Download PDF
J Knee Surg 2023; 36(03): 254-260
DOI: 10.1055/s-0041-1731720
Original Article

The Effect of Aberrant Rotation on Radiographic Patellar Height Measurement Using Canton-Deschamps Index: A Cadaveric Analysis

Hailey P. Huddleston
1   Midwest Orthopedics at Rush, Rush University Medical Center, Chicago, Illinois
,
Michael L. Redondo
1   Midwest Orthopedics at Rush, Rush University Medical Center, Chicago, Illinois
,
William M. Cregar
1   Midwest Orthopedics at Rush, Rush University Medical Center, Chicago, Illinois
,
David R. Christian
1   Midwest Orthopedics at Rush, Rush University Medical Center, Chicago, Illinois
,
Charles P. Hannon
1   Midwest Orthopedics at Rush, Rush University Medical Center, Chicago, Illinois
,
Adam B. Yanke
1   Midwest Orthopedics at Rush, Rush University Medical Center, Chicago, Illinois
› Author Affiliations Funding This study received its financial support from CONMED Linvatec personal fees, JRF Ortho personal fees, Olympus personal fees, Organogenesis grant, Patient IQ stock/stock options, Smith & Nephew nonfinancial support, Sparta Biomedical nonfinancial support, grants from Vericel, grants from Arthrex, Inc. and Aastrom Biosciences Inc. outside the submitted work. Medical Device Business Services Inc. $2100–(2019).
› Further Information
    Permissions and Reprints

Abstract

The Caton-Deschamps Index (CDI) is a measurement used to evaluate patella alta based on true lateral radiographs; however, no prior study has investigated how altering the degree of radiograph aberrancy affects CDI measurement. The primary and secondary purpose of this study was to evaluate effects of rotational radiographic changes on patella height measurements and compare these findings to MRI measurements, respectively. Five cadaver knees (n = 5) were utilized in this study. True lateral radiographs were obtained for each specimen by using a fluoroscopic C-arm machine. The C-arm was then altered in two planes (axial and coronal) in both the clockwise and counterclockwise direction and radiographs were taken at 5, 10, and 15 degrees of error from the true lateral position. A CDI measurement of each specimen was performed based on sagittal magnetic resonance imaging (MRI) slices and compared with radiographic CDI measurements. Three orthopedic surgeons measured the CDI for each radiograph and MRI performed. Interrater reliability and changes in CDI were analyzed. Clinically significant difference in CDI was set to 0.1. Mean intraclass correlation coefficient was high (≥0.7) at true lateral and at all varying degrees of error. When performing a pairwise comparison of mean CDI from the true lateral position to increasing degrees of error, statistically significant differences were observed in the axial plane. The largest change in CDI measurements was seen with rotational malposition in the axial plane and counterclockwise direction. No statistically significant differences in mean CDI were observed in the coronal plane. The change in CDI from the true lateral position reached an absolute maximum of at least 0.1 in all four scenarios at each tested degree of error. This study found that aberrant radiographic rotation in the axial plane resulted in a significantly different mean CDI measurement when compared with true lateral radiographs. All degrees of error in both directions and in both planes could have a clinically significant effect on CDI (≥0.1). Our findings confirm the importance of a perfect true lateral radiograph when measuring patella height.

Keywords

Caton-Deschamps Index - perfect lateral radiograph - knee


Publication History

Received: 12 October 2020

Accepted: 31 May 2021

Article published online:
14 July 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Waterman BR, Belmont Jr PJ, Owens BD. Patellar dislocation in the United States: role of sex, age, race, and athletic participation. J Knee Surg 2012; 25 (01) 51-57
    Article in Thieme ConnectPubMedGoogle Scholar
  • 2 Steensen RN, Bentley JC, Trinh TQ, Backes JR, Wiltfong RE. The prevalence and combined prevalences of anatomic factors associated with recurrent patellar dislocation: a magnetic resonance imaging study. Am J Sports Med 2015; 43 (04) 921-927
    CrossrefPubMedGoogle Scholar
  • 3 Weber AE, Nathani A, Dines JS. et al. An algorithmic approach to the management of recurrent lateral patellar dislocation. J Bone Joint Surg Am 2016; 98 (05) 417-427
    CrossrefPubMedGoogle Scholar
  • 4 Fitzpatrick CK, Steensen RN, Tumuluri A, Trinh T, Bentley J, Rullkoetter PJ. Computational analysis of factors contributing to patellar dislocation. J Orthop Res 2016; 34 (03) 444-453
    CrossrefPubMedGoogle Scholar
  • 5 Hiemstra LA, Kerslake S, Loewen M, Lafave M. Effect of trochlear dysplasia on outcomes after isolated soft tissue stabilization for patellar instability. Am J Sports Med 2016; 44 (06) 1515-1523
    CrossrefPubMedGoogle Scholar
  • 6 Askenberger M, Arendt EA, Ekström W, Voss U, Finnbogason T, Janarv P-M. Medial patellofemoral ligament injuries in children with first-time lateral patellar dislocations: a magnetic resonance imaging and arthroscopic study. Am J Sports Med 2016; 44 (01) 152-158
    CrossrefPubMedGoogle Scholar
  • 7 Charles MD, Haloman S, Chen L, Ward SR, Fithian D, Afra R. Magnetic resonance imaging-based topographical differences between control and recurrent patellofemoral instability patients. Am J Sports Med 2013; 41 (02) 374-384
    CrossrefPubMedGoogle Scholar
  • 8 Jaquith BP, Parikh SN. Predictors of recurrent patellar instability in children and adolescents after first-time dislocation. J Pediatr Orthop 2017; 37 (07) 484-490
    CrossrefPubMedGoogle Scholar
  • 9 Lewallen LW, McIntosh AL, Dahm DL. Predictors of recurrent instability after acute patellofemoral dislocation in pediatric and adolescent patients. Am J Sports Med 2013; 41 (03) 575-581
    CrossrefPubMedGoogle Scholar
  • 10 Redler LH, Meyers KN, Brady JM, Dennis ER, Nguyen JT, Shubin Stein BE. Anisometry of medial patellofemoral ligament reconstruction in the setting of increased tibial tubercle-trochlear groove distance and patella alta. Arthroscopy 2018; 34 (02) 502-510
    CrossrefPubMedGoogle Scholar
  • 11 Shah JN, Howard JS, Flanigan DC, Brophy RH, Carey JL, Lattermann C. A systematic review of complications and failures associated with medial patellofemoral ligament reconstruction for recurrent patellar dislocation. Am J Sports Med 2012; 40 (08) 1916-1923
    CrossrefPubMedGoogle Scholar
  • 12 Bartsch A, Lubberts B, Mumme M, Egloff C, Pagenstert G. Does patella alta lead to worse clinical outcome in patients who undergo isolated medial patellofemoral ligament reconstruction? A systematic review. Arch Orthop Trauma Surg 2018; 138 (11) 1563-1573
    CrossrefPubMedGoogle Scholar
  • 13 Berard J-B, Magnussen RA, Bonjean G. et al. Femoral tunnel enlargement after medial patellofemoral ligament reconstruction: prevalence, risk factors, and clinical effect. Am J Sports Med 2014; 42 (02) 297-301
    CrossrefPubMedGoogle Scholar
  • 14 Caton J, Deschamps G, Chambat P, Lerat JL, Dejour H. [Patella infera. Apropos of 128 cases]. Revue De Chir Orthopédique Et Réparatrice De L'appareil Moteur 1982; 68: 317-325
    PubMedGoogle Scholar
  • 15 van Duijvenbode D, Stavenuiter M, Burger B, van Dijke C, Spermon J, Hoozemans M. The reliability of four widely used patellar height ratios. Int Orthop 2016; 40 (03) 493-497
    CrossrefPubMedGoogle Scholar
  • 16 Narkbunnam R, Chareancholvanich K. Effect of patient position on measurement of patellar height ratio. Arch Orthop Trauma Surg 2015; 135 (08) 1151-1156
    CrossrefPubMedGoogle Scholar
  • 17 Yue RA, Arendt EA, Tompkins MA. Patellar height measurements on radiograph and magnetic resonance imaging in patellar instability and control patients. J Knee Surg 2017; 30 (09) 943-950
    Article in Thieme ConnectPubMedGoogle Scholar
  • 18 Laugharne E, Bali N, Purushothamdas S, Almallah F, Kundra R. Variability of measurement of patellofemoral indices with knee flexion and quadriceps contraction: an MRI-based anatomical study. Knee Surg Relat Res 2016; 28 (04) 297-301
    CrossrefPubMedGoogle Scholar