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Alignment in the transverse plane, but not sagittal or coronal plane, affects the risk of recurrent patella dislocation

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

A Correction to this article was published on 18 December 2017

This article has been updated

Abstract

Purpose

Abnormalities of lower extremity alignment (LEA) in recurrent patella dislocation (RPD) have been studied mostly by two-dimensional (2D) procedures leaving three-dimensional (3D) factors unknown. This study aimed to three-dimensionally examine risk factors for RPD in lower extremity alignment under the weight-bearing conditions.

Methods

The alignment of 21 limbs in 15 RPD subjects was compared to the alignment of 24 limbs of 12 healthy young control subjects by an our previously reported 2D–3D image-matching technique. The sagittal, coronal, and transverse alignment in full extension as well as the torsional position of the femur (anteversion) and tibia (tibial torsion) under weight-bearing standing conditions were assessed by our previously reported 3D technique. The correlations between lower extremity alignment and RPD were assessed using multiple logistic regression analysis. The difference of lower extremity alignment in RPD between under the weight-bearing conditions and under the non-weight-bearing conditions was assessed.

Results

In the sagittal and coronal planes, there was no relationship (statistically or by clinically important difference) between lower extremity alignment angle and RPD. However, in the transverse plane, increased external tibial rotation [odds ratio (OR) 1.819; 95% confidence interval (CI) 1.282–2.581], increased femoral anteversion (OR 1.183; 95% CI 1.029–1.360), and increased external tibial torsion (OR 0.880; 95% CI 0.782–0.991) were all correlated with RPD. The tibia was more rotated relative to femur at the knee joint in the RPD group under the weight-bearing conditions compared to under the non-weight-bearing conditions (p < 0.05).

Conclusions

This study showed that during weight-bearing, alignment parameters in the transverse plane related to the risk of RPD, while in the sagittal and coronal plane alignment parameters did not correlate with RPD. The clinical importance of this study is that the 3D measurements more directly, precisely, and sensitively detect rotational parameters associated with RPD and hence predict risk of RPD.

Level of evidence

III.

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Change history

  • 18 December 2017

    The author would like to correct the errors in the publication of the original article. The corrected detail is given below for your reading.

References

  1. Ariumi A, Sato T, Kobayashi K, Koga Y, Omori G, Minato I, Endo N (2010) Three-dimensional lower extremity alignment in the weight bearing standing position in healthy elderly subjects. J Orthop Sci 15:64–70

    Article  Google Scholar 

  2. Bauer J, Patrick Do K, Feng J, Pierce R, Aiona M (2017) Knee recurvatum in children with spastic diplegic cerebral palsy. J Pediatr Orthop. https://dx.doi.org/10.1097/BPO.0000000000000985

    Article  PubMed  Google Scholar 

  3. Beaconsfield T, Pintore E, Maffulli N, Petri GJ (1994) Radiological measurements in patellofemoral disorders. A review. Clin Orthop Relat Res 308:18–28

    Google Scholar 

  4. Boden BP, Pearsall AW, Garrett WE, Feagin JA Jr (1997) Patellofemoral instability: evaluation and management. J Am Acad Orthop Surg 5:47–57

    Article  CAS  Google Scholar 

  5. Colvin AC, West RV (2008) Patellar instability. J Bone Joint Surg Am 90:2751–2762

    Article  Google Scholar 

  6. Dejour H, Walch G, Nove-Josserand L, Guier C (1994) Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc 2:19–26

    Article  CAS  Google Scholar 

  7. Diederichs G, Issever AS, Scheffler S (2010) MR imaging of patellar instability: injury patterns and assessment of risk factors. Radiographics 30:961–981

    Article  Google Scholar 

  8. Diederichs G, Kohliz T, Kornaropoulos E, Heller MO, Vollnberg B, Scheffler S (2013) Magnetic resonance imaging analysis of rotational alignment in patients with patellar dislocations. Am J Sports Med 41:51–57

    Article  Google Scholar 

  9. Eckhoff DG, Jacofsky DJ, Springer BD, Dunbar M, Cherian JJ, Elmallah RK, Mont MA, Greene KA (2016) Bilateral symmetrical comparison of femoral and tibial anatomic features. J Arthroplast 31:1083–1090

    Article  Google Scholar 

  10. Eckhoff DG, Johnson KK (1994) Three-dimensional computed tomography reconstruction of tibial torsion. Clin Orthop Relat Res 302:42–46

    Google Scholar 

  11. Elias DA, White LM (2004) Imaging of patellofemoral disorders. Clin Radiol 59:543–557

    Article  CAS  Google Scholar 

  12. Erkocak OF, Altan E, Altintas M, Turkmen F, Aydin BK, Bayar A (2016) Lower extremity rotational deformities and patellofemoral alignment parameters in patients with anterior knee pain. Knee Surg Sports Traumatol Arthrosc 24:3011–3020

    Article  Google Scholar 

  13. Fabry G, Cheng LX, Molenaers G (1994) Normal and abnormal torsional development in children. Clin Orthop Relat Res 302:22–26

    Google Scholar 

  14. Gillespie D, Mandziak D, Howie C (2015) Influence of posterior lateral femoral condyle geometry on patellar dislocation. Arch Orthop Trauma Surg 135:1503–1509

    Article  Google Scholar 

  15. Hermans K, Claes S, Bellemans J (2013) Valgus instability as a cause for recurrent lateral patellar dislocation: a new mechanism for patellofemoral instability? Acta Orthop Belg 79:495–501

    PubMed  Google Scholar 

  16. Jakob RP, Haertel M, Stüssi E (1980) Tibial torsion calculated by computerised tomography and compared to other methods of measurement. J Bone Joint Surg Br 62-B:238–242

    Article  CAS  Google Scholar 

  17. Kearney SP, Mosca VS (2015) Selective hemiepiphyseodesis for patellar instability with associated genu valgum. J Orthop 27:17–22

    Article  Google Scholar 

  18. Kobayashi K, Sakamoto M, Tanabe Y, Ariumi A, Sato T, Omori G, Koga Y (2009) Automated image registration for assessing three-dimensional alignment of entire lower extremity and implant position using bi-plane radiography. J Biomech 42:2818–2822

    Article  Google Scholar 

  19. Nomura E, Inoue M, Kobayashi S (2006) Generalized joint laxity and contralateral patellar hypermobility in unilateral recurrent patellar dislocators. Arthroscopy 22:861–865

    Article  Google Scholar 

  20. Parikh S, Frank R. Noyes FR (2011) Patellofemoral disorders: role of computed tomography and magnetic resonance imaging in defining abnormal rotational lower limb alignment. Sports Health 3:158–169

    Article  Google Scholar 

  21. Peduzzi P, Concato J, Kemper E, Holford TR, Feinstein AR (1996) A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol 49:1373–1379

    Article  CAS  Google Scholar 

  22. Prakash J, Seon JK, Woo SH, Jin C, Song EK (2016) Comparison of radiological parameters between normal and patellar dislocation groups in korean population: a rotational profile ct-based study. Knee Surg Relat Res 28:302–311

    Article  Google Scholar 

  23. Redziniak DE, Diduch DR, Mihalko WM, Fulkerson JP, Novicoff WM, Sheibani-Rad S, Saleh KJ (2009) Patellar instability. J Bone Joint Surg Am 91-A:2264–2275

    Google Scholar 

  24. Runow A (1983) The dislocating patella. Etiology and prognosis in relation to generalized joint laxity and anatomy of the patellar articulation. Acta Orthop Scand 201:1–53

    Article  CAS  Google Scholar 

  25. Sato T, Koga Y, Omori G (2004) Three-dimensional lower extremity alignment assessment system: application to evaluation of component position after total knee arthroplasty. J Arthroplast 19:620–628

    Article  Google Scholar 

  26. Schiphouwer L, Rood A, Tigchelaar S, Koëter S (2017) Complications of medial patellofemoral ligament reconstruction using two transverse patellar tunnels. Knee Surg Sports Traumatol Arthrosc 25:245–250

    Article  Google Scholar 

  27. Staheli LT, Corbett M, Wyss C (1985) Lower-extremity rotational problems in children. Normal values to guide management. J Bone Joint Surg Am 67-B:39–47

    Article  Google Scholar 

  28. Staheli LT (1989) Torsion: treatment indications. Clin Orthop 247:61–66

    Google Scholar 

  29. Takai S, Sakakida K, Yamashita F, Suzu F, Izuta F (1985) Rotational alignment of the lower limb in osteoarthritis of the knee. Int Orthop 9:209–215

    Article  CAS  Google Scholar 

  30. Takai S (1996) Biomechanics of the patellofemoral joint. J Joint Surg 15:16–25 (in Japanese)

    Google Scholar 

  31. Tamari K, Tinley P, Briffa K, Breidahl W (2005) Validity and reliability of existing and modified clinical methods of measuring femoral and tibiofibular torsion in healthy subjects: use of different reference axes may improve reliability. Clin Anat 18:46–55

    Article  Google Scholar 

  32. Thienpont E, Parvizi J (2016) A new classification for the varus knee. J Arthroplast 31:2156–2160

    Article  Google Scholar 

  33. Turner MS (1994) The association between tibial torsion and knee joint pathology. Clin Orthop Relat Res 302:47–51

    Google Scholar 

  34. Weiner DS, Cook AJ, Hoyt WA Jr, Oravec CE (1978) Computed tomography in the measurement of femoral anteversion. Orthopedics 1:299–306

    Article  CAS  Google Scholar 

  35. Yamada Y, Toritsuka Y, Nakamura N, Horibe S, Sugamoto K, Yoshikawa H, Shino K (2017) Correlation of 3D shift and 3D tilt of the patella in patients with recurrent dislocation of the patella and healthy volunteers: an in vivo analysis based on 3-dimensional computer models. Am J Sports Med 45:3111–3118

    Article  Google Scholar 

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Acknowledgements

The authors thank the members of the radiology unit of Niigata Medical Center and Niigata University Hospital.

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Authors and Affiliations

  1. Division of Orthopaedic Surgery, Department of Regenerative and Transplant Medicine, Graduate School of Medicine and Dental Sciences, Niigata University, 1-754 Asahimachidori Cuo-ku, Niigata, Niigata, 951-8510, Japan

    Shigeru Takagi, Osamu Tanifuji, Tomoharu Mochizuki & Naoto Endo

  2. Niigata Medical Center, Niigata, Japan

    Takashi Sato & Satoshi Watanabe

  3. Niigata University of Health and Welfare, Niigata, Japan

    Go Omori

Authors
  1. Shigeru Takagi
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  2. Takashi Sato
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  3. Satoshi Watanabe
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  4. Osamu Tanifuji
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  5. Tomoharu Mochizuki
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  6. Go Omori
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  7. Naoto Endo
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Contributions

ST, TS, SW, OT, TM, GO, and NE contributed to study concept and design. ST, TS, SW, OT, TM, GO, and NE contributed to acquisition of data. ST and TS analysed and interpreted data. ST and TS drafted the manuscript. ST and TS contributed to critical revision. All authors have read and approved the manuscript for submission.

Corresponding author

Correspondence to Shigeru Takagi.

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Conflict of interest

Shigeru Takagi, Takashi Sato, Satoshi Watanabe, Osamu Tanifuji, Tomoharu Mochizuki, Go Omori, and Naoto Endo declare that they have no conflicts of interest.

Funding

This study was not provided any outside financial support.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the ethics committee of Niigata medical center (ID number 201501).

Informed consent

All subjects gave informed consent to participate in this study.

Additional information

The original version of this article was revised: In the second paragraph of the Results section, the production team has wrongly added minus symbol before two values.

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Takagi, S., Sato, T., Watanabe, S. et al. Alignment in the transverse plane, but not sagittal or coronal plane, affects the risk of recurrent patella dislocation. Knee Surg Sports Traumatol Arthrosc 26, 2891–2898 (2018). https://doi.org/10.1007/s00167-017-4806-1

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