Patellar shape can be a predisposing factor in patellar instability

  • Alfredo Schiavone Panni
  • Simone Cerciello
  • Nicola Maffulli
  • Mariachiara Di Cesare
  • Elvire Servien
  • Philippe Neyret
Knee
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Accepted:

Abstract

Purpose

Predisposing factors to objective patellar instability include trochlear dysplasia, patella alta, patellar tilt and elevated tibial tuberosity–femoral groove distance. The shape of the patella is classically not considered a predisposing factor. Anomalies of dynamic and static factors, including excessive patellar height, tibial tubercle lateralisation or trochlear dysplasia, may influence the development of the patella.

Methods

One hundred and five patients (140 knees) with objective patellar instability were retrospectively reviewed to identify a possible association between the above-mentioned predisposing factors and patellar shape. All patients were evaluated with static and dynamic CT scans, and plain lateral and antero-posterior radiographs, and skyline patellar views.

Results

Evidence of a significant association emerged between patellar shape and patellar tilt in static (r s = 0.20, P = 0.019) or dynamic conditions (r s = 0.18, P = 0.031) and a significant association between Wiberg patellar shape type C and trochlear dysplasia grade 3 (χ2 = 4.5, P = 0.035). Also, we found a significant association between trochlear dysplasia stage 3 and tibial tuberosity–trochlear groove (TT–TG) and patellar tilt relaxed (P < 0.01 and P < 0.05, respectively). There is an association between patellar shape and patellar tilt.

Conclusion

Increased lateral stresses may produce a Wiberg type C patella, with a hypoplastic medial facet and a more developed lateral facet. Unbalance between dynamic medial and lateral stabilisers may act as an additional factor. A rehabilitation program aiming to reduce this unbalance may decrease the incidence of type C patella in young patients.

Keywords

Patellar shape Objective patellar instability Trochlear dysplasia Patellar tilt 
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Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Alfredo Schiavone Panni
    • 1
  • Simone Cerciello
    • 2
  • Nicola Maffulli
    • 3
  • Mariachiara Di Cesare
    • 4
  • Elvire Servien
    • 5
  • Philippe Neyret
    • 5
  1. 1.Science of Health Orthopaedic DepartmentMolise UniversityCampobassoItaly
  2. 2.Science of Health DepartmentMolise UniversityCampobassoItaly
  3. 3.Centre for Sports and Exercise MedicineQueen Mary University of London, Barts and The London School of Medicine and Dentistry, Mile End HospitalLondonUK
  4. 4.Department of Education, School of Education & Social Work, Essex HouseUniversity of SussexBrightonUK
  5. 5.Centre Albert Trillat. Hôpital de la Croix RousseLyonFrance

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