J Knee Surg 2023; 36(02): 153-158
DOI: 10.1055/s-0041-1731351
Original Article

Association between Patellofemoral Anatomy and Chondral Lesions of the Knee in Patellofemoral Instability

1   Department of Trauma and Orthopaedics, St George's Hospital, St George's University Hospitals National Health Service Foundation Trust, London, United Kingdom
,
Aliya Choudhury
1   Department of Trauma and Orthopaedics, St George's Hospital, St George's University Hospitals National Health Service Foundation Trust, London, United Kingdom
,
Alexandra Biggs
1   Department of Trauma and Orthopaedics, St George's Hospital, St George's University Hospitals National Health Service Foundation Trust, London, United Kingdom
,
Alina J. Humdani
2   St George's Medical School, St George's University London, St George's University Hospitals National Health Service Foundation Trust, London, United Kingdom
,
Oliver Brown
1   Department of Trauma and Orthopaedics, St George's Hospital, St George's University Hospitals National Health Service Foundation Trust, London, United Kingdom
,
Toby O. Smith
3   Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
,
Vivian Ejindu
2   St George's Medical School, St George's University London, St George's University Hospitals National Health Service Foundation Trust, London, United Kingdom
,
Caroline B. Hing
1   Department of Trauma and Orthopaedics, St George's Hospital, St George's University Hospitals National Health Service Foundation Trust, London, United Kingdom
› Author Affiliations
Funding None.

Abstract

Chondral injury is a serious consequence of patellar dislocation and patellofemoral instability (PFI). There is limited data on the relationship between radiological features such as sulcus angle and patellar height to the presence, location, and severity of chondral lesions. The purpose of this study was to determine the association of anatomical variants in patellofemoral instability with injuries sustained due to patellar dislocation. A cohort of 101 patients who had four or more episodes of dislocation or instability undergoing isolated arthroscopy or arthroscopies at the time of corrective realignment surgery were identified. The prevalence of chondral, ligamentous, and meniscal injuries was determined and correlated to the sulcus angle, tibial tubercle trochlear groove distance, and patellar height on magnetic resonance imaging (MRI) scans. A total of 101 patients was identified. At arthroscopy, the patella demonstrated the highest incidence of chondral injury (68%) followed by the trochlear groove (40%). Lateral meniscal injuries were noted in 6% of patients, medial meniscal injuries in 2%, and anterior cruciate ligament (ACL) injury in 3%. Chondral injuries were graded using the Outerbridge criteria and there was a correlation between more severe chondral injuries and a greater tilt angle (p = 0.05). The occurrence of injury to the lateral meniscus was associated with a higher Insall–Salvati ratio (p = 0.05). More severe chondral injuries are seen in patients with a greater tilt angle.



Publication History

Received: 09 September 2020

Accepted: 01 May 2021

Article published online:
29 June 2021

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  • References

  • 1 Fithian DC, Paxton EW, Stone ML. et al. Epidemiology and natural history of acute patellar dislocation. Am J Sports Med 2004; 32 (05) 1114-1121
  • 2 Biant LC, McNicholas MJ, Sprowson AP, Spalding T. The surgical management of symptomatic articular cartilage defects of the knee: consensus statements from United Kingdom knee surgeons. Knee 2015; 22 (05) 446-449
  • 3 Subramanian P, Patel R. Patellofemoral instability: an overview. Orthop Trauma 2019; 33 (02) 119-126
  • 4 Diederichs G, Issever AS, Scheffler S. MR imaging of patellar instability: injury patterns and assessment of risk factors. Radiographics 2010; 30 (04) 961-981
  • 5 Nelitz M, Lippacher S, Reichel H, Dornacher D. Evaluation of trochlear dysplasia using MRI: correlation between the classification system of Dejour and objective parameters of trochlear dysplasia. Knee Surg Sports Traumatol Arthrosc 2014; 22 (01) 120-127
  • 6 Shen J, Qin L, Yao WW, Li M. The significance of magnetic resonance imaging in severe femoral trochlear dysplasia assessment. Exp Ther Med 2017; 14 (06) 5438-5444
  • 7 Gomoll AH, Yoshioka H, Watanabe A, Dunn JC, Minas T. Preoperative measurement of cartilage defects by MRI underestimates lesion size. Cartilage 2011; 2 (04) 389-393
  • 8 Handelberg F, Shahabpour M, Casteleyn PP. Chondral lesions of the patella evaluated with computed tomography, magnetic resonance imaging, and arthroscopy. Arthroscopy 1990; 6 (01) 24-29
  • 9 Harris JD, Brophy RH, Jia G. et al. Sensitivity of magnetic resonance imaging for detection of patellofemoral articular cartilage defects. Arthroscopy 2012; 28 (11) 1728-1737
  • 10 Smith TO, Drew BT, Toms AP, Donell ST, Hing CB. Accuracy of magnetic resonance imaging, magnetic resonance arthrography and computed tomography for the detection of chondral lesions of the knee. Knee Surg Sports Traumatol Arthrosc 2012; 20 (12) 2367-2379
  • 11 Huntington LS, Webster KE, Devitt BM, Scanlon JP, Feller JA. Factors associated with an increased risk of recurrence after a first-time patellar dislocation: a systematic review and meta-analysis. Am J Sports Med 2020; 48 (10) 2552-2562
  • 12 Saggin PR, Saggin JI, Dejour D. Imaging in patellofemoral instability: an abnormality-based approach. Sports Med Arthrosc Rev 2012; 20 (03) 145-151
  • 13 Outerbridge RE. The etiology of chondromalacia patellae. J Bone Joint Surg Br 1961; 43-B: 752-757
  • 14 Escala JS, Mellado JM, Olona M, Giné J, Saurí A, Neyret P. Objective patellar instability: MR-based quantitative assessment of potentially associated anatomical features. Knee Surg Sports Traumatol Arthrosc 2006; 14 (03) 264-272
  • 15 McKinley TO, Borrelli Jr J, D'Lima DD, Furman BD, Giannoudis PV. Basic science of intra-articular fractures and posttraumatic osteoarthritis. J Orthop Trauma 2010; 24 (09) 567-570
  • 16 Hunter DJ, Zhang YQ, Niu JB. et al. Patella malalignment, pain and patellofemoral progression: the Health ABC Study. Osteoarthritis Cartilage 2007; 15 (10) 1120-1127
  • 17 Dejour H, Walch G, Nove-Josserand L, Guier C. Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc 1994; 2 (01) 19-26
  • 18 Sallay PI, Poggi J, Speer KP, Garrett WE. Acute dislocation of the patella. A correlative pathoanatomic study. Am J Sports Med 1996; 24 (01) 52-60 DOI: 10.1177/036354659602400110.
  • 19 Elias DA, White LM, Fithian DC. Acute lateral patellar dislocation at MR imaging: injury patterns of medial patellar soft-tissue restraints and osteochondral injuries of the inferomedial patella. Radiology 2002; 225 (03) 736-743
  • 20 Guerrero P, Li X, Patel K, Brown M, Busconi B. Medial patellofemoral ligament injury patterns and associated pathology in lateral patella dislocation: an MRI study. Sports Med Arthrosc Rehabil Ther Technol 2009; 1 (01) 17
  • 21 Krych AJ, Sousa PL, King AH, Engasser WM, Stuart MJ, Levy BA. Meniscal tears and articular cartilage damage in the dislocated knee. Knee Surg Sports Traumatol Arthrosc 2015; 23 (10) 3019-3025
  • 22 Lancourt JE, Cristini JA. Patella alta and patella infera. Their etiological role in patellar dislocation, chondromalacia, and apophysitis of the tibial tubercle. J Bone Joint Surg Am 1975; 57 (08) 1112-1115
  • 23 Vampertzis T, Barmpagianni C, Nitis G, Papastergiou S. A study of the possible effect of abnormal patella height on meniscal tears. J Orthop 2020; 22: 170-172
  • 24 Lykissas MG, Li T, Eismann EA, Parikh SN. Does medial patellofemoral ligament reconstruction decrease patellar height? A preliminary report. J Pediatr Orthop 2014; 34 (01) 78-85
  • 25 Magnussen RA, De Simone V, Lustig S, Neyret P, Flanigan DC. Treatment of patella alta in patients with episodic patellar dislocation: a systematic review. Knee Surg Sports Traumatol Arthrosc 2014; 22 (10) 2545-2550