The Role of Imaging in the Evaluation of Patellar Instability

Benjamin F Sandberg, Marc A Tompkins

Volume 3 | Issue 1 | Jan – Apr 2018 | Page 10-16


Author: Benjamin F Sandberg [1], Marc A Tompkins [1,2]

[1] Department of, TRIAOrthopaedic Center, 8100 Northland Drive, Bloomington, MN 55431,
[2] Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Suite R200, Minneapolis, MN 55454

Address of Correspondence
Dr. Bradley J Nelson,
Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Suite R200,Minneapolis, MN 55454.
E-mail: ???


Abstract

Patellar instability is a complex problem that requires a thorough evaluation and work up. A critical part of this work up is appropriate imaging. This article reviews key imaging techniques and important imaging findings in patellar instability patients. This includes the evaluation of patella alta, trochlear dysplasia, lateral patellar tilt, extensor mechanism alignment, valgus alignment, rotational alignment, and soft tissue injury. Effective management for patellar instability relies on a comprehensive approach where any of these elements are evaluated when necessary.
Keywords: Patellofemoral Instability, Patellar Instability, Patellar Dislocation, Imaging.


References

1. Dejour D, Saggin PR, Meyer X, Tavernier T. Standard X-ray Examination: Patellofemoral Disorders. In: Zaffagnini S, Dejour D, Arendt EA, editors. Patellofemoral Pain, Instability, and Arthritis: Clinical Presentation, Imaging, and Treatment. New York: Springer; 2010. p. 51-60.
2. Dejour H, Walch G, Nove-Josserand L, Guier C. Factors of patellar instability: An anatomic radiographic study. Knee Surg Sports TraumatolArthrosc 1994;2:19-26.
3. Arendt EA, England K, Agel J, Tompkins MA. An analysis of knee anatomic imaging factors associated with primary lateral patellar dislocations. Knee Surg Sports TraumatolArthrosc 2017;25:3099-107.
4. Charles MD, Haloman S, Chen L, Ward SR, Fithian D, Afra R, et al. Magnetic resonance imaging-based topographical differences between control and recurrent patellofemoral instability patients. Am J Sports Med 2013;41:374-84.
5. Phillips CL, Silver DA, Schranz PJ, Mandalia V. The measurement of patellar height: A review of the methods of imaging. J Bone Joint Surg Br 2010;92:1045-53.
6. Bruderer J, Servien E, Neyret P. Patellar Height: Which Index? In: Zaffagnini S, Dejour D, Arendt EA, editors. Patellofemoral Pain, Instability, and Arthritis: Clinical Presentation, Imaging, and Treatment. Berlin, Heidelberg: Springer Berlin Heidelberg; 2010. p. 61-7.
7. Biedert RM, Albrecht S. The patellotrochlear index: A new index for assessing patellar height. Knee Surg Sports TraumatolArthrosc 2006;14:707-12.
8. Dejour D, Le Coultre B. Osteotomies in patello-femoral instabilities. Sports Med Arthrosc Rev 2007;15:39-46.
9. Yue RA, Arendt EA, Tompkins MA. Patellar height measurements on radiograph and magnetic resonance imaging in patellar instability and control patients. J Knee Surg 2017;30:943-50.
10. Ridley TJ, Hinckel BB, Kruckeberg BM, Agel J, Arendt EA. Anatomical patella instability risk factors on MRI show sensitivity without specificity in patients with patellofemoral instability: A systematic review. J ISAKOS 2016;1:141-52.
11. Galland O, Walch G, Dejour H, Carret JP. An anatomical and radiological study of the femoropatellar articulation. SurgRadiolAnat 1990;12:119-25.
12. Dejour D, Reynaud P, Lecoultre B. Douleursetinstabilitérotulienne: Essai de classification [Pains and patelar instability: Trial classification]. MédHyg (Geneve) 1998;56:1466-71.
13. Thomas S, Rupiper D, Stacy GS. Imaging of the patellofemoral joint. Clin Sports Med 2014;33:413-36.
14. Pfirrmann CW, Zanetti M, Romero J, Hodler J. Femoral trochlear dysplasia: MR findings. Radiology 2000;216:858-64.
15. Askenberger M, Janarv PM, Finnbogason T, Arendt EA. Morphology and anatomic patellar instability risk factors in first-time traumatic lateral patellar dislocations: A Prospective magnetic resonance imaging study in skeletally immature children. Am J Sports Med 2017;45:50-8.
16. Bollier M, Fulkerson JP. The role of trochlear dysplasia in patellofemoral instability. J Am Acad Orthop Surg 2011;19:8-16.
17. Carrillon Y, Abidi H, Dejour D, Fantino O, Moyen B, Tran-Minh VA, et al. Patellar instability: Assessment on MR images by measuring the lateral trochlear inclination-initial experience. Radiology 2000;216:582-5.
18. Biedert RM, Bachmann M. Anterior-posterior trochlear measurements of normal and dysplastic trochlea by axial magnetic resonance imaging. Knee Surg Sports TraumatolArthrosc 2009;17:1225-30.
19. Merchant AC, Mercer RL, Jacobsen RH, Cool CR. Roentgenographic analysis of patellofemoral congruence. J Bone Joint Surg Am 1974;56:1391-6.
20. Saggin PR, Saggin JI, Dejour D. Imaging in patellofemoral instability: An abnormality-based approach. Sports Med Arthrosc Rev 2012;20:145-51.
21. Laurin CA, Lévesque HP, Dussault R, Labelle H, Peides JP. The abnormal lateral patellofemoral angle: A diagnostic roentgenographic sign of recurrent patellar subluxation. J Bone Joint Surg Am 1978;60:55-60.
22. Fithian DC, Neyret P, Servien E. Patellar instability: The Lyon experience. CurrOrthopPract 2008;19:328-38.
23. Graf KH, Tompkins MA, Agel J, Arendt EA. Q-vector measurements: Physical examination versus magnetic resonance imaging measurements and their relationship with tibial tubercle-trochlear groove distance. Knee Surg Sports TraumatolArthrosc 2018;26:697-704.
24. Seitlinger G, Scheurecker G, Högler R, Labey L, Innocenti B, Hofmann S, et al. Tibial tubercle-posterior cruciate ligament distance: A new measurement to define the position of the tibial tubercle in patients with patellar dislocation. Am J Sports Med 2012;40:1119-25.
25. Heidenreich MJ, Camp CL, Dahm DL, Stuart MJ, Levy BA, Krych AJ, et al. The contribution of the tibial tubercle to patellar instability: Analysis of tibial tubercle-trochlear groove (TT-TG) and tibial tubercle-posterior cruciate ligament (TT-PCL) distances. Knee Surg Sports TraumatolArthrosc 2017;25:2347-51.
26. Saggin PR, Dejour D, Meyer X, Tavernier T. Computed Tomography and Arthro-CT Scan in Patellofemoral Disorders. In: Zaffagnini S, Dejour D, Arendt EA, editors. Patellofemoral Pain, Instability, and Arthritis. Berlin: Springer-Verlag; 2010. p. 73-8.
27. Feller JA, Amis AA, Andrish JT, Arendt EA, Erasmus PJ, Powers CM, et al. Surgical biomechanics of the patellofemoral joint. Arthroscopy 2007;23:542-53.
28. Seitlinger G, Moroder P, Scheurecker G, Hofmann S, Grelsamer RP. The contribution of different femur segments to overall femoral torsion. Am J Sports Med 2016;44:1796-800.
29. Diederichs G, Issever AS, Scheffler S. MR imaging of patellar instability: Injury patterns and assessment of risk factors. Radiographics 2010;30:961-81.
30. Tompkins MA, Rohr SR, Agel J, Arendt EA. Anatomic patellar instability risk factors in primary lateral patellar dislocations do not predict injury patterns: An MRI-based study. Knee Surg Sports Traumatol Arthrosc 2018;26:677-84..


How to Cite this article:. Sandberg BF, Tompkins MA. The Role of Imaging in the Evaluation of Patellar Instability. Asian Journal Arthroscopy. Jan-April 2018;3(1):10-16.


(Abstract)      (Full Text HTML)      (Download PDF)


0 replies

Leave a Reply

Want to join the discussion?
Feel free to contribute!

Leave a Reply

Your email address will not be published. Required fields are marked *