BMC musculoskeletal disorders · 2026
The impact of increasing femoral width on anatomic risk factors for patellar instability in paediatric patients: a retrospective MRI case-control study.
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Schroedter René, Koutp Amir, Sadoghi Patrick, Guggenberger Bernhard, Svehlik Martin, Tschauner Sebastian, Kraus Tanja
Аннотация
BACKGROUND: Chronological age does not reliably reflect skeletal development in children and adolescents. Anatomical risk factors for non-traumatic lateral patellar dislocation (LPD) may therefore be better interpreted relative to knee size. This study aimed to evaluate the relationship between femoral width and MRI-based anatomical risk factors for PFI in skeletally immature patients with and without a history of patellofemoral instability.
METHODS: In this retrospective MRI case-control study, 630 knee MRIs of skeletally immature patients were analysed, including 315 patients with first-time, non-traumatic lateral patella dislocation and 315 age- and sex-matched controls without a history of PFI. Each group comprised 146 males and 169 females, with a mean age of 14.5 years. MRI-based measurements included parameters of trochlear dysplasia, patellar tilt, patellar lateralization, and patellar height. Bicondylar femoral width was measured to normalize anatomical parameters to knee size. Independent t-tests compared group differences, and linear regression analyses assessed associations between femoral width and patellofemoral parameters.
RESULTS: Compared with controls, patients with PFI showed significantly reduced trochlear depth (3.6 ± 0.09 mm vs. 4.5 ± 0.09 mm), lower lateral trochlear inclination (14.4° ± 0.29 vs. 20.8° ± 0.32), greater trochlear sulcus angle (151.0° ± 0.58 vs. 136.5° ± 0.50), lower Laurin angle (- 0.7° ± 0.55 vs. 2.5° ± 0.57), lower Fulkerson angle (2.2° ± 0.55 vs. 8.6° ± 0.57), higher patellar inclination angle (TILT; 21.2° ± 0.53 vs. 18.5° ± 0.55), greater TTTG distance (13.3 ± 0.27 mm vs. 12.0 ± 0.27 mm), and greater TTPCL distance (23.1 ± 0.33 mm vs. 19.4 ± 0.34 mm), as well as a higher Caton-Deschamps Index (1.2 ± 0.01 vs. 1.1 ± 0.01) (all p < 0.05). The Patellotrochlear Index did not differ significantly between groups (47.1 ± 1.09 vs. 47.5 ± 1.02; p = 0.764). Linear regression analysis demonstrated significant associations between increasing femoral width and several parameters, including trochlear depth, patellar inclination, Fulkerson angle, TTPCL distance, Patellotrochlear Index, and Caton-Deschamps Index in at least one cohort (p < 0.05).
CONCLUSION: Anatomical risk factors for non-traumatic LPD differ significantly between skeletally immature patients with and without a history of patellar dislocation. Several patellofemoral parameters vary with femoral width, suggesting that knee size should be considered when interpreting patellofemoral morphology during skeletal development.
METHODS: In this retrospective MRI case-control study, 630 knee MRIs of skeletally immature patients were analysed, including 315 patients with first-time, non-traumatic lateral patella dislocation and 315 age- and sex-matched controls without a history of PFI. Each group comprised 146 males and 169 females, with a mean age of 14.5 years. MRI-based measurements included parameters of trochlear dysplasia, patellar tilt, patellar lateralization, and patellar height. Bicondylar femoral width was measured to normalize anatomical parameters to knee size. Independent t-tests compared group differences, and linear regression analyses assessed associations between femoral width and patellofemoral parameters.
RESULTS: Compared with controls, patients with PFI showed significantly reduced trochlear depth (3.6 ± 0.09 mm vs. 4.5 ± 0.09 mm), lower lateral trochlear inclination (14.4° ± 0.29 vs. 20.8° ± 0.32), greater trochlear sulcus angle (151.0° ± 0.58 vs. 136.5° ± 0.50), lower Laurin angle (- 0.7° ± 0.55 vs. 2.5° ± 0.57), lower Fulkerson angle (2.2° ± 0.55 vs. 8.6° ± 0.57), higher patellar inclination angle (TILT; 21.2° ± 0.53 vs. 18.5° ± 0.55), greater TTTG distance (13.3 ± 0.27 mm vs. 12.0 ± 0.27 mm), and greater TTPCL distance (23.1 ± 0.33 mm vs. 19.4 ± 0.34 mm), as well as a higher Caton-Deschamps Index (1.2 ± 0.01 vs. 1.1 ± 0.01) (all p < 0.05). The Patellotrochlear Index did not differ significantly between groups (47.1 ± 1.09 vs. 47.5 ± 1.02; p = 0.764). Linear regression analysis demonstrated significant associations between increasing femoral width and several parameters, including trochlear depth, patellar inclination, Fulkerson angle, TTPCL distance, Patellotrochlear Index, and Caton-Deschamps Index in at least one cohort (p < 0.05).
CONCLUSION: Anatomical risk factors for non-traumatic LPD differ significantly between skeletally immature patients with and without a history of patellar dislocation. Several patellofemoral parameters vary with femoral width, suggesting that knee size should be considered when interpreting patellofemoral morphology during skeletal development.