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The influence of patellofemoral stabilisation surgery on joint congruity: an MRI surface mapping study

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Abstract

Background

In the unstable patellofemoral joint (PFJ), the patella will articulate in an abnormal manner, producing an uneven distribution of forces. It is hypothesised that incongruency of the PFJ, even without clinical instability, may lead to degenerative changes. The aim of this study was to record the change in joint contact area of the PFJ after stabilisation surgery using an established and validated MRI mapping technique.

Methods

A prospective MRI imaging study of patients with a history of PFJ instability was performed. The patellofemoral joints were imaged with the use of an MRI scan during active movement from 0° through to 40° of flexion. The congruency through measurement of the contact surface area was mapped in 5-mm intervals on axial slices. Post-stabilisation surgery contact area was compared to the pre-surgery contact area.

Results

In all, 26 patients were studied. The cohort included 12 male and 14 female patients with a mean age of 26 (15–43). The greatest mean differences in congruency between pre- and post-stabilised PFJs were observed at 0–10 degrees of flexion (0.54 cm2 versus 1.18 cm2, p = 0.04) and between 11° and 20° flexion (1.80 cm2 versus 3.45 cm2; p = 0.01).

Conclusion

PFJ stabilisation procedures increase joint congruency. If a single axial series is to be obtained on MRI scan to compare the pre- and post-surgery joint congruity, the authors recommend 11° to 20° of tibiofemoral flexion as this was shown to have the greatest difference in contact surface area between pre- and post-operative congruency.

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Acknowledgement

This study was supported by the NIHR Biomedical Research Centre at University Hospitals Bristol NHS Foundation Trust and the University of Bristol.The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health and Social Care.

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No funds, grants, or other financial support were received.

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Correspondence to Jarrad M. Stevens.

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The authors have no conflicts of interest to declare that are relevant to the content of this article.

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Ethical approval was sought and approved from the Southwest research ethics committee via the Integrated Research Application System (IRAS) and all participants gave written informed consent. (12/SW/0155).

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Stevens, J.M., Eldridge, J.D., Tortonese, D. et al. The influence of patellofemoral stabilisation surgery on joint congruity: an MRI surface mapping study. Eur J Orthop Surg Traumatol 32, 419–425 (2022). https://doi.org/10.1007/s00590-021-02980-8

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  • DOI: https://doi.org/10.1007/s00590-021-02980-8

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