The American journal of sports medicine · 2025
Radiological Risk Factors for Osteochondral Fractures in Patients With First-Time and Recurrent Patellar Instability: Data From the JUPITER Cohort.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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McGinley James J, Ellis Henry B, Propp Bennett, Veerkamp Matthew W, Wilson Philip L, Kramer Dennis E, Heyworth Benton E, Strickland Sabrina, Wall Eric, Koh Jason, Yen Yi-Meng, Halsey Matthew, Magnussen Robert, Roberts David, Farr Jack, Green Daniel, Fabricant Peter, Brady Jacqueline, Tompkins Marc, Redler Lauren H, Yanke Adam B, Sherman Seth L, Parikh Shital N, Shubin Stein Beth E
Аннотация
BACKGROUND: Radiological risk factors for an osteochondral fracture (OCF) associated with patellar instability are rarely studied, particularly in patients with recurrent instability.
PURPOSE: To identify specific radiological characteristics that relate to the increased prevalence of OCFs associated with patellar instability.
STUDY DESIGN: Case-control study; Level of evidence, 3.
METHODS: Patient data (n = 730) from the Justifying Patellar Instability Treatment by Early Results (JUPITER) multicenter study were reviewed for radiological findings. Trochlear crossing sign, Caton-Deschamps index (CDI), tibial tubercle-trochlear groove (TT-TG) distance, patellar tilt, trochlear depth, trochlear bump, sulcus angle, and patellar subluxation were measured on radiography or magnetic resonance imaging and classified into 2 categories based on pathological thresholds for general patellar instability. Patients were grouped according to the presence or absence of an OCF and analyzed with the Mann-Whitney test, chi-square test, and multivariate regression.
RESULTS: A high CDI was associated with a 0.43 decreased odds of an OCF, while a high TT-TG distance was a risk factor for an OCF, with a 2.17 times increased odds. Although a first-time dislocation increased the odds of an OCF by 4.72 times, recurrent instability was found to have the same predictive relationship of CDI and TT-TG distance with fracture incidence. A lower CDI, a shallower trochlear depth, a smaller trochlear bump, and the presence of a patellar subluxation were more common in patients with OCFs. A lower CDI, positive trochlear crossing sign, and shallower trochlear depth were more common in the subset of patients with recurrent instability and associated OCFs.
CONCLUSION: Patella alta was protective of OCFs in patients with first-time and recurrent instability, while a lateralized tibial tubercle was a risk factor. These radiological characteristics should guide health care professionals on the risk of future OCFs during treatment planning after a patellar instability event.
PURPOSE: To identify specific radiological characteristics that relate to the increased prevalence of OCFs associated with patellar instability.
STUDY DESIGN: Case-control study; Level of evidence, 3.
METHODS: Patient data (n = 730) from the Justifying Patellar Instability Treatment by Early Results (JUPITER) multicenter study were reviewed for radiological findings. Trochlear crossing sign, Caton-Deschamps index (CDI), tibial tubercle-trochlear groove (TT-TG) distance, patellar tilt, trochlear depth, trochlear bump, sulcus angle, and patellar subluxation were measured on radiography or magnetic resonance imaging and classified into 2 categories based on pathological thresholds for general patellar instability. Patients were grouped according to the presence or absence of an OCF and analyzed with the Mann-Whitney test, chi-square test, and multivariate regression.
RESULTS: A high CDI was associated with a 0.43 decreased odds of an OCF, while a high TT-TG distance was a risk factor for an OCF, with a 2.17 times increased odds. Although a first-time dislocation increased the odds of an OCF by 4.72 times, recurrent instability was found to have the same predictive relationship of CDI and TT-TG distance with fracture incidence. A lower CDI, a shallower trochlear depth, a smaller trochlear bump, and the presence of a patellar subluxation were more common in patients with OCFs. A lower CDI, positive trochlear crossing sign, and shallower trochlear depth were more common in the subset of patients with recurrent instability and associated OCFs.
CONCLUSION: Patella alta was protective of OCFs in patients with first-time and recurrent instability, while a lateralized tibial tubercle was a risk factor. These radiological characteristics should guide health care professionals on the risk of future OCFs during treatment planning after a patellar instability event.