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Magnetic resonance imaging overestimates patellar height compared with radiographs



To evaluate the inter-observer and inter-method reliability for patellar height measurements between conventional radiographs (CR) and magnetic resonance imaging (MRI) using one or two slices.


This was a reliability study, with 60 patients divided in two groups: 30 patients with patellar instability (patella group) and 30 patients with anterior cruciate ligament or meniscus injury (control group). CR and MRI were evaluated by two independent observers. Insall–Salvati index (IS) and Caton–Deschamps index (CD) were measured using three different methods: CR, one-slice MRI or two-slice MRI. Intra-class correlation coefficients (ICC) were calculated for inter-observer reliability and inter-method reliability. Bland–Altman agreement was also calculated.


The inter-observer reliability was very good for the IS with ICCs of 0.93, 0.84 and 0.82, for the CR, one-slice MRI and two-slice MRI, respectively. Similarly, for the CD the ICCs were good, 0.76, 0.80 and 0.75 for the CR, one-slice MRI and two-slice MRI, respectively. No differences were found between the patella and the control group. The inter-method analysis results were: ICCs for IS (0.83, 0.86, 0.93) and CD (0.72, 0.82, 0.83), for the comparisons of CR/one-slice MR, CR/two-slice MRI and one-slice MRI/two-slice MRI, respectively. The Bland–Altman mean differences showed an 8% and a 7% increase on IS values with one-slice MRI and two-slice MRI compared to CR results, while the increase was of 9% and 1% in CD for the respective comparisons with CR.


MRI can overestimate patellar height compared to CR, as much as an 8% increase in Insall–Salvati values when using one- or two-slice MRI measurements, and up to a 9% increase in Caton–Deschamps value when using the one-slice MRI method. It is recommended to use the CR as the preferred method when measuring patellar height.

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Authors and Affiliations



EA, BBH and JPM-C contributed to the study conception. All authors contributed to the study design. Material preparation and data collection were performed by RGG, GBC and JPM-C. Analysis was performed by PNG. The first draft of the manuscript was written by BBH and JPM, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Juan Pablo Martinez-Cano.

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All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the institutional review board of University of Sao Paulo (No. 30227520.9.0000.0068).

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Martinez-Cano, J.P., Gobbi, R.G., Giglio, P.N. et al. Magnetic resonance imaging overestimates patellar height compared with radiographs. Knee Surg Sports Traumatol Arthrosc 30, 3461–3469 (2022).

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  • Patellofemoral joint
  • Patellar dislocation
  • Magnetic resonance imaging
  • X-rays
  • Patellar height