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Influence of posterior lateral femoral condyle geometry on patellar dislocation

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Patellar instability is a condition with multifactorial aetiology, potentially involving soft tissue characteristics, the bony anatomy of the patella, femur and tibia, and alignment of the lower limb. The shape of the distal femur and patellofemoral joint has been frequently studied using plain orthogonal and skyline radiographs. We investigated a possible contribution of hypoplasia of the lateral femoral condyle in the axial plane to patellar instability.

Methods

The geometry of the distal femur and alignment of the lower limb on plain radiographs and MRI scans in 25 young adult patients with patellar instability was measured, and compared to a control group of 75 age-matched patients. Measurements were validated by intra-observer and inter-observer reliability studies, and multivariate analysis was used to compare the groups. Cases with and without high Beighton score or knee hyperextension were also compared.

Results

The anatomical posterior condylar angle, anterior condylar angle and sulcus angle on axial MRI scans showed insignificant differences between groups. The Blackburne-Peel ratio, anatomical femoro-tibial angle and femoral joint angle showed significant differences between groups, but not the tibial plateau angle. There was a significant correlation between posterior condylar angle and valgus knee alignment. In cases with joint hypermobility, femoral joint angle was significantly increased and posterior condylar angle was significantly decreased.

Conclusions

Multiplanar hypoplasia of the lateral femoral condyle resulting in a valgus knee is a risk factor for patellar instability in young patients without osteoarthritis or joint hypermobility. Isolated posterior lateral condyle hypoplasia appears to be unrelated to patellar instability.

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Acknowledgments

The authors would like to thank Mrs Janet Christie for Assistance with PACS software; Dr David Hamilton for guidance on statistics and manuscript review; Mr Paul Jenkins for guidance on study design and patient identification; Dr Sarah-Louise Kelly for performing measurements for interobserver analysis; Mrs Deborah MacDonald for study management; Mrs Margaret MacDougall for statistics guidance for the reliability study; and Mr Tae Tawonsawatruk for performing measurements for interobserver analysis.

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Authors and Affiliations

  1. Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, EH16 4SA, UK

    Dominic Gillespie, Daniel Mandziak & Colin Howie

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  1. Dominic Gillespie
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  2. Daniel Mandziak
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  3. Colin Howie
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Corresponding author

Correspondence to Dominic Gillespie.

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This study was performed with ethics committee approval in accordance with the Declaration of Helsinki.

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Gillespie, D., Mandziak, D. & Howie, C. Influence of posterior lateral femoral condyle geometry on patellar dislocation. Arch Orthop Trauma Surg 135, 1503–1509 (2015). https://doi.org/10.1007/s00402-015-2310-y

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