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. 2016 Jul 8;4(7):2325967116656328.
doi: 10.1177/2325967116656328. eCollection 2016 Jul.

Patellar Articular Overlap on MRI Is a Simple Alternative to Conventional Measurements of Patellar Height

Jacqueline L Munch  1 , Jaron P Sullivan  2 , Joseph T Nguyen  3 , Douglas Mintz  3 , Daniel W Green  3 , Beth E Shubin Stein  3 , Sabrina Strickland  3
Affiliations

Patellar Articular Overlap on MRI Is a Simple Alternative to Conventional Measurements of Patellar Height

Jacqueline L Munch et al. Orthop J Sports Med. .

Abstract

Background: Patella alta describes an abnormally high-riding patella in relationship to the femur and has been shown to correlate with patellofemoral pain, instability, chondromalacia, and arthrosis. Conventional measurements of patella alta involve multiple measurements and are often not defined on cross-sectional imaging as related to radiographs.

Hypothesis: Patellar articular overlap on sagittal magnetic resonance imaging (MRI) will correlate well with conventional measurements of patella alta as measured by a standardized technique defined by our group.

Study design: Cohort study (diagnosis); Level of evidence, 2.

Methods: MRIs of 239 knees were reviewed by 3 attending surgeons with practices focusing on patellofemoral disease, as well as 2 sports medicine fellows and 1 musculoskeletal radiologist. Measurements included articular overlap, percentage of articular coverage, Caton-Deschamps index, Blackburne-Peel index, and modified Insall-Salvati index.

Results: Interrater reliability was high for Caton-Deschamps, Blackburne-Peel, and modified Insall-Salvati indices (intraclass correlation coefficient [ICC], 0.877, 0.828, and 0.787, respectively). Articular overlap and percentage articular coverage correlated well with each other (ICC, 0.961; P < .001) and with the Caton-Deschamps (overlap r = -0.271, P < .001; coverage r = -0.131, P = .037) and Blackburne-Peel (overlap r = 0.343, P < .001; coverage r = -0.238, P < .001) indices. Articular overlap and percentage coverage failed to correlate with the modified Insall-Salvati index (overlap r = -0.117, P = .091; coverage r = 0.007, P = .918).

Conclusion: Patellar articular overlap and percentage of patellar articular coverage show promise as a simpler alternative to conventional, ratio-based measurements of patellar height. Future studies are needed to evaluate the range of normal and the relationship to our traditionally used measurements.

Keywords: MRI; knee; patellofemoral.

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Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: J.L.M. has received education grants for resident simulation training from Arthrex and Acumed; J.T.N. has received an outside grant from the Clinical and Translational Science Center for salary support; D.W.G. is a consultant for Arthrex; a close family member of B.E.S.S. is a consultant for Arthrex; S.S. owns stock/stock options in Zimmer.

Figures

Figure 1.
Figure 1.
(A) Posterior condylar line at most caudal portion of trochlea. (B) Axial magnetic resonance image with widest patellar dimension. (C) Bisect offset = a/(a + b).
Figure 2.
Figure 2.
Articular overlap = a. Percentage coverage = (a/b) × 100.
Figure 3.
Figure 3.
Calculation (a/b) of the (A) Caton-Deschamps index, (B) Blackburne-Peel index, and (C) modified Insall-Salvati index.
See this image and copyright information in PMC

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