Is There an Association between Chronicity of Patellar Instability and Patellofemoral Cartilage Lesions? An Arthroscopic Assessment of Chondral Injury

Abstract

The purpose of this study was to investigate the association between chronicity of patellar instability on the prevalence, grade, and location of chondral lesions in patients with recurrent patellar instability. Patellofemoral chondral status was documented and graded according to the Outerbridge classification in 38 patients who underwent arthroscopic examination at the time of a medial patellofemoral ligament reconstruction procedure. Chondral lesions of any location were observed in 63.2% of patients. Patellar and trochlear lesions were observed in 57.9 and 13.2% of patients, respectively. There was a significantly higher duration of patellar instability in patients with a trochlear lesion versus those without a trochlear lesion (p < 0.01), and in patients with combined patellar and trochlear lesions versus those without both patellar and trochlear lesions (p < 0.01). There was a significant correlation between chronicity of patellar instability and Outerbridge grade of trochlear chondral injury (p = 0.01). Chi-squared analysis revealed that chronicity of patellar instability greater than 5 years was significantly associated with the likelihood of trochlear lesions (p < 0.05). We conclude that patients with increasing chronicity of patellar instability may have a higher likelihood of and higher grade of patellofemoral chondral injuries, specifically for trochlear lesions.

Keywords

chronic patellofemoral instability - chondral injury - articular cartilage

• References

• 1 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 (3) 736-743
• 2 Freiberger RH, Kotzen LM. Fracture of the medial margin of the patella, a finding diagnostic of lateral dislocation. Radiology 1967; 88 (5) 902-904
• 3 Jerabek SA, Asnis PD, Bredella MA, Ouellette HA, Poon SK, Gill IV TJ. Medial patellar ossification after patellar instability: a radiographic finding indicative of prior patella subluxation/dislocation. Skeletal Radiol 2009; 38 (8) 785-790
• 4 Luhmann SJ, Schoenecker PL, Dobbs MB, Gordon JE. Arthroscopic findings at the time of patellar realignment surgery in adolescents. J Pediatr Orthop 2007; 27 (5) 493-498
• 5 Nomura E, Inoue M. Cartilage lesions of the patella in recurrent patellar dislocation. Am J Sports Med 2004; 32 (2) 498-502
• 6 Sillanpää PJ, Mattila VM, Mäenpää H, Kiuru M, Visuri T, Pihlajamäki H. Treatment with and without initial stabilizing surgery for primary traumatic patellar dislocation. A prospective randomized study. J Bone Joint Surg Am 2009; 91 (2) 263-273
• 7 Murrell GA, Maddali S, Horovitz L, Oakley SP, Warren RF. The effects of time course after anterior cruciate ligament injury in correlation with meniscal and cartilage loss. Am J Sports Med 2001; 29 (1) 9-14
• 8 Oksman A, Dmytruk V, Proust J, Mabit C, Charissoux JL, Arnaud JP. Patellar chondropathy prevalence at anterior cruciate ligament reconstruction: analysis of 250 cases. Orthop Traumatol Surg Res 2009; 95 (1) 36-39
• 9 Fithian DC, Paxton EW, Stone ML , et al. Epidemiology and natural history of acute patellar dislocation. Am J Sports Med 2004; 32 (5) 1114-1121
• 10 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 (8) 1112-1115
• 11 Letts RM, Davidson D, Beaule P. Semitendinosus tenodesis for repair of recurrent dislocation of the patella in children. J Pediatr Orthop 1999; 19 (6) 742-747
• 12 Nomura E, Inoue M, Kobayashi S. Generalized joint laxity and contralateral patellar hypermobility in unilateral recurrent patellar dislocators. Arthroscopy 2006; 22 (8) 861-865
• 13 Rünow A. The dislocating patella. Etiology and prognosis in relation to generalized joint laxity and anatomy of the patellar articulation. Acta Orthop Scand Suppl 1983; 201: 1-53
• 14 Dejour H, Walch G, Nove-Josserand L, Guier C. Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc 1994; 2 (1) 19-26
• 15 Brown GD, Ahmad CS. Combined medial patellofemoral ligament and medial patellotibial ligament reconstruction in skeletally immature patients. J Knee Surg 2008; 21 (4) 328-332
• 16 Ahmad CS, McCarthy M, Gomez JA, Shubin Stein BE. The moving patellar apprehension test for lateral patellar instability. Am J Sports Med 2009; 37 (4) 791-796
• 17 Outerbridge RE. The etiology of chondromalacia patellae. J Bone Joint Surg Br 1961; 43–B: 752-757
• 18 Beighton P, Horan F. Orthopaedic aspects of the Ehlers-Danlos syndrome. J Bone Joint Surg Br 1969; 51 (3) 444-453
• 19 Carter C, Wilkinson J. Persistent joint laxity and congenital dislocation of the hip. J Bone Joint Surg Br 1964; 46: 40-45
• 20 Blackburne JS, Peel TE. A new method of measuring patellar height. J Bone Joint Surg Br 1977; 59 (2) 241-242
• 21 Skaggs DL. Extra-articular injuries of the knee. In: Beaty JH, Kasser JR, , eds. Rockwood and Wilkens' Fractures in Children. 6th ed. Philadelphia: Lippincott Williams & Wilkins; 2006: 975-982
• 22 Chen SC, Ramanathan EB. The treatment of patellar instability by lateral release. J Bone Joint Surg Br 1984; 66 (3) 344-348
• 23 Dandy DJ, Griffiths D. Lateral release for recurrent dislocation of the patella. J Bone Joint Surg Br 1989; 71 (1) 121-125
• 24 Utting MR, Mulford JS, Eldridge JD. A prospective evaluation of trochleoplasty for the treatment of patellofemoral dislocation and instability. J Bone Joint Surg Br 2008; 90 (2) 180-185
• 25 Nomura E, Inoue M. Second-look arthroscopy of cartilage changes of the patellofemoral joint, especially the patella, following acute and recurrent patellar dislocation. Osteoarthritis Cartilage 2005; 13 (11) 1029-1036
• 26 Karadimas JE, Piscopakis N, Syrmalis L. Patella alta and chondromalacia. Int Orthop 1981; 5 (4) 247-249
• 27 Milgram JW, Rogers LF, Miller JW. Osteochondral fractures: mechanisms of injury and fate of fragments. AJR Am J Roentgenol 1978; 130 (4) 651-658
• 28 Møller BN, Møller-Larsen F, Frich LH. Chondromalacia induced by patellar subluxation in the rabbit. Acta Orthop Scand 1989; 60 (2) 188-191
• 29 Larsen E, Lauridsen F. Conservative treatment of patellar dislocations. Influence of evident factors on the tendency to redislocation and the therapeutic result. Clin Orthop Relat Res 1982; (171) 131-136
• 30 Pidoriano AJ, Weinstein RN, Buuck DA, Fulkerson JP. Correlation of patellar articular lesions with results from anteromedial tibial tubercle transfer. Am J Sports Med 1997; 25 (4) 533-537
• 31 Noyes FR, Stabler CL. A system for grading articular cartilage lesions at arthroscopy. Am J Sports Med 1989; 17 (4) 505-513