The mean values for each of these ratios was identified and patella alta and patella baja assigned to values +/- 2 SD above and below the mean. With regard to patellofemoral morphology, we established an association between abnormal femoral trochlear osseous anatomy and severe PFJ cartilage defects of the knee. However, to our knowledge, no study has used MRI to specifically analyze the relationship between the trochlear anatomy and patellofemoral cartilage defects. Check for errors and try again. Bone bruises at the anterolateral aspect of the lateral femoral condyle and at the inferomedial patella are the most constant findings in patients who have sustained a recent patellar dislocation. the patella. In previous studies of the morphologic features of the patellofemoral region, investigators have focused their attention on the patellar aspect of the joint. E%) [26] have studied different trochlear measurements to describe trochlear dysplasia on MRI. Haj-Mirzaian A, Guermazi A, Pishgar F, Pourvaziri A, Roemer FW, Sereni C, Hakky M, Zikria B, Stefanik JJ, Demehri S. Osteoarthritis Cartilage. The slice for this measurement was the same as the one used for the axial trochlear measurements. This high prevalence of patellofemoral disease in men has not been documented before. w3T0WI2P0T5T R (32.7%). There were five knees with no trochlear prominence (0 mm) that had normal cartilage. 3. The trochlear depth was defined as the maximum distance of the trochlear groove from the line connecting the medial and lateral trochlear facets (Fig. xs Linear regression was used to test the associations between age and anatomic measurement indices. Conventional MRI-derived subchondral trabecular biomarkers and their association with knee cartilage volume loss as early as 1year: a longitudinal analysis from Osteoarthritis Initiative. The severity of the chondral defect was determined according to the International Cartilage Repair Society Classification system using the depth of the lesion [21] (Table 2). has 2 years of experience interpreting CT images). These results were recorded in a Microsoft Excel file (Microsoft Corporation, Seattle, WA) and were submitted for independent statistical analysis. 7. and transmitted securely. ^Ey9 Therefore, the region needs to be reevaluated with particular attention to the trochlear anatomy to understand the cartilage changes in the region. In that series one observer assessed a lateral radiograph for the presence or absence of patellofemoral joint abnormality. endstream 37 0 obj In seven patients (16%) no compartment was narrowed to less than 3 mm. Knee; Magnetic resonance imaging; Osteoarthritis. Giesler P, Baumann FA, Weidlich D, Karampinos DC, Jung M, Holwein C, Schneider J, Gersing AS, Imhoff AB, Bamberg F, Jungmann PM. 2018 Nov;28(11):4669-4680. doi: 10.1007/s00330-018-5460-9. Dr. Tanaka additionally has interest in improving the understanding of treatment outcomes and injury prevention in female athletes. 1A, 1B, 1C). [16], Tecklenburg et al. One possible explanation could be the changes in articulation and contact patterns between the patella and trochlear groove during flexionextension of the knee. This classification has been studied extensively to determine a correlation between patellar morphology and chondromalacia patella using both radiography [810] and MRI [11]. Epub 2018 Nov 14. Similarly, the angle formed between the lateral trochlear facet and a line connecting the posterior-most cortical surfaces of the femoral condyles was measured and determined to be the lateral trochlear inclination (Fig. The slice corresponding to the horizontal line passing through the greatest ventral trochlear prominence was determined and used to calculate the axial measurement (Fig. endobj Bethesda, MD 20894, Web Policies Axial and sagittal MR images of 100 patients with various pathologic knee conditions were analyzed. Some error has occurred while processing your request. By continuing to use this website you are giving consent to cookies being used. Radiology records were reviewed to identify 25 patients (male-female ratio, 0.56; median age, 20 years; range, 13-43 years) . Second, in our study we modified the measurements to exclude the cartilaginous surface and measured only to the most ventral cortical points. 5,9 Others recognize the importance of radiologic assessment of the patellofemoral compartment but use a lateral radiograph for this purpose. Davies, A. P. MRCS*; Vince, A. S. FRCS*; Shepstone, L. PhD**; Donell, S. T. FRCS*; Glasgow, M. M. FRCS*. 2022 1, Vastus medialis . The results of a recent survey of practice among orthopaedic surgeons in the United Kingdom 12 suggest that this message requires restating. The distribution of each patellar and trochlear measurement was determined. Formal assessment of the patellofemoral compartment using a skyline radiograph must be included in the primary radiographic series for assessment of osteoarthritis of the knee. Consequently, measurement of patellar alignment has come to be accepted as an integral part of the examination of patellofemoral pain syndrome. 5 0 obj endobj There was a statistically significant difference in the trochlear measurements of the ventral prominence (p = 0.012), trochlear depth (p = 0.001), sulcus angle (p = 0.208), and lateral inclination (p = 0.154) between normal knees and knees with severe cartilage defects in patients younger than 40 years. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. This retrospective study was performed in compliance with HIPAA regulations, with approval from our institutional review board and with a waiver of informed consent. Zikria B, Rinaldi J, Guermazi A, Haj-Mirzaian A, Pishgar F, Roemer FW, Hakky M, Sereni C, Demehri S. Knee. The positive predictive value of an abnormal lateral radiograph was 52%. Federal government websites often end in .gov or .mil. Please enable it to take advantage of the complete set of features! The purposes of doing so were to eliminate variability in cartilage encountered in knees with chondral defects and to counter differences in surface geometry of the articular cartilage and the corresponding subchondral osseous anatomy [10]. F Only 30 subjects were found to have undergone arthroscopy after MRI. 4 0 obj 28 0 obj {"url":"/signup-modal-props.json?lang=us\u0026email="}, Roberts D, MRI patellofemoral instability measurements (reporting aid). E%) Overall, 9% of knees had patellofemoral changes in isolation however, for patients older than 60 years this figure rose to 13.6% for women and 15.4% for men. Epub 2021 Jul 4. 2021 Sep;40(9):3511-3521. doi: 10.1007/s10067-021-05634-6. The ventral trochlear prominence was described as the distance between the line paralleling the ventral cortical surface of the distal femur and the most ventral cortical point of the femoral trochlear floor (Fig. @!E4C@@c\C k The fact that the patella sits atop the anterior surface of the femoral condyles, increases the angle at which the quadriceps tendon pulls on the shaft of the tibia. official website and that any information you provide is encrypted Although these measurements have improved our understanding of the trochlear morphology, there remains a dearth of information in the literature regarding the correlation of these measurements with PFJ abnormalities. . 2020. A decreased lateral trochlear inclination was seen in knees with severe cartilage defects (mean = 14.7), whereas this value was considerably greater in knees with normal cartilage (mean = 22.8). Axial and sagittal MR images were reviewed to grade the severity of focal cartilage defects in the patellofemoral region on the basis of the depth of the lesion. Dejour et al. Ethical approval was granted before the start of the study. Nineteen (43%) showed changes isolated to the tibiofemoral compartments. The comparison in axial trochlear measurements revealed a significant difference in the trochlear depth (p = 0.001), sulcus angle (p = 0.003), and lateral trochlear inclination (p = 0.007) between knees with normal-appearing cartilage and severe cartilage defects in patients younger than 40 years. Some studies of knee osteoarthritis have focused solely on the tibiofemoral compartments. government site. Experimental investigations have shown that cartilage may become less compliant to changes and stiffer with aging because of a decrease in interstitial water content [29]. Patellofemoral osteoarthritis was present in 45 knees. During knee flexion the patella moves inferiorly to be completely engaged with the trochlear groove and significant medial and lateral facet contact is evident [30]. Last, we divided our population into two age groups to account for osteoarthritic changes in older knees [2729]. Six knees (13.6%) had patellofemoral changes with normal tibiofemoral compartments. Lawrence JS, Bremner JM, Bier F: Osteoarthritis: Prevalence in the population and relationship between symptoms and xray changes. Also known as "runner's knee," patellofemoral pain syndrome refers to chronic pain in the patella, or kneecap. No significant difference was seen in this measurement between patients with normal cartilage and those with mild cartilage defects in either age group. This is as described by Ahlback. In nine patients (17%) no compartment was narrowed to less than 3 mm. endstream Ann Rheum Dis 25:123, 1966. <>>>/BBox[0 0 576 756]/Length 103>>stream x The xray beam was horizontal and perpendicular to the tibial plateau and the xray plate. Arthritis Rheum 30:914918, 1987. Osteoarthritis is more common in the patellofemoral joints of men and women than previously documented and only can be properly assessed using a skyline radiograph. 3B). [14], Carrillon et al. P values were corrected using the Benjamini-Hochberg procedure. Measurements of the patellofemoral relationships during active mo- tion are not available, and clinicians currently rely What is patellofemoral pain syndrome? E%) All measurements were made by one observer using electronic calipers. w3T0WI2P0T5T R You may be trying to access this site from a secured browser on the server. Over the years, many have investigated this theory using radiography [8, 23] and MRI [11] but without much success [24]. In patients younger than 40 years, 34 knees (69%) were assessed to have normal-appearing cartilage, eight (16%) to have mild cartilage defects, and seven (14%) to have severe cartilage defects. -, Iijima H, Fukutani N, Aoyama T et al (2016) Clinical impact of coexisting patellofemoral osteoarthritis in Japanese patients with medial knee osteoarthritis. 4B). We also did not find a significant correlation between patellofemoral articular congruency and different grades of patellofemoral cartilage defects on MRI. The interobserver reliability (Cohen's kappa coefficient) was determined between the grading of patellofemoral chondral defects on arthroscopy and imaging in patients who underwent surgery. Patients were imaged at our institution for various clinical conditions (Table 1). 8600 Rockville Pike Epub 2019 Dec 2. The patellophyseal index (Fig 5d) used the reverse of the measurement used by Miller 32 comparing PC to the length of the patellar cartilage above the level of the physeal scar (PHY). This was done to account for age-related osteoarthritic changes seen in the older population. This is the population of most relevance to the orthopaedic surgeon because the purpose of the specialist consultation is to establish the cause of the knee pain and determine the place of surgical treatment. Therefore, unlike the authors of previous studies, we used the maximum ventral trochlear prominence as a reference point to determine the axial slice for the measurements. 12. Nineteen patients (9.2%) had patellofemoral osteoarthritis with normal tibiofemoral compartments. Forty-five knees (21.8%) had patellofemoral changes either alone or in combination with other compartments. Patellofemoral osteoarthritis was present with normal tibiofemoral compartments in six patients (13.6%). Departments of 1 Radiology and 2 Orthopedic Surgery, University of Iowa Hospitals, Iowa City, Iowa, USA Abstract. Copyright 2013-2020, American Roentgen Ray Society, ARRS, All Rights Reserved. The resulting instability to the PFJ may cause an unequal distribution of forces and an unfavorable mechanical joint stress within the joint. Pfirrmann et al. They found that trochlear dysplasia can be diagnosed reliably on sagittal and transverse images using measures of ventral prominence, trochlear depth, and facet asymmetry [14]. She was inducted into the International Patellofemoral Study Group in 2017 and was the recipient of the 2017, 2019, 2020 and 2021 grant awards from the Arthroscopy Association of North America. We also found a larger prominence, shallower trochlear groove, wider sulcus angle, and more horizontal lateral facet to be associated with severe cartilage defects (Figs. Knee Diameter and Cross-Section Area Measurements in MRI as New Promising Methods of Chondromalacia Diagnosis-Pilot Study. In 15 cases the abnormal patellofemoral joint only could be seen on the skyline radiograph (Figs 1, 2). 1 The current study uses joint space narrowing to less than 3 mm on PA and skyline radiographs as the criteria for diagnosis of osteoarthritis in any compartment. Merchant AC: Patellofemoral imaging. Additional analysis of these data was done with reference to the age and gender of the patients. No significant difference was seen in the patellar measurements between normal knees and knees with severe cartilage defects. 2019 Feb;27(2):278-285. doi: 10.1016/j.joca.2018.10.013. E% Careers. Of all patellofemoral morphology measurements, the only lateralization of the tibial tubercle may be considered as a risk factor for lateral (not medial) tibiofemoral osteoarthritis worsening. Joint space narrowing is not the only radiologic feature of osteoarthritis but it has been shown to be the most reproducible in the assessment of radiographs. Patients were divided into two age groups: 49 subjects (age range, 1238 years; 29 male, 20 female) were younger than 40 years and 51 subjects (range, 4087 years; 26 male, 25 female) were 40 years old or older. The following measurements were obtained: patellar length, the length of the patellar tendon, the length of the patellar articular cartilage, and the length of the trochlear articular cartilage overlapping with the patellar cartilage. -. These results are shown in Figure 3. The current authors are not aware of any previous series in which the patellofemoral joints of symptomatic patients were examined with a skyline radiograph. Meta-analysis on the association between knee extensor strength and structural changes of knee osteoarthritis. E% For all trochlear measurements, the cartilage was excluded and only the osseous surfaces were used as a reference. i !\ Wolters Kluwer Health endobj Patients younger than 40 years or with a diagnosis of rheumatoid arthritis were not considered for the study. ADVERTISEMENT: Supporters see fewer/no ads. (21.8%). The negative value indicates a trochlea with a convex anterior surface. Direct measurements of minimum joint spaces were made using a standard ruler with millimeter gradations. Findings of patellofemoral malalignment are commonly under-reported by radiologists. Please enable scripts and reload this page. Subjects with a history of arthroscopic surgery were excluded from the study. Also, elderly individuals apply different motor strategies during physical exercise [33], potentially leading to lower joint loads during exercise. However, most authors have failed to establish a relationship between the two. 1. As the debate regarding unicompartmental joint replacement continues, the need for data regarding the prevalence of unicompartmental osteoarthritis increases. 9 articles feature images from this case 22 public playlists include this case 1B), and to determine the Insall-Salvati index, which is the ratio of the length of the patellar tendon in relation to the diagonal length of the patella (Fig. -, Duncan RC, Hay EM, Saklatvala J, Croft PR (2006) Prevalence of radiographic osteoarthritis--it all depends on your point of view. to maintaining your privacy and will not share your personal information without Lateral radiographs were reported solely in terms of presence or absence of patellofemoral arthritis. Seven sets of radiographs could not be retrieved for repeated examination and so were excluded from additional analysis. The finding of such a high prevalence of patellofemoral osteoarthritis in this group reinforces the importance of requesting an axial radiograph for all patients who present with knee pain. Lanyon P, Jones A, Doherty M: Assessing progression of patellofemoral osteoarthritis: A comparison between two radiographic methods. A survey of orthopaedic surgeons in the United Kingdom. These values are equivalent or superior to those achieved in other series. The patellofemoral joint is the portion of the knee joint between the patella and the femoral condyles. For information on cookies and how you can disable them visit our Privacy and Cookie Policy. Thirty-nine patients had bilateral symptoms. There were 213 knees in 174 patients in the study. Patellofemoral osteoarthritis was present with normal tibiofemoral compartments in eight patients (15.4%). (not medial) tibiofemoral osteoarthritis worsening. your express consent. 4C). Osteochondral injuries of the inferomedial patella are seen in up to 70% of patellofemoral . Physiologically, thinning of PFJ cartilage occurs with aging in the absence of cartilage disease [27, 28]. In knees in which more than one cartilage defect was observed, the defect with the greatest severity was chosen. Dataset . Methods: A total of 1431 consecutive Laurin views of the PFJ were retrospectively collected and divided into two parts: (1) the model development dataset (dataset 1, n = 1230) and (2) the hold-out test set (dataset 2, n = 201). Lateral patellar tilt and its longitudinal association with patellofemoral osteoarthritis-related structural damage: Analysis of the osteoarthritis initiative data. Epub 2022 Apr 2. The lack of correlation in our study between patellar indices and cartilage defects provides evidence to conclude that patellar height and surface anatomy are not associated with patellofemoral chondral defects and to justify the importance of focusing our attention on the trochlear aspect of the joint. Key points: These radiographs were reported independently by two observers, both of whom were blinded to any previous measurements. 2020 Jul;28(7):2224-2232. doi: 10.1007/s00167-019-05802-x. ^Ey9 Additionally, we confirmed previous results indicating a lack of correlation between patellar morphology and cartilage defects in patients younger than 40 years. Eighty-six knees (41.8%) showed changes isolated to the tibiofemoral compartments. The results of the current study confirm that osteoarthritis of the knee can affect each of the three knee compartments alone or in any combination. Articular cartilage congruence between the patella and femoral trochlea has been proposed as an alternate view in understanding the development of chondral changes in the region. 5. xs endstream The difference in our findings and those of the other studies [14, 16, 25, 26] can be attributed to multiple factors. An axial radiograph of the same knee shows the patellofemoral compartment to be grossly abnormal. Clinical Orthopaedics and Related Research: A lateral radiograph shows an apparently well-preserved patellofemoral joint space. Of all patellofemoral morphology measurements, the only lateralization of the tibial tubercle may be considered as a risk factor for lateral (not medial) tibiofemoral osteoarthritis worsening. 2022 Mar;51(3):535-547. doi: 10.1007/s00256-021-03832-6. We found that in knees with gross trochlear abnormalities, the most remarkable axial changes were seen in the slice corresponding to the greatest ventral trochlear prominence. Skeletal Radiol. Knee Surg Sports Traumatol Arthrosc. 2). On a separate occasion and again blinded to the previous reports, the lateral radiographs were reported for presence or absence of changes of osteoarthritis. Analysis of the sagittal trochlear measurements revealed a statistical difference in the ventral trochlear prominence between patients with normal cartilage and patients with severe cartilage defects (< 40 years, p = 0.012; 40 years, p = 0.015) (Table 5). The middle cerebral artery travels to the lateral fissure. Minimum joint space was measured using a millimeter ruler on weightbearing posteroanterior and skyline patellofemoral radiographs. The https:// ensures that you are connecting to the j Epub 2021 Feb 24. 8. Vince AS, Singhania AK, Glasgow MMS: What xrays do we need? The lateral radiograph had poor results for detection of patellofemoral osteoarthritis with a sensitivity of 66% and specificity of 83%. No statistically significant difference was seen in the calculated patellar facet measurements (patients < 40 years, p = 0.37; patients 40 years, p = 0.21), patellar trochlear index (< 40 years, p = 0.64; 40 years, p = 0.34), and Insall-Salvati index (< 40 years, p = 0.14; 40 years, p = 0.12) between cases with normal and severe cartilage defects. 11, Fibula. Treasure Island (FL): StatPearls Publishing; 2022 Jan. 17 0 obj Please try again soon. Unable to process the form. Measurements for patellofemoral morphology were obtained at knee extension by using static 4D CT images in patients with PI and multidetector CT images in . 1 Patellofemoral changes were seen alone or in combination in 36.1% of women and 32.7% of men older than 60 years. The results showed objective joint space narrowing to less than 3 mm in the patellofemoral compartment of 32.7% of men and 36.1% of women older than 60 years. Later studies have added other quantitative measurements such as the sulcus angle and the lateral trochlear inclination [16, 17]. Because previous authors had made no such distinction, this difference in study design might also have led to the difference in measurements. Clipboard, Search History, and several other advanced features are temporarily unavailable. may email you for journal alerts and information, but is committed The interobserver intraclass correlation coefficients also have good reliability of joint space measurements. 2. Keywords: This is presented with 95% confidence intervals. Patellar instability MRI measurements are associated with knee joint degeneration after reconstruction of the medial patellofemoral ligament. @!E4C@@c\C k We believe that the failures of these studies to conclusively show any correlation between patellofemoral morphology and chondromalacia patella are related in part to the neglect of the trochlear aspect of the joint. Laurin CA, Dussault R, Levesque HP: The tangential xray investigation of the patellofemoral joint. 2020 Dec;27(6):1971-1979. doi: 10.1016/j.knee.2020.11.002. As early as 1964, Outerbridge [9] had proposed that the motion of the medial patellar facet on the rim of the medial femoral condyle may cause wear of the cartilage in the area. w3T0WI2P0T5T R Association of patella alta with worsening of patellofemoral osteoarthritis-related structural damage: data from the Osteoarthritis Initiative. For the 30 subjects who underwent arthroscopy, substantial agreement ( = 0.621) was found between the grade of the patellofemoral cartilage on arthroscopy and MRI [22]. wZ.kI2vlc5H FOIA Measurements such as condylar width and height and patellar height from the true lateral view are helpful to determine the type and severity of intercondylar dysplasia. McAlindon TE, Snow S, Cooper C, et al: Radiographic patterns of osteoarthritis of the knee joint in the community: The importance of the patellofemoral joint. MRI patellofemoral instability measurements (reporting aid). endstream endobj On MRI, TT-PCL and PT-PCL measurements have significantly less variability compared with TT-TG and PT-TG measurements, regardless of knee position. Pitfalls and Pearls in MRI of the Knee, Review. Methods A total of 1431 consecutive Laurin views of the PFJ were retrospectively collected and divided into two parts: (1) the model development dataset (dataset 1, n = 1230) and (2) the hold-out test set (dataset 2, n = 201). j Clinical Orthopaedics and Related Research402:206-212, September 2002. There was a fixed distance from the patella to the plate of 20 cm to minimize magnification error. The reliability of the definition of osteoarthritis of the knee (< 3 mm joint space) was assessed using Cohens kappa statistic. Clin Orthop Relat Res 402:206212 <>>>/BBox[0 0 576 756]/Length 103>>stream endstream No associations were detected between patellofemoral morphology measurements and MTFC OA progression. The patella was measured from the proximal margin to the distal anterior tip excluding osteophytes and enthesophytes (Fig. In our study, we found no statistical correlation between patellar facet measurements and different grades of cartilage defects. For more information, please refer to our Privacy Policy. sharing sensitive information, make sure youre on a federal This highlights the importance of formally assessing the patellofemoral compartment clinically and radiologically in all patients. Subsequently, patients were divided into four age groups: pre-pubertal school-aged children (7-10 years old), early adolescents (11-14 years old), and late adolescents (15-18 years old). Endo et al. Ann Rheum Dis 55:875879, 1996. 2022 Aug 23;58(9):1142. doi: 10.3390/medicina58091142. Twenty-four patients (46.1%) had isolated medial tibiofemoral osteoarthritis. The angle formed between the medial and lateral trochlear facets was simultaneously measured and determined to be the sulcus angle (Fig. Osteoarthritis Cartilage 24:16971707 We believe that this might account for the lack of development of cartilage defects in cases with abnormal trochlear anatomy in the elderly. In women older than 60 years, (n = 42) seven knees (16%) did not fulfill the criteria for narrowing in any of the three knee compartments. Specifically, we found that knees with a large ventral trochlear prominence, shallow trochlear groove, increased sulcus angle, and decreased lateral trochlear inclination in patients younger than 40 years are associated with severe PFJ chondral defects. Osteoarthritis of the knee is common and disabling. <>>>/BBox[0 0 576 756]/Length 135>>stream CONCLUSION. F x 8 All measurements were made on the sagittal slice showing the greatest patella length. Clin Rheumatol. Ahlback S: Osteoarthritis of the knee: A radiographic investigation. The patients wore a lead apron to minimize xray exposure to the torso and held the xray plate against the anterior aspect of their tibia. A landmark-based 3D analysis reveals a narrower tibial plateau and patella in trochlear dysplastic knees. However, the ventral trochlear prominence (mean, 6.9 mm), trochlear facet asymmetry (54%), and lateral trochlear inclination (mean, 14.7 mm) measurements were found to lie outside these cutoff values. 12 0 obj -, Kobayashi S, Pappas E, Fransen M, Refshauge K, Simic M (2016) The prevalence of patellofemoral osteoarthritis: a systematic review and meta-analysis. Four different measurements were made on the axial proton density fat-saturated sequences: the trochlear depth, trochlear facet asymmetry, sulcus angle, and lateral trochlear inclination. MeSH Rheumatology (Oxford) 45:757760 The PA radiograph was made according to the method of Ahlback. Pishgar F, Guermazi A, Ashraf-Ganjouei A, Haj-Mirzaian A, Roemer FW, Zikria B, Sereni C, Hakky M, Demehri S. Skeletal Radiol. By adopting the skyline radiograph for patellofemoral imaging in a large, consecutive series of patients the current series more accurately documents the true prevalence of arthritic changes affecting the patellofemoral joint. 2 Early radiographic attempts to assess the morphology of the trochlea employed axial radiographs of the knee. Seventeen knees (32.7%) had patellofemoral changes either alone or in combination with other compartments. 3A). There is an association between abnormal trochlear morphology and severe patellofemoral cartilage defects in patients younger than 40 years. In PFJs with no trochlear prominence, the anterior physeal line was used as a reference for determining the axial slice (Fig. The .gov means its official. Patellofemoral morphology measurements were not associated with longitudinal joint space loss in the MTFC or MOAKS determinants. Patellofemoral instability or maltracking is the clinical syndrome due to morphologic abnormalities in the patellofemoral joint where the patella is prone to recurrent lateral dislocation. The lengths of the medial and lateral trochlear facets were measured, and asymmetry was calculated as the ratio of the medial-to-lateral facet length (Fig. endobj [1] defined femoral trochlear dysplasia by one qualitative (the crossing sign) and two quantitative (trochlear bump and trochlear depth) features on true lateral radiographs. MRI Findings in Transient Patellofemoral Dislocation. Get new journal Tables of Contents sent right to your email inbox, The Association of Bone and Joint Surgeons, September 2002 - Volume 402 - Issue - p 206-212, The Radiologic Prevalence of Patellofemoral Osteoarthritis, Articles in Google Scholar by A. P. Davies, MRCS, Other articles in this journal by A. P. Davies, MRCS. Sagittal proton densityweighted fast spin-echo (FSE) sequences and axial proton density fat-saturated sequences were used to analyze the sagittal and axial images, respectively. Methods: Seventy five knees (36.4%) had no compartment narrowed to less than 3 mm. Epub 2020 Nov 25. PMC endstream The axial radiograph was made according to the method of Laurin et al 8 with the knee flexed to 25. The importance of trochlear dysplasia first came to light in 1802, when the French surgeon Richerand noticed several cases of patellar dislocation in which the lateral femoral condyle was less prominent than usual. Patellofemoral morphology measurements of patella alta, trochlear dysplasia, patellar tilt . 2022 Sep 18. The authors are not aware of any previous systematic evaluation of such a cohort for patellofemoral osteoarthritis. The femoral trochlea has been described in the literature using radiography [12, 13], CT [1], and MRI [1416]. Intraobserver intraclass correlation coefficients show excellent reliability of joint space measurements (Table 1). <>>>/BBox[0 0 576 756]/Length 135>>stream Additionally, no significant difference was seen between any of the axial measurements of knees with normal cartilage and knees with mild cartilage defects. 4D). Therefore, in elderly subjects, deformation of cartilage is considerably less than in the young [27]. Previous series that have reported the prevalence of radiologic changes of osteoarthritis of the knee have relied on subjective criteria such as grading of changes 46,11 or have made joint space measurements from lateral radiographs. This study is the first, to the authors knowledge, to document the prevalence of patellofemoral osteoarthritis in a large series of patients using the axial skyline radiograph to confirm the diagnosis. @!E4C@@c\C k Boegard T, Rudling O, Petersson IF, et al: Posteroanterior radiogram of the knee in weightbearing and semiflexion: Comparison with MR imaging. In knees with severe cartilage defects, the ventral trochlear prominence was always greater than 5 mm, with the maximum measurement being 10 mm. The stacks of images can be used to conveniently review the different measurement techniques. 6,7,11. 2022 Oct;51(10):1959-1966. doi: 10.1007/s00256-022-04042-4. In patients 40 years old or older, all axial measurements of patients with normal cartilage, mild cartilage defects, and severe cartilage defects were found to be similar. <>>>/BBox[0 0 576 756]/Length 103>>stream These findings were similar in both age groups. Peeters W, Van Haver A, Van den Wyngaert S, Verdonk P. Knee Surg Sports Traumatol Arthrosc. You can use Radiopaedia cases in a variety of ways to help you learn and teach. Data are shown for compartmental distribution of osteoarthritis in women older than 60 years (n=42). Patellofemoral morphology measurements of patella alta, trochlear dysplasia, patellar tilt, and lateralization of the tibial tubercle are not associated with radiographic and MRI-based medial tibiofemoral osteoarthritis worsening over 2 years. Patients older than 60 years (n = 95) were analyzed in male and female groups. Comparison of the performance of the lateral radiograph with the skyline view is shown in Table 2. 9. The reader was blinded to the patient's age and trochlear measurements. Reprint requests to A. P. Davies, Department of Orthopaedics, Norfolk and Norwich Hospital, Norwich NR1 3SR, UK. The typical injury pattern is a tear of the medial patellofemoral ligament (MPFL) and bone bruises of the patella and the lateral femoral condyle. Felson DT, Naimark A, Anderson J, et al: The prevalence of knee osteoarthritis in the elderly. Sixteen knees (36.1%) had patellofemoral changes either alone or in combination with other compartments. Ann Rheum Dis 51:8082, 1992. Forty-nine percent of knees showed disease confined to one compartment. Patients with severe cartilage defects had a trochlear groove that was seen to be less deep (mean = 0.29 mm; range, 3 to 4 mm) than that in patients with normal cartilage (mean, 3.68 mm; range, 3 to 7 mm). MATERIALS AND METHODS. In: StatPearls [Internet]. j !\ <>>>/BBox[0 0 576 756]/Length 135>>stream The knee measurements of the two age groups were analyzed separately. In patients 40 years old or older, 12 knees (24%) were assessed to have normal cartilage, whereas 17 (34%) had mild and 22 (44%) had severe cartilage defects. There are a paucity of data on the compartmental distribution of osteoarthritis in modern practice. 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