Kim Hee Kyung, Greenstein Rebecca, Plemmons Alexandra, Rajdev Neil, Parikh Shital, Kim Dong Hoon
Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229-3039.
Department of Radiology. University of Cincinnati, College of Medicine, Cincinnati, OH.
AJR Am J Roentgenol. 2019 Jul;213(1):182-190. doi: 10.2214/AJR.18.20778. Epub 2019 Apr 1.
The objective of our study was to assess correlation between patellofemoral incongruency and injury mechanism, recurrence, bilaterality, and cartilage damage in patients with patellofemoral instability (PFI). Ninety-four knee MRI examinations (10 bilateral) of 84 patients with PFI (47 female and 37 male patients; mean age ± SD, 15.0 ± 2.5 years) who had patella dislocation and medial patellofemoral ligament reconstruction (MPFLR) and 66 examinations of age- and sex-matched control subjects were reviewed. The PFI group was subclassified on the basis of injury, recurrence, and bilaterality. Patellofemoral congruence was assessed in both groups with the following MRI measurements: lateral femoral trochlear inclination angle, femoral sulcus depth, medial-to-lateral facet ratio, distance between tibial tuberosity (TT) and trochlear groove (TG), and patellar tendon ratio. Patella cartilage damage was assessed in the PFI group using conventional MRI (International Cartilage Repair Society grade 0-4) and T2 relaxation time mapping at three locations. MRI measurements were compared between groups and subgroups (Wilcoxon rank sum test) and were correlated with cartilage damage (Spearman correlation). All MRI measurements were significantly different between the group with PFI and the group without PFI ( < 0.0001). The bilateral PFI group had significantly increased TT-TG distance (mean, 15.9 vs 13.1 mm, < 0.05) and patellar tendon ratio (mean, 1.6 vs 1.4, < 0.05) compared with the unilateral PFI group. The TT-TG distance positively correlated with T2 values of medial and lateral patella cartilage. There were no differences between other subgroups and no correlation between other MRI measurements and the severity of cartilage damage. In patients with PFI, the severity of patellofemoral incongruence was not associated with injury mechanism or cartilage damage. However, increased lateralization of the patellar tendon (TT-TG distance) and patella alta (patellar tendon ratio) correlated with injury to the contralateral knee requiring bilateral MPFLR.
我们研究的目的是评估髌股关节不协调与髌股关节不稳定（PFI）患者的损伤机制、复发、双侧性和软骨损伤之间的相关性。回顾了84例PFI患者（47例女性和37例男性患者；平均年龄±标准差，15.0±2.5岁）的94次膝关节MRI检查（10例双侧），这些患者均有髌骨脱位并接受了内侧髌股韧带重建术（MPFLR），并对66例年龄和性别匹配的对照受试者进行了检查。PFI组根据损伤、复发和双侧性进行亚分类。两组均采用以下MRI测量评估髌股关节的一致性：股骨外侧滑车倾斜角、股骨髁间沟深度、内侧与外侧小面比率、胫骨结节（TT）与滑车沟（TG）之间的距离以及髌腱比率。使用传统MRI（国际软骨修复协会0-4级）和三个位置的T2弛豫时间映射评估PFI组的髌骨软骨损伤。比较组间和亚组间的MRI测量值（Wilcoxon秩和检验），并与软骨损伤进行相关性分析（Spearman相关性）。PFI组和非PFI组之间所有MRI测量值均有显著差异（<0.0001）。与单侧PFI组相比，双侧PFI组的TT-TG距离显著增加（平均值，15.9对13.1 mm，<0.05），髌腱比率也显著增加（平均值，1.6对1.4，<0.05）。TT-TG距离与内侧和外侧髌骨软骨的T2值呈正相关。其他亚组之间无差异，其他MRI测量值与软骨损伤严重程度之间无相关性。在PFI患者中，髌股关节不协调的严重程度与损伤机制或软骨损伤无关。然而，髌腱外侧移位增加（TT-TG距离）和髌骨高位（髌腱比率）与对侧膝关节损伤相关，需要双侧MPFLR。
