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Unilateral anterior knee pain is associated with increased patellar lateral position after stressed lateral translation

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To objectively compare side-to-side patellar position and mobility in patients with idiopathic unilateral anterior knee pain (AKP) using a stress-testing device concomitantly with magnetic resonance imaging. It is hypothesized that the painful knees present greater patellar mobility than the contralateral non-painful knees.

Methods

From a total sample of 359 patients, 23 patients with idiopathic unilateral AKP (30.9 years, 23.4 kg/m2, 43% males) were included within the present study. Both knees of all the patients were examined by conventional imaging, including the measurement of trochlear sulcus angle, Caton-Deschamps index, tibial tuberosity to trochlear groove distance, patellar tilt angle and patellar subluxation (both at rest and upon quadriceps contraction). Additionally, the same patients underwent stress testing (Porto Patella Testing Device); these measurements were taken with the patella at rest, after lateral patellar translation and after lateral patellar tilt. Clinical and functional outcomes were obtained using physical examination and the Kujala and Lysholm scores.

Results

Painful knees showed statistically significant higher patellar lateral position after stressed lateral translation than non-painful knees (p = 0.028), 9.8 ± 3.6 mm and 7.1 ± 6.3 mm, respectively. The adjusted multivariate logistic model identified the patellar position after lateral displacement to be significantly associated with AKP (OR = 1.165) and the model (AUC = 0.807, p < 0.001) showed reasonable sensitivity (67%) and specificity (73%).

Conclusion

Patients with idiopathic unilateral AKP with morphologically equivalent knees showed statistically significant increased patellar lateral position after stressed lateral displacement in their painful knee. The greater lateral patellar mobility quantified by the PPTD testing brings more objectivity to the diagnosis.

Level of evidence

II.

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Acknowledgements

The authors would like to sincerely acknowledge: the Clinical Director of SMIC Dragão (Dr. Rui Aguiar) and their team for the technical support in the imaging study; Professor Sérgio Barreira for his help and valuable discussion on statistical analysis.

Funding

One author (AL) reports funding from FCT - Fundação para a Ciência e a Tecnologia and FLAD—Fundação Luso-Americana para o Desenvolvimento, for the PhD Studentship in Industry (SFRH/BDE/51821/2012) and Internship grant (Proj.16/2015).

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Authors and Affiliations

  1. Mechanical Engineering Department, CMEMS Center for MicroElectroMechanical Systems, University of Minho, Guimarães, Portugal

    Ana Leal, Paulo Flores & Filipe S. Silva

  2. Dom Henrique Research Centre, Porto, Portugal

    Ana Leal, Renato Andrade & João Espregueira-Mendes

  3. Clínica Do Dragão, Espregueira-Mendes Sports Centre, FIFA Medical Centre of Excellence, Porto, Portugal

    Renato Andrade & João Espregueira-Mendes

  4. Faculty of Sports of Porto University, Porto, Portugal

    Renato Andrade

  5. University of Connecticut School of Medicine, Farmington, CT, USA

    John Fulkerson

  6. Department of Orthopaedic Surgery, Centre Albert-Trillat, Hôpital de La Croix-Rousse, Lyon, France

    Philippe Neyret

  7. Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA

    Elizabeth Arendt

  8. ICVS/3B’s–PT Government Associate Laboratory, Braga/Guimarães, Portugal

    João Espregueira-Mendes

  9. School of Medicine, Minho University, Braga, Portugal

    João Espregueira-Mendes

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  1. Ana Leal
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  2. Renato Andrade
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  3. Paulo Flores
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  6. Philippe Neyret
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  7. Elizabeth Arendt
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  8. João Espregueira-Mendes
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Contributions

(AL, PF, FSS, JEM) developed the PPTD device and protocol (AL) carried out the PPTD procedure and measurements (JF, PN, EA, JEM) validated and interpreted the PPTD measurements. (AL, RA) drafted the manuscript and performed the statistical analysis. (AL, RA, EA, JEM) designed the study. (JF, PN, EA, JEM) validated and critically reviewed the scientific content of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to João Espregueira-Mendes.

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Conflict of interest

No financial or non-financial competing interest exists for this manuscript. The manuscript was not influenced by personal or financial relationship with other people or organizations.

Ethical approval

The study approval by the Institutional Review Board of Clínica do Dragão, Espregueira-Mendes Sports Centre—FIFA Medical Centre of Excellence: protocol number #005/0014.

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Leal, A., Andrade, R., Flores, P. et al. Unilateral anterior knee pain is associated with increased patellar lateral position after stressed lateral translation. Knee Surg Sports Traumatol Arthrosc 28, 454–462 (2020). https://doi.org/10.1007/s00167-019-05652-7

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