The patellotrochlear index: a new index for assessing patellar height

Abstract

The radiological methods to determine patellar height described in the literature are variable, not reliable and depend on the chosen ratio. The purpose of this paper is to describe another method of measuring patellar height on sagittal MRI using the true articular cartilage patellotrochlear relationship. An analysis of magnetic resonance (MR) examinations of 66 consecutive patients was performed. The most common diagnoses were meniscal or anterior cruciate ligament pathologies. No patient suffered from patellofemoral complaints. Measurements on sagittal MR images included different parameters using the articular cartilage of the patella and the trochlea. The ratio patella : trochlea of the cartilage baselines was measured in percentages and described as patellotrochlear index. The measurements were assessed at two different times by three raters under blinded conditions. The mean patellotrochlear index was 31.7% (CI: 12.5-50.0; range -5.0 to 61.1%; SD +/-11.6). The intraobserver variability showed only in the "second observer" a difference of the mean values of the two different measurements (t=2.189; P=0.032). The interobserver correlation was high and significant (0.663-0.893; P=0.000). Our results indicate that the patellotrochlear index is a reliable and precise method to determine the exact articular correlation of the patellofemoral joint and the patellar height. The results represent the average patellotrochlear index in the normal population without patellofemoral complaints. Measurements of the articular cartilage congruence can be helpful to define an underlying pathology of patellar height, such as patella alta or infera.