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Case Report: Quantitative MRI of Tibial Tubercle Transfer During Active Quadriceps Contraction

  • Case Report
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

The evaluation of distal transfer procedures relies primarily on qualitative clinical findings. Although quantitative MRI measurements provide an objective supplement to qualitative clinical findings, an association between qualitative clinical findings and quantitative patellofemoral indices has yet to be established.

Case Description

A 21-year-old man presented with frequent episodes of patellar dislocation. Clinical and radiographic findings identified the patient as a candidate for realignment. MR images were obtained with the quadriceps contracted at 30° flexion and in full extension preoperatively and postoperatively. The procedure eliminated the clinical J-sign, defined as lateral movement of the patella over the lateral femoral condyle during active leg extension, which was confirmed quantitatively using established patellofemoral indices in conjunction with MRI.

Literature Review

Movement of the patellofemoral joint is complex and dependent on many factors, including skeletal geometry, dynamic muscle action, and soft tissue restraints. Therefore, proper clinical and radiographic evaluation of patellar tracking requires observation during active quadriceps contraction. However, it is unclear whether there is any association between quantitative radiographic indices and qualitative clinical assessment during active quadriceps contraction.

Purposes and Clinical Relevance

We believe objective measurements are valuable in determining the radiographic assessment of patellar realignment procedures. Lateral patellar edge appears to quantify the clinical J-sign. The association between radiographic medialization of the patella and clinical improvement postoperatively in this patient warrants additional investigation in a larger group of patients with longer followup.

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Acknowledgments

We thank the University of Iowa Carver College of Medicine and the University of Iowa Hospitals and Clinics, Department of Orthopaedics, for the support and resources required to complete this study.

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Authors and Affiliations

  1. University of Iowa Carver College of Medicine, Iowa City, IA, USA

    Kyle Duchman BA, Chloe Mellecker BS & Ahmad Y. El-Hattab BS

  2. Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 01008 JPP, Iowa City, IA, 52242, USA

    John P. Albright MD

Authors
  1. Kyle Duchman BA
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  2. Chloe Mellecker BS
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  3. Ahmad Y. El-Hattab BS
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  4. John P. Albright MD
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Corresponding author

Correspondence to John P. Albright MD.

Additional information

Each author certifies that he or she has no commercial associations that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution has approved the reporting of this case, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at the University of Iowa Carver College of Medicine, Iowa City, IA, USA.

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Duchman, K., Mellecker, C., El-Hattab, A.Y. et al. Case Report: Quantitative MRI of Tibial Tubercle Transfer During Active Quadriceps Contraction. Clin Orthop Relat Res 469, 294–299 (2011). https://doi.org/10.1007/s11999-010-1598-8

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  • DOI: https://doi.org/10.1007/s11999-010-1598-8

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