Department of Radiology, Charité-Universitätsmedizin Berlin, Campus Charité Mitte, Germany.
Am J Sports Med. 2013 Jan;41(1):51-7. doi: 10.1177/0363546512464691. Epub 2012 Nov 7.
The role of anatomic risk factors in patellofemoral instability is not yet fully understood, as they have been observed in patients either alone or in combination and in different degrees of severity.
To prospectively analyze rotational limb alignment in patients with patellofemoral instability and in controls using magnetic resonance imaging (MRI).
Cross-sectional study; Level of evidence, 3.
Thirty patients (mean age, 22.9 y; range, 12-41 y) with a history of patellar dislocation and 30 age- and sex-matched controls (mean age, 25.2 y; range, 16-37 y) were investigated. The patients underwent MRI of the leg at 1.5 T using a peripheral angiography coil and a T2-weighted half-Fourier acquisition single-shot turbo spin echo (HASTE) sequence for measuring femoral antetorsion, tibial torsion, knee rotation, and mechanical axis deviation (MAD). The mean values of these parameters were compared between patients and controls. In addition, the patients underwent an assessment to determine the influence of rotational limb alignment on lateral trochlear inclination, trochlear facet asymmetry, trochlear depth, Insall-Salvati index, and tibial tuberosity-trochlear groove distance.
Patients had 1.56-fold higher mean femoral antetorsion (20.3° ± 10.4° vs 13.0° ± 8.4°; P < .01) and 1.6-fold higher knee rotation (9.4° ± 5.0° vs 5.7° ± 4.3°; P < .01) compared with controls. Moreover, patients had 2.9 times higher MAD (0.81 ± 0.75 mm vs -0.28 ± 0.87 mm; P < .01). Differences in tibial torsion were not significant. Also, there were no significant correlations between parameters of rotational alignment and standard anatomic risk factors.
Our results suggest that some patients with nontraumatic patellar instability have greater internal femoral rotation, greater knee rotation, and a tendency for genu valgum compared with healthy controls. Rotational malalignment may be a primary risk factor in patellar dislocation that has so far been underestimated.
解剖学危险因素在髌股关节不稳定中的作用尚不完全清楚，因为这些危险因素在患者中单独或组合存在，且严重程度不同。
前瞻性分析髌股关节不稳定患者和对照组患者的旋转肢体对线情况，并使用磁共振成像（MRI）进行分析。
横断面研究；证据等级，3 级。
30 例（平均年龄 22.9 岁；范围 12-41 岁）有髌脱位病史的患者和 30 例年龄和性别匹配的对照组（平均年龄 25.2 岁；范围 16-37 岁）接受了 1.5 T 腿部 MRI 检查，使用外周血管造影线圈和 T2 加权半傅里叶采集单次激发涡轮自旋回波（HASTE）序列测量股骨前扭转、胫骨扭转、膝关节旋转和机械轴偏差（MAD）。比较患者和对照组之间这些参数的平均值。此外，患者还进行了评估，以确定旋转肢体对线对线对外侧滑车倾斜度、滑车关节面不对称、滑车深度、Insall-Salvati 指数和胫骨结节-滑车沟距离的影响。
与对照组相比，患者的股骨前扭转（20.3°±10.4°比 13.0°±8.4°；P<.01）和膝关节旋转（9.4°±5.0°比 5.7°±4.3°；P<.01）平均值高 1.56 倍。此外，患者的 MAD（0.81±0.75mm 比-0.28±0.87mm；P<.01）高 2.9 倍。胫骨扭转差异无统计学意义。此外，旋转对线参数与标准解剖学危险因素之间无显著相关性。
我们的结果表明，与健康对照组相比，一些非外伤性髌股关节不稳定患者的股骨内旋更大、膝关节旋转更大，且有发生膝内翻的趋势。旋转对线不良可能是髌脱位的一个主要危险因素，目前这一危险因素被低估了。
