Witoński D, Góraj B
Department and Clinic of Orthopaedics, Medical University of Lodz, Poland.
Arch Orthop Trauma Surg. 1999;119(1-2):46-9. doi: 10.1007/s004020050353.
Ten consecutive patients (12 knees), all women, with anterior knee pain syndrome participated in the study. The patellofemoral joints were examined with the knee in 0 degrees, 10 degrees, 20 degrees, and 30 degrees of flexion. At each knee position, kinematic and dynamic, an axial magnetic resonance (MR) image was used to focus on the sagittal plane, followed by an axial image focused through the middle of the patella. Ten healthy volunteers (20 knees) with no history of previous or current knee problems or anterior knee pain also underwent MRI scanning following the same procedure. Three angles were measured: patellar tilt angle (PTA), sulcus angle (SA), and congruence angle (CA). For statistical analyses, we used the Mann-Whitney U-test. Compared with the control knees, five patterns of malalignment were identified. The most frequently observed was tilt and lateralisation, with elevated CA and decreased PTA. In extension, the average CA for this group was 22 degrees and PTA -4.8 degrees vs -8.1 degrees and 14.3 degrees for control knees respectively. Contraction of the muscles caused tilt of the patella in symptomatic knees. This decrease of the PTA was statistically significant in extension (P < 0.05) and in 10 degrees of flexion (P < 0.05). Contraction of the thigh muscle increased CA in 30 degrees of flexion. This lateral pull was statistically significant (P < 0.05). There were no statistically significant differences of SA between the groups, regardless of muscle contraction or flexion angle. At 30 degrees of flexion, muscle contraction increased CA and decreased PTA. In our opinion, imaging in the first 30 degrees of flexion with thigh muscle contraction is necessary for a correct diagnosis.
十名连续的患有膝前疼痛综合征的患者（12个膝关节），均为女性，参与了该研究。在膝关节处于0度、10度、20度和30度屈曲时对髌股关节进行检查。在每个膝关节位置，进行运动学和动力学检查时，使用轴向磁共振（MR）图像聚焦于矢状面，随后是通过髌骨中部聚焦的轴向图像。十名无既往或当前膝关节问题或膝前疼痛病史的健康志愿者（20个膝关节）也按照相同程序接受了MRI扫描。测量了三个角度：髌骨倾斜角（PTA）、沟角（SA）和吻合角（CA）。对于统计分析，我们使用了曼-惠特尼U检验。与对照膝关节相比，确定了五种排列不齐模式。最常观察到的是倾斜和外侧移位，CA升高而PTA降低。在伸直位时，该组的平均CA为22度，PTA为-4.8度，而对照膝关节分别为-8.1度和14.3度。有症状膝关节的肌肉收缩导致髌骨倾斜。这种PTA的降低在伸直位（P<0.05）和10度屈曲位（P<0.05）时具有统计学意义。大腿肌肉收缩使30度屈曲位时的CA增加。这种侧向拉力具有统计学意义（P<0.05）。两组之间的SA无论肌肉收缩或屈曲角度如何均无统计学显著差异。在30度屈曲位时，肌肉收缩使CA增加而PTA降低。我们认为，在大腿肌肉收缩的情况下，对最初30度屈曲进行成像对于正确诊断是必要的。
