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Association Between Measures of Patella Height, Morphologic Features of the Trochlea, and Patellofemoral Joint Alignment: The MOST Study

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Patellofemoral joint (PFJ) malalignment (lateral patella displacement and tilt) has been proposed as a cause of patellofemoral pain. Patella height and/or the morphologic features of the femoral trochlea may predispose one to patella malalignment.

Questions/purposes

The purposes of our study were to assess the associations among patella height, morphologic features of the trochlea, and measures of PFJ alignment and to determine which measures of patella height and morphologic features of the trochlea were the best predictors of PFJ alignment.

Methods

Measures of patella height (Insall-Salvati ratio and modified Insall-Salvati ratio), morphologic features of the trochlea (sulcus angle, trochlear angle, lateral trochlear inclination, medial trochlear inclination), and PFJ alignment (bisect offset and patella tilt angle) were assessed in 566 knees from the Multicenter Osteoarthritis Study.

Results

Bisect offset was correlated with the Insall-Salvati ratio (r = 0.25) and lateral trochlear inclination (r = −0.38). Patella tilt angle correlated with the trochlear angle (−0.27) and lateral trochlear inclination (−0.32). Linear regression models including the Insall-Salvati ratio and lateral trochlear inclination explained 20% and 11% of the variance in bisect offset and patella tilt angle, respectively.

Conclusions

Of the variables measured in the current study, the Insall-Salvati ratio and lateral trochlear inclination were the best predictors of lateral patella displacement and lateral tilt. This knowledge will aid clinicians in the identification of anatomic risk factors for PFJ malalignment and/or PFJ dysfunction.

Level of Evidence

Level III, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We thank the MOST study participants.

Author information

Authors and Affiliations

  1. Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, 650 Albany Street, Suite 200, Boston, MA, 02118, USA

    Joshua J. Stefanik MSPT, PhD

  2. University of Iowa, Iowa City, IA, USA

    Neil A. Segal MD

  3. University of California, San Francisco, CA, USA

    John A. Lynch PhD

  4. University of Southern California, Los Angeles, CA, USA

    Christopher M. Powers PT, PhD

  5. Department of Anatomy and Neurobiology, Boston University School of Medicine, 75 East Concord St, Boston, MA, 02118, USA

    Ann C. Zumwalt PhD

Authors
  1. Joshua J. Stefanik MSPT, PhD
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  2. Ann C. Zumwalt PhD
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  3. Neil A. Segal MD
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  4. John A. Lynch PhD
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  5. Christopher M. Powers PT, PhD
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Corresponding author

Correspondence to Joshua J. Stefanik MSPT, PhD.

Additional information

The Multicenter Osteoarthritis Study was supported by the National Institutes of Health (NIH) (grants U01-AG18820, U01-AG18832, U01-AG18947, U01-AG19069, and AR-47785). One of the author’s (JJS) work was supported by a doctoral dissertation award from the Arthritis Foundation and NIH grant T32AR007598. He is currently supported by a Postdoctoral Fellowship from the Arthritis Foundation and the Research Scientist Development Award from the American College of Rheumatology.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained. One author (CMP) confirms that no institutional review board approval was required from his institution.

Each author certifies that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained from the institutions that supplied data.

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Stefanik, J.J., Zumwalt, A.C., Segal, N.A. et al. Association Between Measures of Patella Height, Morphologic Features of the Trochlea, and Patellofemoral Joint Alignment: The MOST Study. Clin Orthop Relat Res 471, 2641–2648 (2013). https://doi.org/10.1007/s11999-013-2942-6

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