[Radiological diagnostics of patellofemoral instability and patellar dislocation].

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Abstract

[Indexed for MEDLINE] 15. Skeletal Radiol. 2024 Mar;53(3):499-506. doi: 10.1007/s00256-023-04446-w. Epub 2023 Sep 5. Acute patellar dislocation: how skeletal maturity affects patterns of injury. Varada SL(1), Wong TT(2), Popkin CA(3), Jaramillo D(4). Author information: (1)Department of Radiology, Division of Musculoskeletal Imaging & Intervention, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA. svarada@mgh.harvard.edu. (2)Department of Radiology, Division of Musculoskeletal Radiology, Columbia University Irving Medical Center, 622 West 168th Street, MC-28, New York, NY, 10032, USA. (3)Department of Orthopaedic Surgery, Center for Shoulder, Elbow and Sports Medicine & Pediatric Orthopedics, Columbia University Irving Medical Center, 3959 Broadway Avenue 8th Floor, New York, NY, 10032, USA. (4)Department of Radiology, Division of Pediatric Radiology, Columbia University Irving Medical Center, 630 West 168th Street, MC-28, New York, NY, 10032, USA. OBJECTIVE: The main objective of this study was to understand the role of skeletal maturity in the different patterns of osteochondral and ligamentous injuries after an acute lateral patellar dislocation. MATERIALS AND METHODS: Two radiologists independently reviewed MRIs of 212 knees performed after an acute lateral patellar dislocation to evaluate the presence of high-grade patellar osteochondral injury, femoral osteochondral injury, and medial patellofemoral ligament injury. The association of skeletal maturity (indicated by a closed distal femoral physis), age, sex, and first-time versus recurrent dislocation with each of these various lesions was analyzed using Chi-square or T test, and multivariable logistic regression with estimation of odds ratios (OR). RESULTS: Skeletal maturity was significantly associated with high-grade patellar osteochondral injury [OR=2.72 (95% CI 1.00, 7.36); p=0.049] and femoral-side MPFL tear [OR=2.34 (95% CI 1.05, 5.25); p=0.039]. Skeletal immaturity was significantly associated with patellar-side MPFL tear [OR=0.35 (95% CI 0.14, 0.90); p=0.029]. CONCLUSION: Patterns of injury to the patella and medial patellofemoral ligament vary notably between the skeletally immature and mature, and these variations may be explained by the inherent weakness of the patellar secondary physis. © 2023. The Author(s), under exclusive licence to International Skeletal Society (ISS). DOI: 10.1007/s00256-023-04446-w