Patellofemoral Disorders: Role of Computed Tomography and Magnetic Resonance Imaging in Defining Abnormal Rotational Lower Limb Alignment

Overview

Journal Sports Health

Publisher Sage Publications

Specialty Orthopedics

Date 2012 Sep 28

PMID 23016003

Citations 29

Authors

Shital Parikh

Frank R Noyes

Affiliations

Soon will be listed here.

Abstract

Background: The contribution of lower limb rotational malalignment to patellofemoral pain and instability has been well recognized. The purpose of the present study is to review the role of computed tomography (CT) and magnetic resonance imaging (MRI) in assessment of abnormal rotational alignment of lower limb.

Evidence Acquisition: An analysis of all available literature in the English language through 2010 was performed to provide data on a comparison between MRI and CT-specifically, the techniques and normative values used to determine abnormal lower limb alignment.

Results: CT and MRI are highly accurate in defining abnormal alignment of the lower limb. Determination of axis of femoral anteversion in proximal femur has been the subject of debate in the literature. The determination of distal femoral condylar axis, proximal tibial axis and distal tibial axis are less controversial.

Conclusions: CT and MRI are both used for assessing the rotational abnormalities of the femur and tibia during evaluation for patellofemoral disorders. MRI has an advantage over CT because femoral anteversion measurements are more accurate and ionizing radiation is avoided. A standardized protocol defining the level and axes for measurement of femoral and tibial alignment indices should be used to maintain consistency in measurements.

Citing Articles

Coronal alignment does not enable to predict the degree of femoral and tibial torsion.

Grunwald L, Schmidt S, Ahrend M, Histing T, Dobele S J Exp Orthop. 2025; 12(1):e70073.

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Patellar Non-Traumatic Pathologies: A Pictorial Review of Radiologic Findings.

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Assessing Femoral Anteversion in Patients With Bilateral Recurrent Patellar Dislocations.

Honkonen E, Sillanpaa P, Reito A, Kiekara T, Maenpaa H, Mattila P Orthop J Sports Med. 2024; 12(12):23259671241300319.

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Increased knee torsional misalignment associated with femoral torsion is related to non-contact anterior cruciate ligament injury: a case-control study.

Wang D, Fan H, Hu L, Liang X, Huang W, Li K J Orthop Surg Res. 2024; 19(1):124.

PMID: 38321464 PMC: 10845642. DOI: 10.1186/s13018-024-04609-y.

Analysis of lower extremity alignment (LEA) in children with recurrent patellar dislocation by EOS system.

Miao M, Cai H, Zhang L, Cai H Front Pediatr. 2023; 11:1291739.

PMID: 37954430 PMC: 10634357. DOI: 10.3389/fped.2023.1291739.

References

Tamari K, Tinley P, Briffa K, Breidahl W . 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. 2004; 18(1):46-55. DOI: 10.1002/ca.20050. View

Paulos L, Swanson S, Stoddard G, Barber-Westin S . Surgical correction of limb malalignment for instability of the patella: a comparison of 2 techniques. Am J Sports Med. 2009; 37(7):1288-300. DOI: 10.1177/0363546509334223. View

Lee T, Anzel S, Bennett K, Pang D, Kim W . The influence of fixed rotational deformities of the femur on the patellofemoral contact pressures in human cadaver knees. Clin Orthop Relat Res. 1994; (302):69-74. View

McWalter E, MacIntyre N, Cibere J, Wilson D . A single measure of patellar kinematics is an inadequate surrogate marker for patterns of three-dimensional kinematics in healthy knees. Knee. 2009; 17(2):135-40. DOI: 10.1016/j.knee.2009.08.001. View

KINGSLEY P, OLMSTED K . A study to determine the angle of anteversion of the neck of the femur. J Bone Joint Surg Am. 1948; 30A(3):745-51. View

Elias D, White L . Imaging of patellofemoral disorders. Clin Radiol. 2004; 59(7):543-57. DOI: 10.1016/j.crad.2004.01.004. View

McNally E, Ostlere S, Pal C, Phillips A, Reid H, Dodd C . Assessment of patellar maltracking using combined static and dynamic MRI. Eur Radiol. 2000; 10(7):1051-5. DOI: 10.1007/s003300000358. View

Schneider B, Laubenberger J, Jemlich S, Groene K, Weber H, Langer M . Measurement of femoral antetorsion and tibial torsion by magnetic resonance imaging. Br J Radiol. 1997; 70(834):575-9. DOI: 10.1259/bjr.70.834.9227249. View

Citak M, Gardner M, Citak M, Krettek C, Hufner T, Kendoff D . Navigated femoral anteversion measurements: a new intraoperative technique. Injury. 2008; 39(4):467-71. DOI: 10.1016/j.injury.2007.09.024. View

10.

Jarrett D, Oliveira A, Zou K, Snyder B, Kleinman P . Axial oblique CT to assess femoral anteversion. AJR Am J Roentgenol. 2010; 194(5):1230-3. DOI: 10.2214/AJR.09.3702. View

11.

Dejour H, Walch G, Nove-Josserand L, Guier C . Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc. 1994; 2(1):19-26. DOI: 10.1007/BF01552649. View

12.

Rosen H, SANDICK H . The measurement of tibiofibular torsion. J Bone Joint Surg Am. 1955; 37-A(4):847-55. View

13.

Radler C, Kranzl A, Manner H, Hoglinger M, Ganger R, Grill F . Torsional profile versus gait analysis: consistency between the anatomic torsion and the resulting gait pattern in patients with rotational malalignment of the lower extremity. Gait Posture. 2010; 32(3):405-10. DOI: 10.1016/j.gaitpost.2010.06.019. View

14.

Dunn D . Anteversion of the neck of the femur; a method of measurement. J Bone Joint Surg Br. 1952; 34-B(2):181-6. DOI: 10.1302/0301-620X.34B2.181. View

15.

Beaconsfield T, Pintore E, Maffulli N, Petri G . Radiological measurements in patellofemoral disorders. A review. Clin Orthop Relat Res. 1994; (308):18-28. View

16.

HUGHSTON J . Subluxation of the patella. J Bone Joint Surg Am. 1968; 50(5):1003-26. View

17.

Souza R, Powers C . Concurrent criterion-related validity and reliability of a clinical test to measure femoral anteversion. J Orthop Sports Phys Ther. 2009; 39(8):586-92. DOI: 10.2519/jospt.2009.2996. View

18.

STAHELI L . Torsion--treatment indications. Clin Orthop Relat Res. 1989; (247):61-6. View

19.

Shin C, Dana Carpenter R, Majumdar S, Ma C . Three-dimensional in vivo patellofemoral kinematics and contact area of anterior cruciate ligament-deficient and -reconstructed subjects using magnetic resonance imaging. Arthroscopy. 2009; 25(11):1214-23. DOI: 10.1016/j.arthro.2009.05.013. View

20.

Harbaugh C, Wilson N, Sheehan F . Correlating femoral shape with patellar kinematics in patients with patellofemoral pain. J Orthop Res. 2010; 28(7):865-72. PMC: 3269909. DOI: 10.1002/jor.21101. View