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. 2022 Jun 20;56(8):1403-1409.
doi: 10.1007/s43465-022-00632-5. eCollection 2022 Aug.

The Dynamic Effect of Anterior Cruciate Ligament Deficiency on Patellar Height

Francesco Luceri  1   2 , Mattia Basilico  2   3 , Cécile Batailler  2 , Pietro Simone Randelli  4   5 , Sébastien Lustig  2   6 , Elvire Servien  2   7
Affiliations

The Dynamic Effect of Anterior Cruciate Ligament Deficiency on Patellar Height

Francesco Luceri et al. Indian J Orthop. .

Abstract

Background: The anterior tibial translation (ATT) in case of Anterior Cruciate Ligament (ACL) tear can lead to dynamic alterations of the extensor apparatus biomechanics. The aim of this study is to evaluate the dynamic effect of isolated ACL deficiency on patellar height. The hypothesis is that the ATT of ACL-insufficient knees dynamically reduces patellar height.

Methods: Skeletally mature patients who underwent ACL reconstruction using hamstring graft between January and December 2018 were included in this study. The Posterior Tibial Slope (PTS), Caton-Deschamps (CDI), modified Insall-Salvati (MISI), and Blackburne-Peel (BPI) indices were calculated in standard lateral and TELOS X-rays. The mean of the measurements calculated between two observers was used to compare these parameters.

Results: 95 patients (M: 57; F: 38; 95 knees) were included in the study with a mean age of 31.8 years (16-56 years old). Significant patellar height reduction (CDI: 0.11 [- 0.32; 0.31]; MISI: 0.09 [- 0.66; 0.30]) was reported in TELOS compared with standard lateral knee radiography (p < 0.001). 20.0% of the study knees reported an abnormal CDI and 84.2% (16/19 knees) of them reduced this index to within normal limits in TELOS. 20.0% of the knees with mild patella alta reduced CDI in TELOS but always remained above 1.2.

Conclusions: The abnormal ATT in case of ACL-deficient knees results in a lowering effect of the patella in TELOS X-rays. In patients with ACL tear and anterior pain the reconstructive ligament surgery should be performed to avoid also chronic anterior knee pain.

Level of evidence: Basic Science Study (Case Series).

Clinical relevance: The decrease in patellar height in stress-X-rays compared with standard lateral knee radiography in ACL deficient knees, should be considered as a possible contributing cause of anterior pain in these patients.

Keywords: Anterior Cruciate Ligament; Anterior Knee Pain; Anterior Tibial Translation; Patellar Height.

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Conflict of interest statement

Conflict of InterestFL has nothing to disclose. MB has nothing to disclose. CB has nothing to disclose. PSR reports personal fees from Arthrex, personal fees from Depuy (Johnson&Johnson), outside the submitted work. SL reports personal fees from Lepine, personal fees from Depuy (Johnson&Johnson), personal fees from Heraeus, personal fees from Smith & Nephew, personal fees from Stryker, personal fees from Medacta, other from Corin, other from Amplitude, outside the submitted work. ES reports personal fees from Smith & Nephew, grants from Corin, outside the submitted work.

Figures

Fig. 1
Fig. 1
PTS is the angle between the perpendicular to the tibial diaphysis (red line) and the tangent to the most superior point at the anterior and posterior edges of the medial tibial plateau (yellow line)
Fig. 2
Fig. 2
Patellar height indices: a Caton–Deschamps index ratio of the distance between the anterosuperior point of the tibial plateau and the distal pole of the patella (blue line) to the joint patellar surface (yellow line); b Modified Insall–Salvati index ratio of the distance between the distal pole of the patella and the tibial tuberosity (red line) to the joint patellar surface (yellow line); c Blackburne–Peel index ratio of the height of the distal pole of the patellar articular surface above the tibial plateau line (green line) to the joint patellar surface (yellow line)
Fig. 3
Fig. 3
The reduction of CDI of a right ACL-deficient knee in Standard (a) and TELOS (b) lateral X-ray was 0.1
See this image and copyright information in PMC

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