Top

Knee Surgery, Sports Traumatology, Arthroscopy

Published in:

01-02-2021 | KNEE

Osteoarthritic knees have a highly variable patellofemoral alignment: a systematic review

Authors: Bettina Hochreiter, Lukas B. Moser, Silvan Hess, Michael T. Hirschmann, Felix Amsler, Henrik Behrend

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 2/2021

Abstract

Purpose

This systematic review aimed to evaluate the variability of patellofemoral (PF) alignment and trochlear morphology in osteoarthritic knees.

Methods

PF alignment of the knee was defined by the following parameters: the sulcus angle (SA), femoral trochlear depth (FTD), patellar tilt angle (PTA), lateral patellofemoral angle (LPFA), lateral femoral trochlear inclination (LFTI) and tibial tubercle–trochlear groove distance (TT–TG). The electronic databases MEDLINE and EMBASE were searched from database inception to the search date (February 19, 2019) and were screened for relevant studies. The PRISMA guidelines were followed. Articles reporting PF alignment measurements of osteoarthritic knees in patients over 40 years old were included. Data were extracted and methodological quality was assessed using a 14-item checklist.

Results

A total of 8 studies met the inclusion criteria. The studies reported mean values ± SD between 120° and 141.1° ± 7.7 for the SA; 5.8 mm ± 1.4 for the FTD; between − 0.1° ± 3.3 and 10.3° ± 5.7 for the PTA; between 5.8° ± 5.4 and 17° for the LPFA; between 23.2° ± 5.0 and 27.1° ± 4.4 for the LFTI; and 5.8 mm ± 5.4 for the TT-TG.

Conclusion

PF alignment in the osteoarthritic knee is more variable than expected. This finding should encourage surgeons to consider the individual preoperative PF alignment more precisely with the aim of reducing anterior knee pain (AKP) after TKA. 3D-CT imaging might be of great value to analyse the PF alignment in an appropriate way.

Level of evidence

Level III.

Available only for authorised users

Du Z, Chen S, Yan M, Yue B, Wang Y (2017) Differences between native and prosthetic knees in terms of cross-sectional morphology of the femoral trochlea: a study based on three-dimensional models and virtual total knee arthroplasty. BMC Musculoskelet Disord 18:1–8CrossRef

Hochreiter B, Hirschmann MT, Amsler F, Behrend H (2018) Highly variable tibial tubercle-trochlear groove distance (TT-TG) in osteoarthritic knees should be considered when performing TKA. Knee Surg Sports Traumatol Arthrosc 27(5):1403–1409CrossRef

Slevin O, Schmid FA, Schiapparelli FF, Rasch H, Amsler F, Hirschmann MT (2017) Coronal femoral TKA position significantly influences in vivo patellar loading in unresurfaced patellae after primary total knee arthroplasty. Knee Surg Sport Traumatol Arthrosc 25(11):3605–3610CrossRef

Stephen JM, Lumpaopong P, Dodds AL, Williams A, Amis AA (2015) The effect of tibial tuberosity medialization and lateralization on patellofemoral joint kinematics, contact mechanics, and stability. Am J Sport Med 43(1):186–194CrossRef

Drew BT, Redmond AC, Smith TO, Penny F, Conaghan PG (2016) Which patellofemoral joint imaging features are associated withpatellofemoral pain? Systematic review and meta-analysis. Osteoarthritis Cartil 24(2):224–236CrossRef

Davies-Tuck M, Teichtahl AJ, Wluka AE, Wang Y, Urquhart DM, Cui J, Cicuttini FM (2008) Femoral sulcus angle and increased patella facet cartilage volume in an osteoarthritic population. Osteoarthritis Cartil 16(1):131–135CrossRef

Drew BT, Bowes MA, Redmond AC, Dube B, Kingsbury SR, Conaghan PG (2017) Patellofemoral morphology is not related to pain using three-dimensional quantitative analysis in an older population: data from the osteoarthritis initiative. Rheumatology 56:2135–2144CrossRef

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

Macri EM, Felson DT, Zhang Y, Guermazi A, Roemer FW et al (2017) Patellofemoral morphology and alignment: reference values and dose–response patterns for the relation to MRI features of patellofemoral osteoarthritis. Osteoarthritis Cartil 25:1690–1697CrossRef

10.

Stefanik JJ, Roemer FW, Zumwalt AC, Zhu Y, Gross KD et al (2012) Association between measures of trochlear morphology and structural features of patellofemoral joint osteoarthritis on MRI: the MOST study. J Orthop Res 30(1):1–8CrossRef

11.

Stefanik JJ, Zumwalt AC, Segal NA, Lynch JA, Powers CM (2013) Association between measures of patella height, morphologic features of the trochlea, and patellofemoral joint alignment: the MOST study knee. Clin Orthop Relat Res 471(8):2641–2648CrossRef

12.

Tsavalas N, Katonis P, Karantanas AH (2012) Knee joint anterior malalignment and patellofemoral osteoarthritis: an MRI study. Eur Radiol 22(2):418–428CrossRef

13.

Widjajahakim R, Roux M, Jarraya M, Roemer FW, Neogi T et al (2017) Relationship of trochlear morphology and patellofemoral joint alignment to superolateral hoffa fat pad edema on MR images in individuals with or at risk for osteoarthritis of the knee: the MOST study. Radiology 284(3):806–814CrossRef

14.

Downs SH, Black N (1998) The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health 52:377–384CrossRef

15.

Langham S, Langham J, Goertz HP, Ratcliffe M (2011) Large-scale, prospective, observational studies in patients with psoriasis and psoriatic arthritis: a systematic and critical review. BMC Med Res Methodol 11:32CrossRef

16.

Mills K, Hunt MA, Ferber R (2013) Biomechanical deviations during level walking associated with knee osteoarthritis: a systematic review and meta-analysis. Arthritis Care Res 65:1643–1665CrossRef

17.

Deeks JJ, Dinnes J, D’Amico R, Sowden AJ, Sakarovitch C, Song F, Petticrew M, Altman DG (2003) Evaluating non-randomised intervention studies. Health Technol Assess 7:1–173CrossRef

18.

Sanderson S, Tatt ID, Higgins JPT (2007) Tools for assessing quality and susceptibility to bias in observational studies in epidemiology: a systematic review and annotated bibliography. Int J Epidemiol 36:666–676CrossRef

19.

von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP et al (2007) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 370:1453–1457CrossRef

20.

Rathleff MS, Rathleff CR, Crossley KM, Barton CJ (2014) Is hip strength a risk factor for patellofemoral pain? A systematic review and meta-analysis. Br J Sports Med 48(14):1088CrossRef

21.

Hochreiter B, Hess S, Moser L, Hirschmann MT, Amsler F, Behrend H (2019) Healthy knees have a highly variable patellofemoral alignment: a systematic review. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-019-05587-zCrossRefPubMed

22.

Werth L, Saffarini M, Amsler F, Abdelkafy A, Hirschmann MT (2017) The need for secondary resurfacing is affected by trochlear height in total knee arthroplasty. Knee Surg Sport Traumatol Arthrosc 25(12):3818–3823CrossRef

23.

Chen JY, Chin PL, Tay DKJ, Chia S-L, Lo NN, Yeo SJ (2015) Functional outcome and quality of life after patient-specific instrumentation in total knee arthroplasty. J Arthroplasty 30(10):1724–1728CrossRef

24.

Sassoon A, Nam D, Nunley R, Barrack R (2015) Systematic review of patient-specific instrumentation in total knee arthroplasty: new but not improved. Clin Orthop Relat Res 473(1):151–158CrossRef

25.

Hirschmann MT, Behrend H (2018) Functional knee phenotypes: a call for a more personalised and individualised approach to total knee arthroplasty? Knee Surg Sports Traumatol Arthrosc 26(10):2873–2874CrossRef

26.

Hirschmann MT, Konala P, Amsler F, Iranpour F, Friederich NF et al (2011) The position and orientation of total knee replacement components: a comparison of conventional radiographs, transverse 2D-CT slices and 3D-CT reconstrution. Bone Joint J 93(5):629–633

27.

Shibanuma N, Sheehan FT, Stanhope SJ (2005) Limb positioning is critical for defining patellofemoral alignment and femoral shape. Clin Orthop Relat Res 434:198–206CrossRef

Title: Osteoarthritic knees have a highly variable patellofemoral alignment: a systematic review
Authors: Bettina Hochreiter
Lukas B. Moser
Silvan Hess
Michael T. Hirschmann
Felix Amsler
Henrik Behrend
Publication date: 01-02-2021
Publisher: Springer Berlin Heidelberg
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 2/2021
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-020-05928-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Osteoarthritic knees have a highly variable patellofemoral alignment: a systematic review

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Level of evidence

Please log in to get access to this content

Other articles of this Issue 2/2021

Different effects of the lateral meniscus complete radial tear on the load distribution and transmission functions depending on the tear site

The sagittal cutting plane affects evaluation of the femoral bone tunnel position on three-dimensional computed tomography after anterior cruciate ligament reconstruction

Patella alta is reduced following MPFL reconstruction but has no effect on quality-of-life outcomes in patients with patellofemoral instability

Mid-flexion stability in the anteroposterior plane is achieved with a medial congruent insert in cruciate-retaining total knee arthroplasty for varus osteoarthritis

A predictive model with radiographic signs can be a useful supplementary diagnostic tool for complete discoid lateral meniscus in adults

Meniscoplasty leads to good mid-term to long-term outcomes for children and adolescents with discoid lateral meniscus