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Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 10/2018

01-10-2018 | Knee

Alignment in the transverse plane, but not sagittal or coronal plane, affects the risk of recurrent patella dislocation

Authors: Shigeru Takagi, Takashi Sato, Satoshi Watanabe, Osamu Tanifuji, Tomoharu Mochizuki, Go Omori, Naoto Endo

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 10/2018

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Abstract

Purpose

Abnormalities of lower extremity alignment (LEA) in recurrent patella dislocation (RPD) have been studied mostly by two-dimensional (2D) procedures leaving three-dimensional (3D) factors unknown. This study aimed to three-dimensionally examine risk factors for RPD in lower extremity alignment under the weight-bearing conditions.

Methods

The alignment of 21 limbs in 15 RPD subjects was compared to the alignment of 24 limbs of 12 healthy young control subjects by an our previously reported 2D–3D image-matching technique. The sagittal, coronal, and transverse alignment in full extension as well as the torsional position of the femur (anteversion) and tibia (tibial torsion) under weight-bearing standing conditions were assessed by our previously reported 3D technique. The correlations between lower extremity alignment and RPD were assessed using multiple logistic regression analysis. The difference of lower extremity alignment in RPD between under the weight-bearing conditions and under the non-weight-bearing conditions was assessed.

Results

In the sagittal and coronal planes, there was no relationship (statistically or by clinically important difference) between lower extremity alignment angle and RPD. However, in the transverse plane, increased external tibial rotation [odds ratio (OR) 1.819; 95% confidence interval (CI) 1.282–2.581], increased femoral anteversion (OR 1.183; 95% CI 1.029–1.360), and increased external tibial torsion (OR 0.880; 95% CI 0.782–0.991) were all correlated with RPD. The tibia was more rotated relative to femur at the knee joint in the RPD group under the weight-bearing conditions compared to under the non-weight-bearing conditions (p < 0.05).

Conclusions

This study showed that during weight-bearing, alignment parameters in the transverse plane related to the risk of RPD, while in the sagittal and coronal plane alignment parameters did not correlate with RPD. The clinical importance of this study is that the 3D measurements more directly, precisely, and sensitively detect rotational parameters associated with RPD and hence predict risk of RPD.

Level of evidence

III.
Literature
1.
Ariumi A, Sato T, Kobayashi K, Koga Y, Omori G, Minato I, Endo N (2010) Three-dimensional lower extremity alignment in the weight bearing standing position in healthy elderly subjects. J Orthop Sci 15:64–70CrossRef
2.
3.
Beaconsfield T, Pintore E, Maffulli N, Petri GJ (1994) Radiological measurements in patellofemoral disorders. A review. Clin Orthop Relat Res 308:18–28
4.
Boden BP, Pearsall AW, Garrett WE, Feagin JA Jr (1997) Patellofemoral instability: evaluation and management. J Am Acad Orthop Surg 5:47–57CrossRef
5.
Colvin AC, West RV (2008) Patellar instability. J Bone Joint Surg Am 90:2751–2762CrossRef
6.
Dejour H, Walch G, Nove-Josserand L, Guier C (1994) Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc 2:19–26CrossRef
7.
Diederichs G, Issever AS, Scheffler S (2010) MR imaging of patellar instability: injury patterns and assessment of risk factors. Radiographics 30:961–981CrossRef
8.
Diederichs G, Kohliz T, Kornaropoulos E, Heller MO, Vollnberg B, Scheffler S (2013) Magnetic resonance imaging analysis of rotational alignment in patients with patellar dislocations. Am J Sports Med 41:51–57CrossRef
9.
Eckhoff DG, Jacofsky DJ, Springer BD, Dunbar M, Cherian JJ, Elmallah RK, Mont MA, Greene KA (2016) Bilateral symmetrical comparison of femoral and tibial anatomic features. J Arthroplast 31:1083–1090CrossRef
10.
Eckhoff DG, Johnson KK (1994) Three-dimensional computed tomography reconstruction of tibial torsion. Clin Orthop Relat Res 302:42–46
11.
Elias DA, White LM (2004) Imaging of patellofemoral disorders. Clin Radiol 59:543–557CrossRef
12.
Erkocak OF, Altan E, Altintas M, Turkmen F, Aydin BK, Bayar A (2016) Lower extremity rotational deformities and patellofemoral alignment parameters in patients with anterior knee pain. Knee Surg Sports Traumatol Arthrosc 24:3011–3020CrossRef
13.
Fabry G, Cheng LX, Molenaers G (1994) Normal and abnormal torsional development in children. Clin Orthop Relat Res 302:22–26
14.
Gillespie D, Mandziak D, Howie C (2015) Influence of posterior lateral femoral condyle geometry on patellar dislocation. Arch Orthop Trauma Surg 135:1503–1509CrossRef
15.
Hermans K, Claes S, Bellemans J (2013) Valgus instability as a cause for recurrent lateral patellar dislocation: a new mechanism for patellofemoral instability? Acta Orthop Belg 79:495–501PubMed
16.
Jakob RP, Haertel M, Stüssi E (1980) Tibial torsion calculated by computerised tomography and compared to other methods of measurement. J Bone Joint Surg Br 62-B:238–242CrossRef
17.
Kearney SP, Mosca VS (2015) Selective hemiepiphyseodesis for patellar instability with associated genu valgum. J Orthop 27:17–22CrossRef
18.
Kobayashi K, Sakamoto M, Tanabe Y, Ariumi A, Sato T, Omori G, Koga Y (2009) Automated image registration for assessing three-dimensional alignment of entire lower extremity and implant position using bi-plane radiography. J Biomech 42:2818–2822CrossRef
19.
Nomura E, Inoue M, Kobayashi S (2006) Generalized joint laxity and contralateral patellar hypermobility in unilateral recurrent patellar dislocators. Arthroscopy 22:861–865CrossRef
20.
Parikh S, Frank R. Noyes FR (2011) Patellofemoral disorders: role of computed tomography and magnetic resonance imaging in defining abnormal rotational lower limb alignment. Sports Health 3:158–169CrossRef
21.
Peduzzi P, Concato J, Kemper E, Holford TR, Feinstein AR (1996) A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol 49:1373–1379CrossRef
22.
Prakash J, Seon JK, Woo SH, Jin C, Song EK (2016) Comparison of radiological parameters between normal and patellar dislocation groups in korean population: a rotational profile ct-based study. Knee Surg Relat Res 28:302–311CrossRef
23.
Redziniak DE, Diduch DR, Mihalko WM, Fulkerson JP, Novicoff WM, Sheibani-Rad S, Saleh KJ (2009) Patellar instability. J Bone Joint Surg Am 91-A:2264–2275
24.
Runow A (1983) The dislocating patella. Etiology and prognosis in relation to generalized joint laxity and anatomy of the patellar articulation. Acta Orthop Scand 201:1–53CrossRef
25.
Sato T, Koga Y, Omori G (2004) Three-dimensional lower extremity alignment assessment system: application to evaluation of component position after total knee arthroplasty. J Arthroplast 19:620–628CrossRef
26.
Schiphouwer L, Rood A, Tigchelaar S, Koëter S (2017) Complications of medial patellofemoral ligament reconstruction using two transverse patellar tunnels. Knee Surg Sports Traumatol Arthrosc 25:245–250CrossRef
27.
Staheli LT, Corbett M, Wyss C (1985) Lower-extremity rotational problems in children. Normal values to guide management. J Bone Joint Surg Am 67-B:39–47CrossRef
28.
Staheli LT (1989) Torsion: treatment indications. Clin Orthop 247:61–66
29.
Takai S, Sakakida K, Yamashita F, Suzu F, Izuta F (1985) Rotational alignment of the lower limb in osteoarthritis of the knee. Int Orthop 9:209–215CrossRef
30.
Takai S (1996) Biomechanics of the patellofemoral joint. J Joint Surg 15:16–25 (in Japanese)
31.
Tamari K, Tinley P, Briffa K, Breidahl W (2005) Validity and reliability of existing and modified clinical methods of measuring femoral and tibiofibular torsion in healthy subjects: use of different reference axes may improve reliability. Clin Anat 18:46–55CrossRef
32.
Thienpont E, Parvizi J (2016) A new classification for the varus knee. J Arthroplast 31:2156–2160CrossRef
33.
Turner MS (1994) The association between tibial torsion and knee joint pathology. Clin Orthop Relat Res 302:47–51
34.
Weiner DS, Cook AJ, Hoyt WA Jr, Oravec CE (1978) Computed tomography in the measurement of femoral anteversion. Orthopedics 1:299–306CrossRef
35.
Yamada Y, Toritsuka Y, Nakamura N, Horibe S, Sugamoto K, Yoshikawa H, Shino K (2017) Correlation of 3D shift and 3D tilt of the patella in patients with recurrent dislocation of the patella and healthy volunteers: an in vivo analysis based on 3-dimensional computer models. Am J Sports Med 45:3111–3118CrossRef
Metadata
Title
Alignment in the transverse plane, but not sagittal or coronal plane, affects the risk of recurrent patella dislocation
Authors
Shigeru Takagi
Takashi Sato
Satoshi Watanabe
Osamu Tanifuji
Tomoharu Mochizuki
Go Omori
Naoto Endo
Publication date
01-10-2018
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 10/2018
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-017-4806-1

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