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The Dynamic Effect of Anterior Cruciate Ligament Deficiency on Patellar Height

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Abstract

Background

The anterior tibial translation (ATT) in case of Anterior Cruciate Ligament (ACL) tear can lead to dynamic alterations of the extensor apparatus biomechanics. The aim of this study is to evaluate the dynamic effect of isolated ACL deficiency on patellar height. The hypothesis is that the ATT of ACL-insufficient knees dynamically reduces patellar height.

Methods

Skeletally mature patients who underwent ACL reconstruction using hamstring graft between January and December 2018 were included in this study. The Posterior Tibial Slope (PTS), Caton–Deschamps (CDI), modified Insall–Salvati (MISI), and Blackburne–Peel (BPI) indices were calculated in standard lateral and TELOS X-rays. The mean of the measurements calculated between two observers was used to compare these parameters.

Results

95 patients (M: 57; F: 38; 95 knees) were included in the study with a mean age of 31.8 years (16–56 years old). Significant patellar height reduction (CDI: 0.11 [− 0.32; 0.31]; MISI: 0.09 [− 0.66; 0.30]) was reported in TELOS compared with standard lateral knee radiography (p < 0.001). 20.0% of the study knees reported an abnormal CDI and 84.2% (16/19 knees) of them reduced this index to within normal limits in TELOS. 20.0% of the knees with mild patella alta reduced CDI in TELOS but always remained above 1.2.

Conclusions

The abnormal ATT in case of ACL-deficient knees results in a lowering effect of the patella in TELOS X-rays. In patients with ACL tear and anterior pain the reconstructive ligament surgery should be performed to avoid also chronic anterior knee pain.

Level of evidence

Basic Science Study (Case Series).

Clinical relevance

The decrease in patellar height in stress-X-rays compared with standard lateral knee radiography in ACL deficient knees, should be considered as a possible contributing cause of anterior pain in these patients.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. U.O.C. Clinica Ortopedica e Traumatologica Universitaria CTO, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy

    Francesco Luceri

  2. FIFA Medical Center of Excellence, Orthopaedics Surgery and Sports Medicine Department, Croix Rousse Hospital, Civil Hospices of Lyon, 103 Boulevard de la Croix Rousse, 69004, Lyon, France

    Francesco Luceri, Mattia Basilico, Cécile Batailler, Sébastien Lustig & Elvire Servien

  3. Catholic University of the Sacred Heart School of Medicine, L.go A. Gemelli 1, 00168, Rome, Italy

    Mattia Basilico

  4. U.O.C. 1a Divisione, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy

    Pietro Simone Randelli

  5. Laboratorio di Biomeccanica Applicata, Dipartimento di Scienze Biomediche per la Salute, University of Milan, Via Mangiagalli 31, 20133, Milan, Italy

    Pietro Simone Randelli

  6. LBMC UMR T 9406, Laboratory of Chock Mechanics and Biomechanics, Claude Bernard Lyon 1 University, Lyon, France

    Sébastien Lustig

  7. Interuniversity Laboratory of Biology of Mobility, LIBM, EA 7424, Claude Bernard Lyon 1 University, Lyon, France

    Elvire Servien

Authors
  1. Francesco Luceri
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  2. Mattia Basilico
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  3. Cécile Batailler
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  4. Pietro Simone Randelli
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  5. Sébastien Lustig
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Corresponding author

Correspondence to Francesco Luceri.

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Conflict of Interest

FL has nothing to disclose. MB has nothing to disclose. CB has nothing to disclose. PSR reports personal fees from Arthrex, personal fees from Depuy (Johnson&Johnson), outside the submitted work. SL reports personal fees from Lepine, personal fees from Depuy (Johnson&Johnson), personal fees from Heraeus, personal fees from Smith & Nephew, personal fees from Stryker, personal fees from Medacta, other from Corin, other from Amplitude, outside the submitted work. ES reports personal fees from Smith & Nephew, grants from Corin, outside the submitted work.

Ethical Approval

The Advisory Committee on Research Information Processing in the Field of Health approved this study in Paris on May 2019 under number 19-134. Our medical practice has not been modified for this study. All procedures were performed in accordance with the ethical standards of the institutional and/or national research committee, the 1964 Helsinki declaration and its later amendments, or comparable ethical standards.

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As per institutional standards, formal patient consent is not required for this type of study.

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Luceri, F., Basilico, M., Batailler, C. et al. The Dynamic Effect of Anterior Cruciate Ligament Deficiency on Patellar Height. JOIO 56, 1403–1409 (2022). https://doi.org/10.1007/s43465-022-00632-5

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