Beitler Brian G, Sieberer Johannes, Islam Wasif, McDonald Curtis, Yu Kristin, Tommasini Steven M, Fulkerson John P
Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A..
Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut, U.S.A.
Arthroscopy. 2025 Mar;41(3):703-712. doi: 10.1016/j.arthro.2024.04.013. Epub 2024 Apr 30.
To create a metric for evaluating the degree of laterality of the patella's entry into the trochlea, the entry point-trochlear groove (EP-TG) angle, and to evaluate if this laterality is associated with recurrent patella instability.
The time frame of the study was January 2020 to February 2023. The inclusion criteria were patients treated by the senior author (J.P.F.) (with the exception of 2 patients who were treated by another provider at the institution who was aware of the study) who have been diagnosed with recurrent atraumatic patellar dislocations. Controls without knee pathology were selected from the New Mexico Decedent Imaging Database (NMDID). Simpleware ScanIP was used to create 3-dimensional (3D) models of the distal femurs from computed tomography scans. Anteroposterior images of these 3D models were uploaded to a custom EP-TG angle measuring tool. Three measurers used the tool to measure the EP-TG angle of the distal femurs.
Twenty-eight patients were included for the recurrent dislocator group. Twenty-four decedents from the NMDID were selected for the control group, each with a left or right knee chosen randomly for measurement. A 1-sided Mann-Whitney U test, used to evaluate whether the recurrent dislocators had higher EP-TG angle values, yielded a P value <.001, demonstrating a high level of significance. A Bayesian mixed-effect model, used to determine how different the EP-TG angles are between the 2 groups, gave a posterior predictive interval of [11.93°, 19.12°] for the EP-TG angle shift of dislocators. The intraclass correlation coefficient was 0.648.
The morphologic entry point of the patella into the proximal trochlea is more lateral in recurrent patella dislocators than in controls. This increased laterality can be measured by the EP-TG angle, which may be useful information for optimizing treatment of recurrent patella instability.
Level III, case control study.
创建一种用于评估髌骨进入滑车的偏侧程度的指标，即入点 - 滑车沟（EP - TG）角，并评估这种偏侧性是否与复发性髌骨不稳定相关。
研究时间范围为2020年1月至2023年2月。纳入标准为接受资深作者（J.P.F.）治疗的患者（机构中由另一位知晓该研究的提供者治疗的2例患者除外），这些患者被诊断为复发性非创伤性髌骨脱位。从新墨西哥州死者影像数据库（NMDID）中选取无膝关节病变的对照者。使用Simpleware ScanIP从计算机断层扫描创建股骨远端的三维（3D）模型。将这些3D模型的前后位图像上传到自定义的EP - TG角测量工具。三名测量者使用该工具测量股骨远端的EP - TG角。
复发性脱位组纳入28例患者。从NMDID中选取24例死者作为对照组，每组随机选择左膝或右膝进行测量。用于评估复发性脱位者的EP - TG角值是否更高的单侧曼 - 惠特尼U检验得出P值<0.001，显示出高度显著性。用于确定两组之间EP - TG角差异程度的贝叶斯混合效应模型给出了脱位者EP - TG角偏移的后验预测区间为[11.93°，19.12°]。组内相关系数为0.648。
复发性髌骨脱位者中，髌骨进入近端滑车的形态学入点比对照组更偏外侧。这种增加的偏侧性可以通过EP - TG角来测量，这可能是优化复发性髌骨不稳定治疗的有用信息。
III级，病例对照研究。
