability

et al. 2022

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Certain anatomic factors, such as patella alta, increased tibial tubercle-trochlear groove distance, rotational deformity, and trochlear dysplasia, are associated with an increased risk of recurrent patellar instability.The presence of a preoperative J-sign is predictive of recurrent instability after operative management.Isolated medial patellofemoral ligament reconstruction may be considered on an individualized basis, considering whether the patient has anatomic abnormalities such as valgus malalignment, trochlear dysplasia, or patella alta in addition to the patient activity level.More complex operative management (bony or cartilaginous procedures) should be considered in patients with recurrent instability, malalignment, and certain anatomic factors.

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Trochlear Dysplasia as Shown by Increased Sulcus Angle Is Associated With Osteochondral Damage in Patients With Patellar Instability

Cited by 18 publications

References 38 publications

Patellar Lateralization, Absence of Joint Hypermobility, and the Mechanism of Injury Are Associated With Osteochondral Fracture After First-time Acute Lateral Patellar Dislocation in Adolescents: An MRI-based Evaluation

Patellar Lateralization, Absence of Joint Hypermobility, and the Mechanism of Injury Are Associated With Osteochondral Fracture After First-time Acute Lateral Patellar Dislocation in Adolescents: An MRI-based Evaluation

Patterns of Associated Knee Ligament and Chondral Injuries in First-Time Traumatic Patellar Dislocation: A Retrospective Magnetic Resonance Imaging (MRI) -Based Study

Patellar Instability

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