Patellofemoral Update

Patellofemoral Update

Disclosures: Pace reports he received education payments from Arthrex; consulting fees from Arthrex, Ceterix and Smith & Nephew; and non-consulting fees from Arthrex. Jimenez reports no relevant financial disclosures.
April 07, 2021
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Patellar morphology highly variable among knees with and without patella instability

Disclosures: Pace reports he received education payments from Arthrex; consulting fees from Arthrex, Ceterix and Smith & Nephew; and non-consulting fees from Arthrex. Jimenez reports no relevant financial disclosures.
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Published results showed knees with and without patellar instability had highly variable patellar morphology, as well as minimal association between measurements of patellar morphology and trochlear dysplasia.

Andrew E. Jimenez, MD, J. Lee Pace, MD, and colleagues analyzed and compared MRI scans of 97 patients with patella instability and 100 control patients with ACL tears but no patella instability. Researchers collected radiologic measurements of trochlear morphology and 15 measurements of patellar morphology and performed regression analysis to determine associations between the measurements.

Variability in patella shape

Results showed patients in the patellar instability group had significantly smaller medial facet angles of cartilage at the distal level compared with the control group, but no statistically significant differences between medial facet angles of cartilage at the proximal and middle levels. Researchers also found statistically significantly smaller medial facet angles of bone at the proximal level, middle level and distal level among patients with patellar instability.

Andrew E. Jimenez
Andrew E. Jimenez
J. Lee Pace
J. Lee Pace

Researchers noted significantly larger patellar width at the middle level vs. the proximal and distal levels, as well as significantly larger medial facet angle of bone at the proximal and middle levels vs. the distal level among patients with patellar instability. Patients in the control group had significantly larger patellar width at the middle level vs. the proximal level, significantly smaller medial facet angle of bone at the distal level vs. the proximal level and significantly larger lateral facet angle of bone at the middle level vs. the distal level, according to results.

Although regression analysis showed a statistically significant association between medial facet angle of bone and measures of increasing severity of trochlear dysplasia, researchers found these differences to be small. Results showed an association between decreasing sulcus angle and lateral facet angle of cartilage, lateral facet angle of bone and medial facet angle of cartilage.

Treatments for patella instability

According to Pace, results of this study showed variability in the shape of the patella whether it is unstable, with no clear or consistent patellar shape that occurs in patients with patellar instability. Pace noted there is no evidence that the shape of the patella is associated with the development of patellar instability, as well as no evidence that a patella may develop a dysplastic pattern that would match a dysplastic trochlea.

“This work is important because it allows us to focus our treatments for patellar instability on the various patho-anatomic risk factors that have previously been identified: trochlear dysplasia, patella alta, etc.” Pace told Healio Orthopedics. “Further, none of our treatment options for these anatomic risk factors need to be (except in a few rare exceptions) weighed against the shape of the patella when determining surgical options for patients with patellar instability.”