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Patellar shape can be a predisposing factor in patellar instability

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Predisposing factors to objective patellar instability include trochlear dysplasia, patella alta, patellar tilt and elevated tibial tuberosity–femoral groove distance. The shape of the patella is classically not considered a predisposing factor. Anomalies of dynamic and static factors, including excessive patellar height, tibial tubercle lateralisation or trochlear dysplasia, may influence the development of the patella.

Methods

One hundred and five patients (140 knees) with objective patellar instability were retrospectively reviewed to identify a possible association between the above-mentioned predisposing factors and patellar shape. All patients were evaluated with static and dynamic CT scans, and plain lateral and antero-posterior radiographs, and skyline patellar views.

Results

Evidence of a significant association emerged between patellar shape and patellar tilt in static (r s = 0.20, P = 0.019) or dynamic conditions (r s = 0.18, P = 0.031) and a significant association between Wiberg patellar shape type C and trochlear dysplasia grade 3 (χ2 = 4.5, P = 0.035). Also, we found a significant association between trochlear dysplasia stage 3 and tibial tuberosity–trochlear groove (TT–TG) and patellar tilt relaxed (P < 0.01 and P < 0.05, respectively). There is an association between patellar shape and patellar tilt.

Conclusion

Increased lateral stresses may produce a Wiberg type C patella, with a hypoplastic medial facet and a more developed lateral facet. Unbalance between dynamic medial and lateral stabilisers may act as an additional factor. A rehabilitation program aiming to reduce this unbalance may decrease the incidence of type C patella in young patients.

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Authors and Affiliations

  1. Science of Health Orthopaedic Department, Molise University, Campobasso, Italy

    Alfredo Schiavone Panni

  2. Science of Health Department, Molise University, Campobasso, Italy

    Simone Cerciello

  3. Centre for Sports and Exercise Medicine, Queen Mary University of London, Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, UK

    Nicola Maffulli

  4. Department of Education, School of Education & Social Work, Essex House, University of Sussex, Falmer, Brighton, East Sussex, BN1 9QQ, UK

    Mariachiara Di Cesare

  5. Centre Albert Trillat. Hôpital de la Croix Rousse, Lyon, France

    Elvire Servien & Philippe Neyret

Authors
  1. Alfredo Schiavone Panni
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  2. Simone Cerciello
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  3. Nicola Maffulli
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  4. Mariachiara Di Cesare
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  5. Elvire Servien
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  6. Philippe Neyret
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Correspondence to Nicola Maffulli.

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Panni, A.S., Cerciello, S., Maffulli, N. et al. Patellar shape can be a predisposing factor in patellar instability. Knee Surg Sports Traumatol Arthrosc 19, 663–670 (2011). https://doi.org/10.1007/s00167-010-1329-4

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  • DOI: https://doi.org/10.1007/s00167-010-1329-4

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