Skip to main content

Advertisement

SpringerLink
Log in

Ipsilateral patellofemoral morphological abnormalities are more severe than those of contralateral joints in patients with unilateral patellar dislocation

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

Abstract

Purpose

To determine the differences in anatomic parameters between ipsilateral dislocated knees and contralateral non-dislocated knees in patients with unilateral patellar dislocation and to identify any variations in ipsilateral knees contributing to contralateral anatomic abnormalities.

Methods

A total of 82 patients with unilateral patellar dislocation from 2016 to 2019 were retrospectively evaluated. Bilateral anatomic factors, including the tibial tubercle to trochlear groove (TT-TG) distance, lower limb rotational deformities, trochlear dysplasia, patella tilt, and patellar height, were assessed by CT.

Results

The study included 46 patients (32 females and 14 males, mean age ± SD 20.5 ± 6.8). The interobserver reliability of each parameter showed excellent agreement. The ipsilateral TT-TG distance (P = 0.004), patella tilt (P = 0.001), and patellar height (P = 0.01) were greater in the ipsilateral knees than in the contralateral knees. The lateral trochlea inclination (LTI) in the contralateral knees was larger than that in the ipsilateral knees (P = 0.022). There was a significant difference in the distribution of trochlear dysplasia of Dejour between the ipsilateral knees (dislocated side) and the contralateral knees (P = 0.036). However, bilateral femoral and/or tibial torsion, and bilateral knee joint rotation did not differ significantly. Binary logistic regression showed that only ipsilateral LTI revealed significant ORs of 8.83 (P = 0.016) and 7.64 (P = 0.018) with regard to contralateral abnormal tibial torsion and LTI, respectively.

Conclusion

In patients with unilateral patellar dislocation, the ipsilateral TT-TG distance, patella tilt, and patellar height values were larger in the ipsilateral knees than in the contralateral knees, and trochlear dysplasia was more severe in the ipsilateral joints. The risks of contralateral pathological tibial torsion and LTI were 8.8- and 7.6-fold higher, respectively, in patients with abnormal ipsilateral LTI.

Level of evidence

Level IV.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Balcarek P, Oberthür S, Hopfensitz S, Frosch S, Walde TA, Wachowski MM et al (2014) Which patellae are likely to redislocate? Knee Surg Sports Traumatol Arthrosc 22:2308–2314

    Article  PubMed  Google Scholar 

  2. Bayhan IA, Kirat A, Alpay Y, Ozkul B, Kargin D (2018) Tibial tubercle-trochlear groove distance and angle are higher in children with patellar instability. Knee Surg Sports Traumatol Arthrosc 26:3566–3571

    Article  PubMed  Google Scholar 

  3. Brady JM, Rosencrans AS, Shubin Stein BE (2018) Use of TT-PCL versus TT-TG. Curr Rev Musculoskelet Med 11:261–265

    Article  PubMed  PubMed Central  Google Scholar 

  4. Brady JM, Sullivan JP, Nguyen J, Mintz D, Green DW, Strickland S et al (2017) The tibial tubercle-to-trochlear groove distance is reliable in the setting of trochlear dysplasia, and superior to the tibial tubercle-to-posterior cruciate ligament distance when evaluating coronal malalignment in patellofemoral instability. Arthroscopy 33:2026–2034

    PubMed  Google Scholar 

  5. Carlson VR, Boden BP, Shen A, Jackson JN, Yao L, Sheehan FT (2017) The tibial tubercle-trochlear groove distance is greater in patients with patellofemoral pain: implications for the origin of pain and clinical interventions. Am J Sports Med 45:1110–1116

    Article  PubMed  PubMed Central  Google Scholar 

  6. Christensen TC, Sanders TL, Pareek A, Mohan R, Dahm DL, Krych AJ (2017) Risk factors and time to recurrent ipsilateral and contralateral patellar dislocations. Am J Sports Med 45:2105–2110

    Article  PubMed  Google Scholar 

  7. Dagneaux L, Bin Abd Razak HR, Laumonerie P, Faizhan A, LiArno S, Wellings P et al (2021) Bony asymmetry in patellofemoral morphology and risk factors of instability are mostly clinically negligible. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-020-06413-7

    Article  PubMed  Google Scholar 

  8. Demehri S, Thawait GK, Williams AA, Kompel A, Elias JJ, Carrino JA et al (2014) Imaging characteristics of contralateral asymptomatic patellofemoral joints in patients with unilateral instability. Radiology 273:821–830

    Article  PubMed  Google Scholar 

  9. Erickson BJ, Nguyen J, Gasik K, Gruber S, Brady J, Shubin Stein BE (2019) Isolated medial patellofemoral ligament reconstruction for patellar instability regardless of tibial tubercle-trochlear groove distance and patellar height: outcomes at 1 and 2 years. Am J Sports Med 47:1331–1337

    Article  PubMed  Google Scholar 

  10. Fithian DC, Paxton EW, Stone ML, Silva P, Davis DK, Elias DA et al (2004) Epidemiology and natural history of acute patellar dislocation. Am J Sports Med 32:1114–1121

    Article  PubMed  Google Scholar 

  11. Franciozi CE, Ambra LF, Albertoni LJ, Debieux P, Rezende FC, Oliveira MA et al (2017) Increased femoral anteversion influence over surgically treated recurrent patellar instability patients. Arthroscopy 33:633–640

    Article  PubMed  Google Scholar 

  12. Franciozi CE, Ambra LF, Albertoni LJB, Debieux P, Granata GSM Jr, Kubota MS et al (2019) Anteromedial tibial tubercle osteotomy improves results of medial patellofemoral ligament reconstruction for recurrent patellar instability in patients with tibial tuberosity-trochlear groove distance of 17 to 20 mm. Arthroscopy 35:566–574

    Article  PubMed  Google Scholar 

  13. Gravesen KS, Kallemose T, Blønd L, Troelsen A, Barfod KW (2018) High incidence of acute and recurrent patellar dislocations: a retrospective nationwide epidemiological study involving 24.154 primary dislocations. Knee Surg Sports Traumatol Arthrosc 26:1204–1209

    PubMed  Google Scholar 

  14. Huntington LS, Webster KE, Devitt BM, Scanlon JP, Feller JA (2019) Factors associated with an increased risk of recurrence after a first-time patellar dislocation: a systematic review and meta-analysis. Am J Sports Med 48:2552–2562

    Article  PubMed  Google Scholar 

  15. Kaiser P, Konschake M, Loth F, Plaikner M, Attal R, Liebensteiner M et al (2020) Derotational femoral osteotomy changes patella tilt, patella engagement and tibial tuberosity trochlear groove distance. Knee Surg Sports Traumatol Arthrosc 28:926–933

    Article  PubMed  Google Scholar 

  16. Kaiser P, Loth F, Attal R, Kummann M, Schuster P, Riechelmann F et al (2020) Static patella tilt and axial engagement in knee extension are mainly influenced by knee torsion, the tibial tubercle-trochlear groove distance (TTTG), and trochlear dysplasia but not by femoral or tibial torsion. Knee Surg Sports Traumatol Arthrosc 28:952–959

    Article  CAS  PubMed  Google Scholar 

  17. Kaiser P, Schmoelz W, Schoettle P, Zwierzina M, Heinrichs C, Attal R (2017) Increased internal femoral torsion can be regarded as a risk factor for patellar instability - A biomechanical study. Clin Biomech (Bristol, Avon) 47:103–109

    Article  Google Scholar 

  18. Kuroda Y, Matsushita T, Matsumoto T, Kawakami Y, Kurosaka M, Kuroda R (2014) Bilateral medial patellofemoral ligament reconstruction in high-level athletes. Knee Surg Sports Traumatol Arthrosc 22:2465–2469

    Article  PubMed  Google Scholar 

  19. Levy BJ, Tanaka MJ, Fulkerson JP (2020) Current concepts regarding patellofemoral trochlear dysplasia. Am J Sports Med. https://doi.org/10.1177/0363546520958423363546520958423

    Article  PubMed  PubMed Central  Google Scholar 

  20. Lin KM, James EW, Aitchison AH, Schlichte LM, Wang G, Green DW (2021) Increased tibiofemoral rotation on MRI with increasing clinical severity of patellar instability. Knee Surg Sports Traumatol Arthrosc. https://doi.org/10.1007/s00167-020-06382-x

    Article  PubMed  Google Scholar 

  21. Lippacher S, Dejour D, Elsharkawi M, Dornacher D, Ring C, Dreyhaupt J et al (2012) Observer agreement on the Dejour trochlear dysplasia classification: a comparison of true lateral radiographs and axial magnetic resonance images. Am J Sports Med 40:837–843

    Article  PubMed  Google Scholar 

  22. Marcacci M, Zaffagnini S, Iacono F, Visani A, Petitto A, Neri NP (1995) Results in the treatment of recurrent dislocation of the patella after 30 years’ follow-up. Knee Surg Sports Traumatol Arthrosc 3:163–166

    Article  CAS  PubMed  Google Scholar 

  23. Nelitz M, Lippacher S, Reichel H, Dornacher D (2014) Evaluation of trochlear dysplasia using MRI: correlation between the classification system of Dejour and objective parameters of trochlear dysplasia. Knee Surg Sports Traumatol Arthrosc 22:120–127

    Article  CAS  PubMed  Google Scholar 

  24. Paiva M, Blønd L, Hölmich P, Steensen RN, Diederichs G, Feller JA et al (2018) Quality assessment of radiological measurements of trochlear dysplasia; a literature review. Knee Surg Sports Traumatol Arthrosc 26:746–755

    Article  PubMed  Google Scholar 

  25. Parikh SN, Lykissas MG, Gkiatas I (2018) Predicting risk of recurrent patellar dislocation. Curr Rev Musculoskelet Med 11:253–260

    Article  PubMed  PubMed Central  Google Scholar 

  26. Rebolledo BJ, Nam D, Cross MB, Green DW, Sculco TP (2012) Familial association of femoral trochlear dysplasia with recurrent bilateral patellar dislocation. Orthopedics 35:e574-579

    Article  PubMed  Google Scholar 

  27. Sanders TL, Pareek A, Hewett TE, Stuart MJ, Dahm DL, Krych AJ (2018) High rate of recurrent patellar dislocation in skeletally immature patients: a long-term population-based study. Knee Surg Sports Traumatol Arthrosc 26:1037–1043

    PubMed  Google Scholar 

  28. Schöttle PB, Fucentese SF, Pfirrmann C, Bereiter H, Romero J (2005) Trochleaplasty for patellar instability due to trochlear dysplasia: a minimum 2-year clinical and radiological follow-up of 19 knees. Acta Orthop 76:693–698

    Article  PubMed  Google Scholar 

  29. Seitlinger G, Ladenhauf HN, Wierer G (2018) What is the chance that a patella dislocation will happen a second time: update on the natural history of a first time patella dislocation in the adolescent. Curr Opin Pediatr 30:65–70

    Article  PubMed  Google Scholar 

  30. Seitlinger G, Moroder P, Scheurecker G, Hofmann S, Grelsamer RP (2016) The Contribution of Different Femur Segments to Overall Femoral Torsion. Am J Sports Med 44:1796–1800

    Article  PubMed  Google Scholar 

  31. Stephen JM, Lumpaopong P, Dodds AL, Williams A, Amis AA (2015) The effect of tibial tuberosity medialization and lateralization on patellofemoral joint kinematics, contact mechanics, and stability. Am J Sports Med 43:186–194

    Article  PubMed  Google Scholar 

  32. Takagi S, Sato T, Watanabe S, Tanifuji O, Mochizuki T, Omori G et al (2018) 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

    Article  PubMed  Google Scholar 

  33. Tokgöz MA, Çavuşoğlu AT, Ayanoğlu T, Elma T, Vural A (2017) Neglected bilateral congenital dislocation of the patella. Eklem Hastalik Cerrahisi 28:128–131

    Article  PubMed  Google Scholar 

  34. Verhulst FV, van Sambeeck JDP, Olthuis GS, van der Ree J, Koëter S (2020) Patellar height measurements: Insall-Salvati ratio is most reliable method. Knee Surg Sports Traumatol Arthrosc 28:869–875

    Article  PubMed  Google Scholar 

  35. Xiong R, Chen C, Yin L, Gong X, Luo J, Wang F et al (2018) How Do Axial Scan Orientation Deviations Affect the Measurements of Knee Anatomical Parameters Associated with Patellofemoral Instability? A Simulated Computed Tomography Study. J Knee Surg 31:425–432

    Article  PubMed  Google Scholar 

  36. Xu Z, Zhang H, Chen J, Mohamed SI, Zhou A (2020) Femoral anteversion is related to tibial tubercle-trochlear groove distance in patients with patellar dislocation. Arthroscopy 36:1114–1120

    Article  PubMed  Google Scholar 

  37. Xu Z, Zhang H, Fu B, Mohamed SI, Zhang J, Zhou A (2020) Tibial tubercle-roman arch distance: a new measurement of patellar dislocation and indication of tibial tubercle osteotomy. Orthop J Sports Med 8:2325967120914872

    PubMed  PubMed Central  Google Scholar 

  38. Xu Z, Zhang H, Yan W, Qiu M, Zhang J, Zhou A (2021) Validating the role of tibial tubercle-posterior cruciate ligament distance and tibial tubercle-trochlear groove distance measured by magnetic resonance imaging in patients with patellar dislocation: a diagnostic study. Arthroscopy 37:234–242

    Article  PubMed  Google Scholar 

  39. Yang G, Dai Y, Dong C, Kang H, Niu J, Lin W, et al. (2020) Distal femoral morphological dysplasia is correlated with increased femoral torsion in patients with trochlear dysplasia and patellar instability. Bone Joint J 102-b:868–873

  40. Zhang Z, Zhang H, Song G, Wang X, Zhang J, Zheng T et al (2020) A high-grade J sign is more likely to yield higher postoperative patellar laxity and residual maltracking in patients with recurrent patellar dislocation treated with derotational distal femoral osteotomy. Am J Sports Med 48:117–127

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

None.

Funding

The authors did not receive support from any organization for the submitted work.

Author information

Authors and Affiliations

  1. Department of Orthopaedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China

    Jiaxing Chen, Xiao Huang, Zijie Xu, Hua Zhang, Aiguo Zhou, Pei Zhao & Lifeng Yin

  2. Chongqing Medical University, Chongqing, 400016, China

    Jiaxing Chen, Zijie Xu & Lifeng Yin

Authors
  1. Jiaxing Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Xiao Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Zijie Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hua Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Aiguo Zhou
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Pei Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Lifeng Yin
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by PZ, LY and ZX. The first draft of the manuscript was written by JC, and modified by XH. HZ and AZ provided theoretical supports and retrospectively verify the diagnosis of unilateral patellar dislocation of all patients. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Aiguo Zhou.

Ethics declarations

Conflict of interest

The authors declare they have no financial interests.

Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national 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 the First Affiliated Hospital of Chongqing Medical University. (Number: 2019–228).

Consent to participate

The informed consent was waived by the Ethics Committee of the First Affiliated Hospital of Chongqing Medical University in view of the retrospective nature of the study.

Availability of data and material

The data used to support the findings of this study are available from the corresponding author upon request.

Code availability

Not applicable.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chen, J., Huang, X., Xu, Z. et al. Ipsilateral patellofemoral morphological abnormalities are more severe than those of contralateral joints in patients with unilateral patellar dislocation. Knee Surg Sports Traumatol Arthrosc 29, 2709–2716 (2021). https://doi.org/10.1007/s00167-021-06539-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-021-06539-2

Keywords

Search

Navigation