Published in:
01-04-2013 | Musculoskeletal
Prevalence and patterns of anatomical risk factors in patients after patellar dislocation: a case control study using MRI
Published in: European Radiology | Issue 4/2013
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Objective
To assess anatomical risk factors in patients after lateral patellar dislocation (LPD) and controls using MRI.
Methods
MR images of 186 knees after LPD and of 186 age- and gender-matched controls were analysed. The presence of trochlear dysplasia was assessed by evaluation of trochlear inclination, facet asymmetry, and trochlear depth; patella alta was evaluated by the Insall-Salvati index and Caton-Deschamps index; the lateralised force vector was measured by the tibial tuberosity-trochlear groove (TT-TG) distance.
Results
Compared with controls, dislocators had significantly lower values for all three parameters of trochlear dysplasia (−32 %, −32 %, −44 %) and significantly higher values for patella alta (+14 %,+13 %) and TT-TG (+49 %) (all P < 0.001). Trochlear dysplasia was observed in 112 dislocators (66 %), of whom 61 (36 %) additionally had patella alta and 15 (9 %) an abnormal TT-TG. As isolated risk factors, patella alta (15 %) and abnormal TT-TG (1 %) were rare. Only 25 dislocators (15 %) had no anatomical risk factors. Trochlear dysplasia in conjunction with abnormal TT-TG or patella alta is associated with a 37- and 41-fold higher risk.
Conclusion
Most dislocators have anatomical risk factors, varying in severity and constellation.
Key Points
• Magnetic resonance imaging provides unique information about anatomical variation within the knee.
• Anatomical variants increase the risk for lateral patellar dislocation (LPD)
• Trochlear dysplasia is the main risk factor for LPD.
• Patellar alta and abnormal tibial tuberosity-trochlear groove distance may be additional factors.
• Patient-specific evaluation of risk factors following LPD may help future management.