Patellofemoral Update

Patellofemoral Update

Perspective from Peter Jokl, MD
Perspective from Adam B. Yanke, MD, PhD
Disclosures: Weltsch reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
March 05, 2021
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Patellofemoral morphology may predict risk of recurrent instability in pediatric patients

Perspective from Peter Jokl, MD
Perspective from Adam B. Yanke, MD, PhD
Disclosures: Weltsch reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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Tibial tubercle to lateral trochlear ridge distance may accurately predict recurrent patellar instability in a pediatric population with first-time lateral patellar dislocation, according to published results.

From 2005 to 2014, Daniel Weltsch, MD, and colleagues from the Children’s Hospital of Philadelphia used serial axial MRI to analyze 165 patients aged 8 to 19 years with first-time lateral patellar dislocations. The median follow-up was 12.2 months.

According to the study, the researchers assessed all measurements with the intraclass correlation coefficient (ICC), including only measurements with an ICC greater than 0.8. Additionally, they performed univariable and multivariable logistic regression analyses to evaluate variables associated with recurrent instability and dislocation.

Overall, Weltsch and colleagues documented 98 cases (59.4%) of subsequent instability among the cohort. After regression analysis, they determined tibial tubercle to lateral trochlear ridge (LTR) distance was an independent risk factor for recurrent instability, as “patients with a tibial tubercle to LTR distance value greater than 1 mm had a significantly higher rate of recurrent patellar dislocation (72%),” the researchers wrote in the study.

“The main finding in this study was that a new measure relating the center of pull distally to the lateral edge of the trochlear groove, the tibial tubercle to LTR distance, was a significant independent predictor of recurrent patellar instability in an adolescent population,” they concluded. “While further comparative studies are certainly needed, in the assessment of patients with first-time patellar dislocation, the tibial tubercle to LTR distance may aid surgeons and patients in understanding the relevant pathoanatomy and thus help direct treatment,” they wrote.