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Patellar instability can be classified into four types based on patellar movement with knee flexion: a three-dimensional computer model analysis
  1. Yuzo Yamada1,
  2. Yukiyoshi Toritsuka2,
  3. Shuji Horibe3,
  4. Norimasa Nakamura4,
  5. Kazuomi Sugamoto5,
  6. Hideki Yoshikawa6,
  7. Konsei Shino7
  1. 1 Department of Orthopaedic Surgery, Yao Municipal Hospital, Yao, Japan
  2. 2 Department of Orthopaedic Sports Medicine, Kansai Rosai Hospital, Amagasaki, Japan
  3. 3 Comprehensive Rehabilitation, Osaka Prefecture University, Sakai, Japan
  4. 4 Institute for Medical Science in Sports, Osaka Health Science University, Osaka, Japan
  5. 5 Locomotor Biomaterial Limited to the Joint Surgery, Osaka University Graduate School of Medicine, Suita, Japan
  6. 6 Department of Orthopaedics, Osaka University Graduate School of Medicine, Suita, Japan
  7. 7 Department of Orthopaedic Sports Medicine, Yukioka Hospital, Osaka, Japan
  1. Correspondence to Dr Yukiyoshi Toritsuka, Department of Orthopaedic Sports Medicine, Kansai Rosai Hospital, Amagasaki Hyogo 660-0064, Japan; toritukayukiyosi{at}kansaih.johas.go.jp

Abstract

Objective Patellar instability (PI) represents various underlying pathologies, including patellar malalignment. Continuous patellar alignment develops to patellar tracking and is regarded as the end product of combined predisposing factors. We quantitatively investigated the inhomogeneity of patellar tracking in PI.

Methods Sixty knees of 56 patients with PI and 15 knees of 10 healthy volunteers (HVs) were studied. Three-dimensional (3D) computer models were created based on MRIs at 10° intervals over 0°–50° of flexion, and patellar tracking was quantitatively analysed using patellar 3D shift. Classification was performed according to the maximum 3D shift (max-shift), indicating the extent of lateral deviation, and the change of 3D shift from 0° to 50° (change0–50), indicating movement direction. First, the cut-off value (COV) of the max-shift was defined based on the data from HVs. When a value was greater than the COV, it was defined as a major subluxation, and when the value was smaller it was defined as a minor subluxation. Next, the two COVs of change0–50 were similarly defined. When a value was greater than the upper COV, it was defined as a major-lateral type, laterally moving the patella with flexion, and when smaller than the lower COV it was defined as a major-medial type, medially moving the patella with flexion. When a value fell between the two COVs, it was defined as a major-straight type.

Results Fifty-three patellae (88%) with values larger than the COV of the max-shift (mean +1 SD of HV) were defined as major subluxations and seven (12%) showing smaller values as minor subluxations. Among the major subluxations, 25 (42%) showing a smaller value than the lower COV of change0–50 (mean –2 SD of HV) were defined as major-medial type, while 7 (12%) showing a larger value than the upper COV of change0–50 (mean +2 SD) were defined as major-lateral type. Twenty-one (35%) were defined as major-straight type. No further analysis was performed on the seven minor subluxations (the minor type).

Conclusion PI was quantitatively classified into four types according to the extent of lateral deviation and the movement direction of the patellae with flexion, showing inhomogeneity of patellar tracking.

  • knee
  • dislocation
  • instability

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Footnotes

  • Contributors YY provided the patients who were the subjects of the study, performed data collection and analysed the data. YT created the study design, provided the patients who were the subjects of the study and drafted the manuscript. SH provided the patients who were the subjects of the study. NN provided the patients who were the subjects of the study. KS assisted in study design using 3D computer analysing system. HY assisted in study design using 3D computer analysing system. KS assisted in study design and preparation of the manuscript.

  • Funding We do not have any specific grants for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval The ethical review boards of the Japan Community Healthcare Organization Osaka Hospital, Kansai Rosai Hospital and Osaka Rosai Hospital approved this study (numbers 2015–6, 150602, 27–35).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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