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Patellar dislocation is associated with increased tibial but not femoral rotational asymmetry

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Patellar dislocation is associated with a range of anatomical abnormalities affecting the trochlea, extensor mechanism and the tibia. The relationship between patellofemoral instability and rotational abnormalities of the posterior condyles, trochlear groove and proximal tibia has not been adequately determined. This study aimed to identify the frequency and severity of anatomical risk factors to determine their relative contribution to patellofemoral instability.

Methods

A retrospective morphological study was undertaken comparing multiple anatomical measurements with magnetic resonance imaging of 50 patients with patellofemoral instability to an age- and gender-matched Control group (n = 50). Several techniques were assessed measuring both femoral and tibial axial asymmetry. A new measurement, tibial rotational asymmetry, comparing a line between the midpoints of the collateral ligaments to the axis between the patellar tendon and posterior cruciate ligament, was assessed for its association with patellofemoral instability.

Results

Compared to the controls, the patellofemoral instability group demonstrated a significant difference in tibial rotational asymmetry, with a mean of 2.9° (SD 3.2°) externally rotated vs − 1.6° (SD 2.2°) in the control group. Significant differences were also demonstrated regarding the sulcus angle, tibial tubercle–trochlear groove distance, tibial tubercle–posterior cruciate ligament distance, patellar size and the Insall–Salvati ratio. There were no differences between groups regarding the lengths of the posterior condyles, the heights of the trochlear ridges or lateralisation of the trochlear groove. Further analysis of the patellofemoral instability group revealed a subgroup of males with normal anatomy (7/50) and a subgroup of females with isolated patella alta (7/50).

Conclusion

Patellofemoral instability is associated with tibial rotational asymmetry due to lateralisation of the tibial tubercle. It is also associated with patella alta and reduced trochlear groove depth. The femoral axial shape is otherwise unchanged.

Level of evidence

III.

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Funding

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Author information

Authors and Affiliations

  1. The Sports Medicine Practice Hobart, 36 Collins Street, Hobart, TAS, 7000, Australia

    Liam Geraghty

  2. Department of Orthopaedic Surgery, Western Health, 160 Gordon Street, Footscray, VIC, 3011, Australia

    Liam Geraghty, Phoebe Walker, Tat Woon Chao & Simon Talbot

  3. Simon Talbot, 1/210 Burgundy Street, Heidelberg, VIC, 3084, Australia

    Rachel Zordan & Simon Talbot

  4. Honorary Senior Fellow, Melbourne Medical School, University of Melbourne, Parkville, VIC, 3052, Australia

    Rachel Zordan

Authors
  1. Liam Geraghty
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  2. Rachel Zordan
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  3. Phoebe Walker
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  4. Tat Woon Chao
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  5. Simon Talbot
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Contributions

LG designed the study, collected data, and wrote the manuscript. RJ collected data and wrote the manuscript. PW collected data and wrote the manuscript. TC designed the study and wrote the manuscript. ST designed the study, collected data, and wrote the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Liam Geraghty.

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Conflict of interest

None applicable.

Ethical approval

We have approval to complete this study from our Institutional Review Board—the Western Health Research and Governance Administration with the following Reference number—QA 2015.12.

Informed consent

As the study was a retrospective analysis of de-identified data, informed consent was not required as part of the ethics approval.

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Geraghty, L., Zordan, R., Walker, P. et al. Patellar dislocation is associated with increased tibial but not femoral rotational asymmetry. Knee Surg Sports Traumatol Arthrosc 30, 2342–2351 (2022). https://doi.org/10.1007/s00167-021-06813-3

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  • DOI: https://doi.org/10.1007/s00167-021-06813-3

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