Measurements of Patellofemoral Morphology Characteristics in Indonesian Population: an MRI Based Study

Ludwig Andre Pontoh; Ismail Hadisoebroto Dilogo; Achmad Fauzi Kamal; Wahyu Widodo; Sholahuddin Rhatomy; Jessica Fiolin

doi:10.33533/jpm.v15i2.3043

Authors

Ludwig Andre Pontoh
Ismail Hadisoebroto Dilogo Department of Orthopaedic and Traumatology, Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta
Achmad Fauzi Kamal Department of Orthopaedic and Traumatology, Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta
Wahyu Widodo Department of Orthopaedic and Traumatology, Cipto Mangunkusumo General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta
Sholahuddin Rhatomy Department of Orthopaedic and Traumatology, Soeradji Tirtonegoro Hospital, Faculty of Medicine, Public Health of Nursing Universitas Gadjah Mada, Yogyakarta
Jessica Fiolin Jakarta Knee, Shoulder and Orthopaedic Sport Clinic, Pondok Indah Hospital,

DOI:

https://doi.org/10.33533/jpm.v15i2.3043

Keywords:

Patellofemoral Morphology, MRI, Indonesian, Insall-Savati Ratio, Patellar Tilt Angle, Sulcus Angle, TT-TG Distance

Abstract

Patellar malalignment is the imbalance relationship between patella and trochlea, in which clinical findings most of the time are obscured; hence diagnosis is often challenging. Magnetic resonance imaging (MRI) is the most sensitive tool to detect subtle patellar malalignment features, so diagnosis can be made early. However, there has been no clear consensus on the normal value of patella morphology until today. This study aims to determine patellofemoral morphology values in Indonesian using MRI. This was a retrospective study of 202 patients aged 18-40 years old with knee problems without patellar instability. Patellar morphology parameters including Insal Savati ratio (IS ratio), patellar tilt angle (PTA), sulcus angle (SA) and tibial tubercle-trochlear groove distance (TT-TG) were evaluated and recorded for statistical analysis. There was no significant correlation between anthropometric values and patellar morphology values. There were significantly higher PTA, SA and TT-TG values in females compared to males. The mean value of the IS ratio in the Asian population using MRI was 0.99 ± 0.14, PTA was 9.09 ± 6.88, SA was 139.20 ± 6.38, and TT-TG distance was 8.00 ± 5.25. Further studies with larger samples and multi-center results are required.

References

Dejour H, Walch G, Nove-Josserand L, et al. Factors of patella instability: an anatomic radiographic study. Knee Surgery Sports Traumatology Arthroscopy. 1994; 2:19-26.

Berruto M, Ferrua P, Carimati G, Uboldi F, Gala L. Patellofemoral instability: Classification and Imaging. Joints. 2013; 1(2):7-13.

Wittstein, J. R., Bartlett, E. C., Easterbrook, J., & Byrd, J. C. Magnetic Resonance Imaging Evaluation of Patellofemoral Malalignment. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2006; 22(6):643–9.

Jibri Z, Jamieson P, Rakhra KS, Sampaio ML, Dervin G. Patellar maltracking: an update on the diagnosis and treatment strategies. Insights Imaging. 2019; 10:65.

Pontoh LAP, Rahyussalim AJ, Fiolin J. Patient height may predict the length of anterior cruciate ligament: a magnetic resonance imaging study. Arthroscopy, Sports Medicine, and Rehabilitation. 2021; 3(3):733-9.

Mohan H, Chhabria P, Bagaria V, Tadepalli K, Naik L, Kulkarni R. Anthropometry of Nonarthritic Asian Knees: Is It Time for a Race-Specific Knee Implant? Clinics in Orthopaedic Surgery. 2020; 12(2):158.

Insall J, Salvati E. Patella position in the normal knee joint. Radiology. 1971; 101(1):101–4.40.

Miller TT, Staron RB, Feldman F. Patellar height on sagittal MR imaging of the knee. American Journal of Roentgenology. 1996; 167(2):339–41.

Shabshin N, Schweitzer ME, Morrison WB, Parker L. MRI criteria for patella alta and baja. Skeletal Radiology. 2004; 33:445-50.

Van Huyssteen AL, Hendrix MR, Barnett AJ, Wakeley CJ, Eldridge JD. Cartilage-bone mismatch in the dysplastic trochlea. An MRI study. Journal of Bone and Joint Surgery British. 2006; 88(5):688–9.

Schoettle PB, Zanetti M, Seifert B, Pfirrmann CW, Fucentese SF, Romero J. The tibial tuberosity-trochlear groove distance; a comparative study between CT and MRI scanning. The Knee. 2006; 13(1):26–31.

Ali SA, Helmer R, Terk MR. Analysis of the Patellofemoral Region on MRI: Association of Abnormal Trochlear Morphology With Severe Cartilage Defects. American Journal of Roentgenology. 2010; 194:721-7.

Osman NM, Ebrahim SMB. Patellofemoral instability: Quantitative evaluation of predisposing factors by MRI. The Egyptian Journal of Radiology and Nuclear Medicine. 2016; 47:1529-38.

Jimenez AE, Levy BJ, Grimm NL, Andelman SM, Cheng C, Hedgecock JP, et al. Relationship Between Patellar Morphology and Known Anatomic Risk Factors for Patellofemoral Instability. Orthopaedic Journal of Sports Medicine. 2021; 9(3).

Ward, S.R.; Terk, MR; Powers, C.M. Patella alta: Association with patellofemoral alignment and changes in contact area during weight-bearing. Journal of Bone and Joint Surgery. 2007; 89:1749–55.

Le Huang Di T, Hoang Ngoc T, Hon An Ngo D, Thanh Nhan Le N, Le Trong B, Le Trong K, et al. Evaluation of the Insall-Savati Ratio among the Vietnamese population: application for diagnosis of patellar malalignment. Orthopaedic Research and Review. 2021; 13:57-61.

Hong HT, Koh YG, Nam JH, Kim PS, Kwak YH, Kang KT. Gender differences in patellar positions among the Korean population. Applied Science. 2020; 10:8842.

Becher C, Fleischer B, et al. Effects of upright weight bearing and the knee flexion angle on patellofemoral indices using magnetic resonance imaging in patients with patellofemoral instability. Knee Surgery Sports Traumatology Arthroscopy. 2017; 8:2405–13.

Xue Z, Song G, et al. Excessive lateral patellar translation on axial computed tomography indicates positive patellar J sign. Knee Surgery Sports Traumatology Arthroscopy. 2018; 12:3620–5.

Mwakikunga A, Katundu K, Msamati B, Adefolaju AG, Schepartz L. An anatomical and osteometric study of the femoral sulcus angle in adult Malawians. Africal Health Science. 2016; 16:1182–7.

Murshed KA, Çiçekcibaşi AE, Ziylan T, Karabacakoğlu A. Femoral sulcus angle measurements: an anatomical study of magnetic resonance images and dry bones. Turkey Journal of Medical Science. 2004; 34:165–9.

Koh YG, Nam JH, Chung HS, Lee HY, Kim JH, Kim JH, et al. Gender-related morphological differences in sulcus angle and condylar height for the femoral trochlea using magnetic resonance imaging. Knee Surgery Sports Traumatology Arthroscopy. 2019; 27:3560-6.

Thakkar RS, Del Grande F, Wadhwa V, Chalian M, Andreisek G, Carrino JA, et al. Patellar instability: CT and MRI measurements and their correlation with internal derangement findings. Knee Surgery Sports Traumatology Arthroscopy 2015; 24(9).

Diederichs G, Issever AS, Scheffler S. MR imaging of patellar instability: injury patterns and assessment of risk factors. Radiographics. 2010; 30:961–981.