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Static patella tilt and axial engagement in knee extension are mainly influenced by knee torsion, the tibial tubercle–trochlear groove distance (TTTG), and trochlear dysplasia but not by femoral or tibial torsion

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The aim of this study was to investigate the association of femoral (FT), tibial (TT), and knee torsion (KT) on the patella tilt (PT), the axial engagement index (AEI), and the tibial tuberosity–trochlear groove distance (TTTG).

Methods

Femoral torsion, tibial torsion, knee torsion, patella tilt, the axial engagement index, the TTTG, and trochlear dysplasia were retrospectively evaluated on 59 patients suffering from recurrent patella instability or anterior knee pain with 118 torsional lower limb magnetic resonance imaging studies.

Results

FT and TT did not show any significant associations with TTTG, PT, and AEI (n.s.). KT was significantly associated with a higher TTTG, higher PT, and lower AEI (all, p < 0.001). Higher grade trochlear dysplasia was associated with a higher PT and lower AEI (both, p < 0.001). The Dejour classification showed no significant association with FT, TT, KT, and TTTG (n.s.). All measurement parameters showed an excellent interrater agreement (ICC 0.89–0.97).

Conclusions

Static patella tilt and patellofemoral axial engagement in knee extension are mainly influenced by knee torsion, TTTG, and trochlear dysplasia but not by femoral or tibial torsion. These findings help to understand the underlying reasons for the patella position in knee extensions in CT and MRI investigations in patients suffering from patella instability and patellofemoral pain syndrome.

Level of evidence

III.

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Abbreviations

FT:

Femoral torsion

TT:

Tibial torsion

KT:

Knee torsion

PT:

Patellar tilt

AEI:

Axial engagement

TTTG:

Tibial tuberosity–trochlear groove distance

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Authors and Affiliations

  1. Department of Trauma Surgery, Medical University Innsbruck, Innsbruck, Austria

    P. Kaiser, F. Riechelmann & M. Schlumberger

  2. Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, Innsbruck, Austria

    F. Loth

  3. Department of Trauma Surgery, Landeskrankenhaus Feldkirch, Feldkirch, Austria

    R. Attal

  4. Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria

    M. Kummann

  5. Center of Arthroscopy and Sports Medicine, Orthopedic Hospital Markgroeningen, Markgroeningen, Germany

    P. Schuster & M. Schlumberger

  6. Paracelsus Medical Private University, Salzburg, Austria

    P. Schuster

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Contributions

All authors stated on the manuscript were fully involved in evaluating the study and writing the manuscript.

Corresponding author

Correspondence to R. Attal.

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The authors declare that they have no competing interests.

Ethical approval

Institutional review board approval was granted by means of a general waiver for scientific studies with retrospective data analysis (Local research ethics committee, Medical University Innsbruck; 20th February 2009).

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Kaiser, P., Loth, F., Attal, R. et al. Static patella tilt and axial engagement in knee extension are mainly influenced by knee torsion, the tibial tubercle–trochlear groove distance (TTTG), and trochlear dysplasia but not by femoral or tibial torsion. Knee Surg Sports Traumatol Arthrosc 28, 952–959 (2020). https://doi.org/10.1007/s00167-019-05588-y

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