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Knee Surgery, Sports Traumatology, Arthroscopy

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Open Access 01-09-2013 | Knee

Influence of tibial slope asymmetry on femoral rotation in patients with lateral patellar instability

Authors: Peter Balcarek, Annika Terwey, Klaus Jung, Tim Alexander Walde, Stephan Frosch, Jan Philipp Schüttrumpf, Martin Michael Wachowski, Henning Dathe, Klaus Michael Stürmer

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 9/2013

Abstract

Purpose

The geometry of the tibial plateau and its influence on the biomechanics of the tibiofemoral joint has gained increased significance. However, no quantitative data are available regarding the inclination of the medial and lateral tibial slope in patients with patellar instability. It was therefore the purpose of this study to evaluate tibial slope characteristics in patients with patellar dislocations and to assess the biomechanical effect of medial-to-lateral tibial slope asymmetry on lateral patellar instability.

Methods

Medial and lateral tibial slope was measured on knee magnetic resonance images in 107 patients and in 83 controls. The medial-to-lateral tibial slope asymmetry was assessed as the intra-individual difference between the medial and lateral tibial plateau inclination considering severity of trochlear dysplasia. The effect of tibial slope asymmetry on femoral rotation was calculated by means of radian measure.

Results

Severity of trochlear dysplasia was significantly associated with an asymmetric inclination of the tibial plateau. Whereas the medial tibial slope showed identical values between controls and study patients (n.s.), lateral tibial plateau inclination becomes flatter with increasing severity of trochlear dysplasia (p < 0.01). Consequently, the intra-individual tibial slope asymmetry increased steadily (p < 0.01) and increased internal femoral rotation in 20° and 90° of knee flexion angles in patients with severe trochlear dysplasia (p < 0.01). In addition, the extreme values of internal femoral rotation were more pronounced in patients with patellar instability, whereas the extreme values of external femoral rotation were more pronounced in control subjects (p = 0.024).

Conclusion

Data of this study indicate an association between tibial plateau configuration and internal femoral rotation in patients with lateral patellar instability and underlying trochlear dysplasia. Thereby, medial-to-lateral tibial slope asymmetry increased internal femoral rotation during knee flexion and therefore might aggravate the effect of femoral antetorsion in patients with patellar instability.

Level of evidence

III.

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Title: Influence of tibial slope asymmetry on femoral rotation in patients with lateral patellar instability
Authors: Peter Balcarek
Annika Terwey
Klaus Jung
Tim Alexander Walde
Stephan Frosch
Jan Philipp Schüttrumpf
Martin Michael Wachowski
Henning Dathe
Klaus Michael Stürmer
Publication date: 01-09-2013
Publisher: Springer Berlin Heidelberg
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 9/2013
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-012-2247-4

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Springer Medicine

Influence of tibial slope asymmetry on femoral rotation in patients with lateral patellar instability

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

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