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The J-sign and the body mass index determine the disease-specific quality of life in patients with lateral patellar instability

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To determine which risk factors for patellar instability contribute most relevantly to patients’ subjective disease-specific quality of life, aiming to provide implications on the overall treatment decision-making process.

Methods

A total of 182 consecutive patients (male/female 70/112; mean age 23.6 ± 7.3 years) with a history of patellar instability were prospectively enrolled in this study. Patient age, body mass index (BMI), number of dislocations, reversed dynamic patellar apprehension test (ReDPAT), J-sign severity, and pathoanatomic risk factors of patellar instability were assessed. The statistical analysis evaluated the relationships among those variables and determined their ability to predict the Banff Patellofemoral Instability Instrument 2.0 (BPII 2.0) as a disease-specific quality of life measure. Using Spearman correlation, ANOVA and Fisher’s exact test, all variables with ANOVA p ≤ 0.1 or Spearman’s abs (rho) > 0.1 were entered into a multivariate linear model using backward-stepwise selection.

Results

Analysis of the individual variables’ ability to predict BPII 2.0 score values revealed ‘age’, ‘BMI’, ‘ReDPAT’, ‘high grade of trochlear dysplasia’, and ‘high-grade J-Sign’ as possible relevant factors. Backward-stepwise multivariate regression analysis yielded a final parsimonious model that included the factors ‘BMI’ and ‘J-Sign (Grade II and III)’ as the most relevant parameters influencing BPII 2.0 score values (adjusted R2 = 0.418; p < 0.001), with a cutoff value for BMI found at 28 kg/m2 (p = 0.01).

Conclusion

The results of this study indicate that in patients with lateral patellar instability, a high-grade J-sign and an increased BMI significantly impact subjective disease-specific quality of life.

Level of evidence

Level IV.

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Data availability

Raw data can be made available upon request. Data analysis protocols are listed in the “Statistical Analysis Supplement file”.

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Funding

No funding has been received for conducting this study.

Author information

Authors and Affiliations

  1. Arcus Sportklinik, Rastatter Str. 17-19, 75179, Pforzheim, Germany

    Danko Dan Milinkovic & Peter Balcarek

  2. Group for Econometric Analysis, Statistical Office of the Republic of Serbia, Belgrade, Serbia

    Isidora Jovandic

  3. Berufsgenossenschaftliche Unfallklinik Ludwigshafen, Ludwigshafen am Rhein, Germany

    Felix Zimmermann

  4. Department of Trauma Surgery, Orthopaedics, and Plastic Surgery, University Medicine Göttingen, Göttingen, Germany

    Peter Balcarek

Authors
  1. Danko Dan Milinkovic
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  2. Isidora Jovandic
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  3. Felix Zimmermann
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  4. Peter Balcarek
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Contributions

DDM: data acquisition, data analysis, data interpretation, writing the paper, final approval; IJ: statistical analysis, data interpretation, final approval; FZ: data analysis, data interpretation, final approval; PB: study design, data analysis, data interpretation, writing the paper, final approval.

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Correspondence to Danko Dan Milinkovic.

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No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. The authors declare that they have no competing interests.

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This study was approved by the Ethics Committee of Baden-Württemberg, Germany (F-2019-070).

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Milinkovic, D.D., Jovandic, I., Zimmermann, F. et al. The J-sign and the body mass index determine the disease-specific quality of life in patients with lateral patellar instability. Knee Surg Sports Traumatol Arthrosc 30, 1672–1678 (2022). https://doi.org/10.1007/s00167-021-06705-6

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  • DOI: https://doi.org/10.1007/s00167-021-06705-6

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