Top

Knee Surgery, Sports Traumatology, Arthroscopy

Published in:

01-12-2014 | Knee

Assessment of in vivo loading history of the patellofemoral joint: a study combining patellar position, tilt, alignment and bone SPECT/CT

Authors: Stephan N. Schön, Faik K. Afifi, Helmut Rasch, Felix Amsler, Niklaus F. Friederich, Markus P. Arnold, Michael T. Hirschmann

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 12/2014

Abstract

Purpose

The current study investigates whether patella height and tilt or leg alignment influence the intensity values as well as the distribution pattern of single photon emission computerized tomography/computerized tomography (SPECT/CT) tracer uptake in the patellofemoral joint.

Methods

99mTc-HDP-SPECT/CT and radiographs of consecutive 84 knees were prospectively obtained. Lateral radiographs were analyzed in terms of patellar height, Insall-Salvati index and modified Insall-Salvati index. Skyline views were analyzed for Laurin’s lateral patellofemoral angle. On long-leg radiographs, the mechanical leg alignment was classified as varus, valgus or neutral. SPECT/CT was analyzed for each anatomical region using a previously validated SPECT/CT localization and grading algorithm. Mean, standard deviation, minimum and maximum of grading for each area of the localization scheme were recorded. Nonparametric Spearman’s correlations were used to correlate patellar height, lateral patellar angle and leg alignment with the tracer uptake intensity. Chi-square statistics were used for categorical data (p < 0.05).

Results

A patella baja correlated significantly with higher SPECT/CT tracer uptake in all patellar and lateral femoral regions (p < 0.001). A higher lateral patellar tilt correlated significantly with higher tracer uptake in the superior lateral femoral parts and the tibial tubercle. In mechanically varus aligned knees, there was significantly higher SPECT/CT tracer uptake on the medial and in valgus knees on the lateral part of the patellofemoral joint (p < 0.05).

Conclusions

As the intensity and distribution of the SPECT/CT significantly correlated with patella baja and patellar tilt, SPECT/CT might be considered as imaging modality for evaluating patients with patellofemoral disorders and for follow-up of patients after patellofemoral realignment procedures.

Level of evidence

Diagnostic study, Level II.

AL-Sayyad M, Cameron JC (2002) Functional outcome after tibial tubercle transfer for the painful patella alta. Clin Orthop Relat Res 396:152–162PubMedCrossRef

Amis AA, Farahmand F (1996) Biomechanics masterclass: extensor mechanism of the knee. Curr Orthop 10(2):102–109CrossRef

Amis AA, Oguz C, Bull AM, Senavongse W, Dejour D (2008) The effect of trochleoplasty on patellar stability and kinematics: a biomechanical study in vitro. J Bone Joint Surg Br 90(7):864–869PubMedCrossRef

Buck FM, Hoffmann A, Hofer B, Pfirrmann CW, Allgayer B (2009) Chronic medial knee pain without history of prior trauma: correlation of pain at rest and during exercise using bone scintigraphy and MR imaging. Skelet Radiol 38(4):339–347CrossRef

Caton J (1989) Method of measuring the height of the patella. Acta Orthop Belg 55(3):385–386PubMed

Dejour D, Saggin P (2010) The sulcus deepening trochleoplasty-the Lyon’s procedure. Int Orthop 34(2):311–316PubMedCentralPubMedCrossRef

Fulkerson JP, Schutzer SF, Ramsby GR, Bernstein RA (1987) Computerized tomography of the patellofemoral joint before and after lateral release or realignment. Arthroscopy 3(1):19–24PubMedCrossRef

Grelsamer RP, Bazos AN, Proctor CS (1993) Radiographic analysis of patellar tilt. J Bone Joint Surg Br 75(5):822–824PubMed

Grelsamer RP, Meadows S (1992) The modified Insall-Salvati ratio for assessment of patellar height. Clin Orthop Relat Res 282:170–176PubMed

10.

Hirschmann MT, Adler T, Rasch H, Hugli RW, Friederich NF, Arnold MP (2010) Painful knee joint after ACL reconstruction using biodegradable interference screws-SPECT/CT a valuable diagnostic tool? A case report. Sports Med Arthrosc Rehabil Ther Technol 2:24PubMedCentralPubMedCrossRef

11.

Hirschmann MT, Davda K, Iranpour F, Rasch H, Friederich NF (2011) Combined single photon emission computerised tomography and conventional computerised tomography (SPECT/CT) in patellofemoral disorders: a clinical review. Int Orthop 35(5):675–680PubMedCentralPubMedCrossRef

12.

Hirschmann MT, Davda K, Rasch H, Arnold MP, Friederich NF (2011) Clinical value of combined single photon emission computerized tomography and conventional computer tomography (SPECT/CT) in sports medicine. Sports Med Arthrosc 19(2):174–181PubMedCrossRef

13.

Hirschmann MT, Iranpour F, Davda K, Rasch H, Hugli R, Friederich NF (2010) Combined single-photon emission computerized tomography and conventional computerized tomography (SPECT/CT): clinical value for the knee surgeons? Knee Surg Sports Traumatol Arthrosc 18(3):341–345PubMedCrossRef

14.

Hirschmann MT, Iranpour F, Konala P, Kerner A, Rasch H, Cobb JP, Friederich NF (2010) A novel standardized algorithm for evaluating patients with painful total knee arthroplasty using combined single photon emission tomography and conventional computerized tomography. Knee Surg Sports Traumatol Arthrosc 18(7):939–944PubMedCrossRef

15.

Hirschmann MT, Konala P, Iranpour F, Kerner A, Rasch H, Friederich NF (2011) Clinical value of SPECT/CT for evaluation of patients with painful knees after total knee arthroplasty-a new dimension of diagnostics? BMC Musculoskelet Disord 12(1):36PubMedCentralPubMedCrossRef

16.

Hirschmann MT, Mathis D, Afifi FK, Rasch H, Henckel J, Amsler F, Wagner CR, Friederich NF, Arnold MP (2013) Single photon emission computerized tomography and conventional computerized tomography (SPECT/CT) for evaluation of patients after anterior cruciate ligament reconstruction: a novel standardized algorithm combining mechanical and metabolic information. Knee Surg Sports Traumatol Arthrosc 21(4):965–974PubMedCrossRef

17.

Hirschmann MT, Mathis D, Rasch H, Amsler F, Friederich NF, Arnold MP (2013) SPECT/CT tracer uptake is influenced by tunnel orientation and position of the femoral and tibial ACL graft insertion site. Int Orthop 37(2):301–309PubMedCentralPubMedCrossRef

18.

Hirschmann MT, Schon S, Afifi FK, Amsler F, Rasch H, Friederich NF, Arnold MP (2013) Assessment of loading history of compartments in the knee using bone SPECT/CT: a study combining alignment and 99mTc-HDP tracer uptake/distribution patterns. J Orthop Res 31(2):268–274PubMedCrossRef

19.

Hirschmann MT, Wagner CR, Rasch H, Henckel J (2012) Standardized volumetric 3D-analysis of SPECT/CT imaging in orthopaedics: overcoming the limitations of qualitative 2D analysis. BMC Med Imaging 12(1):5PubMedCentralPubMedCrossRef

20.

Insall J, Salvati E (1971) Patella position in the normal knee joint. Radiology 101(1):101–104PubMedCrossRef

21.

Kalichman L, Zhang Y, Niu J, Goggins J, Gale D, Felson DT, Hunter D (2007) The association between patellar alignment and patellofemoral joint osteoarthritis features–an MRI study. Rheumatology (Oxford) 46(8):1303–1308CrossRef

22.

Kalichman L, Zhang Y, Niu J, Goggins J, Gale D, Zhu Y, Felson DT, Hunter DJ (2007) The association between patellar alignment on magnetic resonance imaging and radiographic manifestations of knee osteoarthritis. Arthritis Res Ther 9(2):R26PubMedCentralPubMedCrossRef

23.

Kalichman L, Zhu Y, Zhang Y, Niu J, Gale D, Felson DT, Hunter D (2007) The association between patella alignment and knee pain and function: an MRI study in persons with symptomatic knee osteoarthritis. Osteoarthritis Cartilage 15(11):1235–1240PubMedCrossRef

24.

Karlsson J, Bunketorp O, Lansinger O, Romanus B, Sward L (1986) Lowering of the patella secondary to anterior advancement of the tibial tubercle for the patellofemoral pain syndrome. Arch Orthop Trauma Surg 105(1):40–45PubMedCrossRef

25.

Kraus VB, McDaniel G, Worrell TW, Feng S, Vail TP, Varju G, Coleman RE (2009) Association of bone scintigraphic abnormalities with knee malalignment and pain. Ann Rheum Dis 68(11):1673–1679PubMedCentralPubMedCrossRef

26.

Lancourt JE, Cristini JA (1975) Patella alta and patella infera. Their etiological role in patellar dislocation, chondromalacia, and apophysitis of the tibial tubercle. J Bone Joint Surg Am 57(8):1112–1115PubMed

27.

Laprade J, Culham E (2003) Radiographic measures in subjects who are asymptomatic and subjects with patellofemoral pain syndrome. Clin Orthop Relat Res 414:172–182PubMedCrossRef

28.

Laurin CA, Levesque HP, Dussault R, Labelle H, Peides JP (1978) The abnormal lateral patellofemoral angle: a diagnostic roentgenographic sign of recurrent patellar subluxation. J Bone Joint Surg Am 60(1):55–60PubMed

29.

Lo GH, Hunter DJ, Zhang Y, McLennan CE, Lavalley MP, Kiel DP, McLean RR, Genant HK, Guermazi A, Felson DT (2005) Bone marrow lesions in the knee are associated with increased local bone density. Arthritis Rheum 52(9):2814–2821PubMedCrossRef

30.

Lorberboym M, Ami DB, Zin D, Nikolov G, Adar E (2003) Incremental diagnostic value of 99mTc methylene diphosphonate bone SPECT in patients with patellofemoral pain disorders. Nucl Med Commun 24(4):403–410PubMedCrossRef

31.

Meyer SA, Brown TD, Pedersen DR, Albright JP (1997) Retropatellar contact stress in simulated patella infera. Am J Knee Surg 10(3):129–138PubMed

32.

Rasch H, Falkowski AL, Forrer F, Henckel J, Hirschmann MT (2013) 4D-SPECT/CT in orthopaedics: a new method of combined quantitative volumetric 3D analysis of SPECT/CT tracer uptake and component position measurements in patients after total knee arthroplasty. Skeletal Radiol 42(9):1215–1223PubMedCrossRef

33.

Sasaki T, Yagi T (1986) Subluxation of the patella Investigation by computerized tomography. Int Orthop 10(2):115–120PubMedCrossRef

34.

Singerman R, Davy DT, Goldberg VM (1994) Effects of patella alta and patella infera on patellofemoral contact forces. J Biomech 27(8):1059–1065PubMedCrossRef

35.

Specogna AV, Birmingham TB, Hunt MA, Jones IC, Jenkyn TR, Fowler PJ, Giffin JR (2007) Radiographic measures of knee alignment in patients with varus gonarthrosis: effect of weightbearing status and associations with dynamic joint load. Am J Sports Med 35(1):65–70PubMedCrossRef

36.

Stefanik JJ, Zhu Y, Zumwalt AC, Gross KD, Clancy M, Lynch JA, Frey Law LA, Lewis CE, Roemer FW, Powers CM, Guermazi A, Felson DT (2010) Association between patella alta and the prevalence and worsening of structural features of patellofemoral joint osteoarthritis: the multicenter osteoarthritis study. Arthritis Care Res (Hoboken) 62(9):1258–1265CrossRef

37.

Wirth CJ, Zichner L, Kohn D (2005) Knie. In: Kohn D (ed) Orthopädie und Orthopädische Chirurgie. Thieme, Stuttgart, pp 332–343

Title: Assessment of in vivo loading history of the patellofemoral joint: a study combining patellar position, tilt, alignment and bone SPECT/CT
Authors: Stephan N. Schön
Faik K. Afifi
Helmut Rasch
Felix Amsler
Niklaus F. Friederich
Markus P. Arnold
Michael T. Hirschmann
Publication date: 01-12-2014
Publisher: Springer Berlin Heidelberg
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 12/2014
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-013-2698-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Assessment of in vivo loading history of the patellofemoral joint: a study combining patellar position, tilt, alignment and bone SPECT/CT

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

Please log in to get access to this content

Other articles of this Issue 12/2014

The coronal alignment after medial unicompartmental knee arthroplasty can be predicted: usefulness of full-length valgus stress radiography for evaluating correctability

Lack of evidence to support present medial release methods in total knee arthroplasty

Thank you for 2014

The surgical epicondylar axis is a consistent reference of the distal femur in the coronal and axial planes

Anatomic tibial component design can increase tibial coverage and rotational alignment accuracy: a comparison of six contemporary designs

Computer-assisted surgery improves rotational positioning of the femoral component but not the tibial component in total knee arthroplasty