Increased Tibial Tubercle-trochlear Groove and Patellar Height Indicate a Higher Risk of Recurrent Patellar Dislocation Following Medial Reefing

Overview

Journal Knee Surg Sports Traumatol Arthrosc

Publisher Wiley

Specialties Emergency Medicine
General Surgery
Orthopedics

Date 2021 May 25

PMID 34032867

Citations 13

Authors

Marc-Daniel Ahrend

Tobias Eisenmann

Moritz Herbst

Boyko Gueorguiev

Gabriel Keller

Florian Schmidutz

Stefan Dobele

Steffen Schroter

Christoph Ihle

Affiliations

Soon will be listed here.

Abstract

Purpose: Identifying anatomical risk factors on recurrent dislocation after medial reefing is important for deciding surgical treatment. The present study aimed to retrospectively analyze the preoperative magnetic resonance imaging (MRI)-based parameters of patients treated with medial reefing and whether these parameters lead to a higher risk of recurrent dislocation.

Methods: Fifty-five patients (18.6 ± 6.6 years) who underwent medial reefing after primary traumatic patellar dislocation (84% with medial patellofemoral ligament [MPFL] rupture) were included. Patients were followed up for at least 24 months postoperatively (3.8 ± 1.2 years) to assess the incidence of recurrent patellar dislocation. In patients without recurrent dislocation, the Kujala and subjective IKDC scores were assessed. Moreover, the tibial tubercle-trochlear groove (TT-TG), sulcus angle, patellar tilt, patellar shift, and lateral trochlea index (LTI) were measured. The patellar height was measured using the Caton-Dechamps (CDI), Blackburne-Peel (BPI), and Insall-Salvati index (ISI). The cohort was subclassified into two groups with and without recurrent dislocation. Differences between groups were analyzed with respect to the MRI parameters.

Results: Forty percent had a pathological sulcus angle of > 145°, 7.2% had an LTI of < 11°, 47.3% had a patellar tilt of > 20°, and 36.4% had a TT-TG of ≥ 16 mm. Increased patellar height was observed in 34.5, 65.5, and 34.5% of the patients as per CDI, BPI, and ISI, respectively. Nineteen (34.5%) patients suffered from recurrent dislocation. Compared with patients without recurrent dislocation, those with recurrent dislocation had a significantly lower LTI (p = 0.0467). All other parameters were not significantly different between the groups. Risk factor analysis showed higher odds ratios (OR > 2), although not statistically significant, for MPFL rupture (OR 2.05 [95% confidence interval 0.38-11.03], LTI (6.6 [0.6-68.1]), TT-TG (2.9 [0.9-9.2]), and patellar height according to ISI (2.3 [0.7-7.5]) and CDI (2.3 [0.7-7.5])). Patients without recurrent dislocation had a Kujala score of 93.7 ± 12.1 (42-100) points and an IKDC score of 90.6 ± 11.7 (55.2-100) points.

Conclusion: Anatomical, MRI-based parameters should be considered before indicating medial reefing. A ruptured MPFL, an LTI < 11°, a TT-TG ≥ 16 mm, a patellar tilt > 20 mm, and an increased patellar height according to ISI and CDI were found to be associated, although not significantly, with a higher risk (OR > 2) of recurrent patellar dislocation after medial reefing. Thorough preoperative analysis is crucial to reduce the risk of recurrent dislocation in young patient cohorts.

Level Of Evidence: Level IV.

Citing Articles

Operative Repair of Medial Patellofemoral Ligament Injury Versus Knee Bracing in Acute First-Time Traumatic Patellar Dislocation: A Systematic Review and Meta-Analysis.

Elnewishy A, Elsenosy A, Nahas S, Salem M, Teama H Cureus. 2024; 16(11):e73984.

PMID: 39703292 PMC: 11656640. DOI: 10.7759/cureus.73984.

Morphological Changes of the Posterior Femoral Condyle After Medial Patellar Retinaculum Plasty in Skeletally Immature Patients With Recurrent Patellar Dislocation and Trochlear Dysplasia.

Guo H, Zhou K, Sun Z, Feng A, Qin S, Liu L Orthop J Sports Med. 2024; 12(1):23259671231225671.

PMID: 38304055 PMC: 10832434. DOI: 10.1177/23259671231225671.

The accuracy of multiple regression models for predicting the individual risk of recurrent lateral patellar dislocation.

Yu J, Li Y, Zhang K, Yang R, Yang X, Gong M BMC Musculoskelet Disord. 2023; 24(1):948.

PMID: 38057697 PMC: 10701990. DOI: 10.1186/s12891-023-07094-2.

Lateral trochlear inclination measured by the transepicondylar axis holds potential for evaluating trochlear dysplasia in patients with lateral patellar dislocation.

Chen J, Li X, Feng Y, Li Q, Xu Z, Wang L Knee Surg Sports Traumatol Arthrosc. 2023; 31(12):5611-5620.

PMID: 37851025 DOI: 10.1007/s00167-023-07614-6.

Trochlea dysplasia, increased TT-TG distance and patella alta are risk factors for developing first-time and recurrent patella dislocation: a systematic review.

Danielsen O, Poulsen T, Eysturoy N, Mortensen E, Holmich P, Barfod K Knee Surg Sports Traumatol Arthrosc. 2023; 31(9):3806-3846.

PMID: 36854995 DOI: 10.1007/s00167-022-07255-1.

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