TY - JOUR
T1 - Lateral patellar maltracking due to trochlear dysplasia
T2 - A computational study
AU - Rezvanifar, S. Cyrus
AU - Flesher, Brett L.
AU - Jones, Kerwyn C.
AU - Elias, John J.
N1 - Publisher Copyright:
© 2019 Elsevier B.V.
PY - 2019/12
Y1 - 2019/12
N2 - Background: The study focuses on the influence of trochlear dysplasia on patellar tracking related to patellar instability. Methods: Knee extension against gravity and dual-limb squatting were simulated with seven models representing knees being treated for recurrent instability. Trochlear depth was altered to represent lateral trochlear inclination (LTI) values of 6°, 12° and 24°. Repeated measures analyses compared patellar lateral shift (bisect offset index) across different LTI values. Peak bisect offset index during extension and squatting was correlated with patella alta (Caton–Deschamps index) and maximum lateral position of the tibial tuberosity. Results: Bisect offset index varied significantly (p < 0.05) between different LTI values at multiple flexion angles throughout simulated knee extension and squatting. Average bisect offset values were 1.02, 0.95, and 0.86 for LTI = 6°, 12°, and 24°, respectively, at 0° of flexion for knee extension. The strongest correlation occurred between peak bisect offset index and lateral position of the tibial tuberosity for knee squatting with LTI = 6° (r2 = 0.81, p = 0.006). The strength of the correlation decreased as LTI increased. Caton–Deschamps was only significantly correlated with patellar tracking for LTI = 24° during knee squatting. Conclusions: A shallow trochlear groove increases lateral patellar maltracking. A lateral tibial tuberosity in combination with trochlear dysplasia increases lateral patellar tracking and the risk of patellar instability. Patella alta has relatively little influence on patellar tracking in combination with trochlear dysplasia due to the limited articular constraint provided by the trochlear groove.
AB - Background: The study focuses on the influence of trochlear dysplasia on patellar tracking related to patellar instability. Methods: Knee extension against gravity and dual-limb squatting were simulated with seven models representing knees being treated for recurrent instability. Trochlear depth was altered to represent lateral trochlear inclination (LTI) values of 6°, 12° and 24°. Repeated measures analyses compared patellar lateral shift (bisect offset index) across different LTI values. Peak bisect offset index during extension and squatting was correlated with patella alta (Caton–Deschamps index) and maximum lateral position of the tibial tuberosity. Results: Bisect offset index varied significantly (p < 0.05) between different LTI values at multiple flexion angles throughout simulated knee extension and squatting. Average bisect offset values were 1.02, 0.95, and 0.86 for LTI = 6°, 12°, and 24°, respectively, at 0° of flexion for knee extension. The strongest correlation occurred between peak bisect offset index and lateral position of the tibial tuberosity for knee squatting with LTI = 6° (r2 = 0.81, p = 0.006). The strength of the correlation decreased as LTI increased. Caton–Deschamps was only significantly correlated with patellar tracking for LTI = 24° during knee squatting. Conclusions: A shallow trochlear groove increases lateral patellar maltracking. A lateral tibial tuberosity in combination with trochlear dysplasia increases lateral patellar tracking and the risk of patellar instability. Patella alta has relatively little influence on patellar tracking in combination with trochlear dysplasia due to the limited articular constraint provided by the trochlear groove.
KW - Computational simulation
KW - Patellar instability
KW - Patellar tracking
KW - Trochlear dysplasia
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U2 - 10.1016/j.knee.2019.11.006
DO - 10.1016/j.knee.2019.11.006
M3 - Article
C2 - 31786000
AN - SCOPUS:85076565369
SN - 0968-0160
VL - 26
SP - 1234
EP - 1242
JO - Knee
JF - Knee
IS - 6
ER -