Thouvenin Clara, Erard Julien, Abu Mukh Assala, Joseph Léopold, Lustig Sébastien, Servien Elvire
Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France; Orthopaedic Surgery Department, Bordeaux University Hospital, Bordeaux, France.
Orthopaedics Surgery and Sports Medicine Department, FIFA Medical Center of Excellence, Croix-Rousse Hospital, Lyon University Hospital, Lyon, France.
Knee. 2024 Dec;51:199-205. doi: 10.1016/j.knee.2024.09.007. Epub 2024 Oct 4.
Although patellofemoral instability (PFI) affects both femoral and patellar compartments, literature provided little attention for the patellar morphology contribution on PFI. This study evaluates the patellar morphology patterns on MRI to establish their contribution in PFI.
This study retrospectively analyzes patellar MRI and X-ray measurements performed between 2018 and 2022. 50 knees with recurrent patellar dislocation were matched with 50 matched knees of ACL-reconstruction candidates with no history of patellar dislocation based on age and gender. Caton-Deschamps' index, Wiberg's patellar morphotype, Dejour's trochlear dysplasia classification, sagittal patellofemoral engagement index and additional patellar cartilage and bone parameters and their relative ratio measurements were assessed in both groups.
Study patients present differences in patellar morphology; a wider lateral facet (p = 0,019) and a narrower medial facet compared to the control group (p < 0,001). The subchondral patellar crest is medialized compared to the control group (p < 0,001). The cartilaginous crest measurements of the patella were not significantly different in both groups yet PFI group presents a wider Wiberg angle (p < 0,001), thus a flatter patella, compared to the control group.
The patella in PFI patients presents a larger lateral facet, a narrower medial facet, a flatter surface and a medialized patellar crest compared with the control group. In PFI, a rather medial patellar crest might predispose towards a greater patellar tilt and destabilize the already compromised patellar-trochlear groove congruence. PFI is a multifactorial disease and both trochlea and patella play a role in its manifestation, thus, literature should address patellar morphotype contribution in patellofemoral instability.
Level III.
尽管髌股关节不稳定（PFI）会影响股骨和髌骨关节面，但关于髌骨形态对PFI的影响，文献中关注较少。本研究评估MRI上的髌骨形态模式，以确定它们在PFI中的作用。
本研究回顾性分析了2018年至2022年间进行的髌骨MRI和X线测量。根据年龄和性别，将50例复发性髌骨脱位的膝关节与50例无髌骨脱位病史的ACL重建候选者的匹配膝关节进行配对。在两组中评估了Caton-Deschamps指数、Wiberg髌骨形态类型、Dejour滑车发育不良分类、矢状面髌股关节吻合指数以及额外的髌骨软骨和骨参数及其相对比例测量。
研究患者的髌骨形态存在差异；与对照组相比，外侧关节面更宽（p = 0.019），内侧关节面更窄（p < 0.001）。与对照组相比，髌骨软骨下嵴向内侧移位（p < 0.001）。两组髌骨的软骨嵴测量值无显著差异，但与对照组相比，PFI组的Wiberg角更宽（p < 0.001），因此髌骨更扁平。
与对照组相比，PFI患者的髌骨外侧关节面更大，内侧关节面更窄，表面更扁平，髌骨嵴向内侧移位。在PFI中，相当内侧的髌骨嵴可能会导致更大的髌骨倾斜，并使本已受损的髌股关节沟一致性不稳定。PFI是一种多因素疾病，滑车和髌骨在其表现中都起作用，因此，文献应探讨髌骨形态类型在髌股关节不稳定中的作用。
III级。
