The Difference between Cartilaginous and Bony Sulcus Angles for Patients with or without Patellofemoral Instability: A Systematic Review and Meta-Analysis

Si Heng Sharon Tan; Kiat Soon Jason Chng; Beatrice Ying Lim; Keng Lin Wong; Chintan Doshi; Andrew Kean Seng Lim; James Hoipo Hui

doi:10.1055/s-0038-1677541

The Journal of Knee Surgery, Table of Contents

J Knee Surg 2020; 33(03): 235-241
DOI: 10.1055/s-0038-1677541

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Difference between Cartilaginous and Bony Sulcus Angles for Patients with or without Patellofemoral Instability: A Systematic Review and Meta-Analysis

Authors

Si Heng Sharon Tan

¹Department of Orthopaedic Surgery, National University Health System, Singapore, Singapore
Kiat Soon Jason Chng

¹Department of Orthopaedic Surgery, National University Health System, Singapore, Singapore
Beatrice Ying Lim

¹Department of Orthopaedic Surgery, National University Health System, Singapore, Singapore
Keng Lin Wong

¹Department of Orthopaedic Surgery, National University Health System, Singapore, Singapore
Chintan Doshi

¹Department of Orthopaedic Surgery, National University Health System, Singapore, Singapore
Andrew Kean Seng Lim

¹Department of Orthopaedic Surgery, National University Health System, Singapore, Singapore
James Hoipo Hui

¹Department of Orthopaedic Surgery, National University Health System, Singapore, Singapore

Abstract

The cartilaginous sulcus angle and bony sulcus angle have been widely used to evaluate trochlea dysplasia. The current review aims to evaluate (1) whether there is a difference in measurement for cartilaginous and bony sulcus angles, (2) whether both the cartilaginous and bony sulcus angles could be used to differentiate between patients with or without trochlear dysplasia, and (3) whether the same cut-off of 145 degrees, originally used for radiographs, can be applied for the cartilaginous and bony sulcus angles measured on CT and MRI. The review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRSIMA) guidelines. A total of 11 publications with 1204 patients were included. All publications reported the sulcus angle to be greater in patients with patellofemoral instability. All publications reported the cartilaginous sulcus angle to be greater than the bony sulcus angle (MD 7.27 degrees; 95% CI: 5.67 – 8.87). The mean cartilaginous sulcus angle for the control group was 141.83 degrees (95% CI: 139.90 – 143.76) while the mean cartilaginous sulcus angle for patients with patellofemoral instability was 156.24 degrees (95% CI: 153.71 – 158.77). The mean bony sulcus angle for the control group was noted to be 133.69 degrees (95% CI: 131.23 – 136.15) while the mean bony sulcus angle for patients with patellofemoral instability was 148.42 (95% CI: 144.02 – 152.82). Both the cartilaginous and bony sulcus angles measured on CT and MRI could therefore be used to differentiate between patients with and without trochlear dysplasia. However, the cartilaginous sulcus angles are significantly higher than that of bony sulcus angles. Different cut off values should therefore be used.

Keywords

patellar instability - patellofemoral instability - trochlear dysplasia - sulcus angle - trochlear angle - cartilaginous - bony

Full Text

References

References
1 Redziniak DE, Diduch DR, Mihalko WM. , et al. Patellar instability. J Bone Joint Surg Am 2009; 91 (09) 2264-2275
2 Tan SHS, Ibrahim MM, Lee ZJ, Chee YKM, Hui JH. Patellar tracking should be taken into account when measuring radiographic parameters for recurrent patellar instability. Knee Surg Sports Traumatol Arthrosc 2018; Dec; 26 (12) 3593-3600
3 Tan SHS, Tan LYH, Lim AKS, Hui JH. Hemiepiphysiodesis is a potentially effective surgical management for skeletally immature patients with patellofemoral instability associated with isolated genu valgum. Knee Surg Sports Traumatol Arthrosc 2018 Sep 8. doi: 10.1007/s00167-018-5127-8
4 Dejour H, Walch G, Nove-Josserand L, Guier C. Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc 1994; 2 (01) 19-26
5 Pfirrmann CW, Zanetti M, Romero J, Hodler J. Femoral trochlear dysplasia: MR findings. Radiology 2000; 216 (03) 858-864
6 Lippacher S, Reichel H, Nelitz M. Radiological criteria for trochlear dysplasia in children and adolescents. J Pediatr Orthop B 2011; 20 (05) 341-344
7 Dejour D, Le Coultre B. Osteotomies in patello-femoral instabilities. Sports Med Arthrosc Rev 2007; 15 (01) 39-46
8 Salzmann GM, Weber TS, Spang JT, Imhoff AB, Schöttle PB. Comparison of native axial radiographs with axial MR imaging for determination of the trochlear morphology in patients with trochlear dysplasia. Arch Orthop Trauma Surg 2010; 130 (03) 335-340
9 Askenberger M, Janarv PM, Finnbogason T, Arendt EA. Morphology and anatomic patellar instability risk factors in first-time traumatic lateral patellar dislocations: a prospective magnetic resonance imaging study in skeletally immature children. Am J Sports Med 2017; 45 (01) 50-58
10 Balcarek P, Jung K, Ammon J. , et al. Anatomy of lateral patellar instability: trochlear dysplasia and tibial tubercle-trochlear groove distance is more pronounced in women who dislocate the patella. Am J Sports Med 2010; 38 (11) 2320-2327
11 Balcarek P, Walde TA, Frosch S. , et al. Patellar dislocations in children, adolescents and adults: a comparative MRI study of medial patellofemoral ligament injury patterns and trochlear groove anatomy. Eur J Radiol 2011; 79 (03) 415-420
12 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
13 Düppe K, Gustavsson N, Edmonds EW. Developmental morphology in childhood patellar instability: age-dependent differences on magnetic resonance imaging. J Pediatr Orthop 2016; 36 (08) 870-876
14 Guzzanti V, Gigante A, Di Lazzaro A, Fabbriciani C. Patellofemoral malalignment in adolescents. Computerized tomographic assessment with or without quadriceps contraction. Am J Sports Med 1994; 22 (01) 55-60
15 Parikh SN, Rajdev N, Sun Q. The Growth of Trochlear Dysplasia During Adolescence. J Pediatr Orthop 2018; 38 (06) e318-e324
16 Prakash J, Seon JK, Woo SH, Jin C, Song EK. Comparison of radiological parameters between normal and patellar dislocation groups in Korean population: a rotational profile CT-based study. Knee Surg Relat Res 2016; 28 (04) 302-311
17 Toms AP, Cahir J, Swift L, Donell ST. Imaging the femoral sulcus with ultrasound, CT, and MRI: reliability and generalizability in patients with patellar instability. Skeletal Radiol 2009; 38 (04) 329-338
18 van Huyssteen AL, Hendrix MR, Barnett AJ, Wakeley CJ, Eldridge JD. Cartilage-bone mismatch in the dysplastic trochlea. An MRI study. J Bone Joint Surg Br 2006; 88 (05) 688-691
19 Yılmaz B, Çiçek ED, Şirin E, Özdemir G, Karakuş Ö, Muratlı HH. A magnetic resonance imaging study of abnormalities of the patella and patellar tendon that predispose children to acute patellofemoral dislocation. Clin Imaging 2017; 42: 83-87
20 Deeks JJ, Altman DG, Bradburn MJ. Statistical methods for examining heterogeneity and combining results from several studies in meta-analysis. In Egger M, Smith GD, Altman DG. , eds. Systematic Reviews in Health Care: Meta-analysis in Context. 2nd ed. London: BMJ Publishing Group; 2001: 285-312
21 Fleiss JL. The statistical basis of meta-analysis. Stat Methods Med Res 1993; 2 (02) 121-145
22 Higgins JPT, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ 2003; 327 (7414): 557-560
23 Higgins JPT, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med 2002; 21 (11) 1539-1558
24 Whitehead A. Meta-Analysis of Controlled Clinical Trials. West Sussex, London: John Wiley & Sons Ltd.; 2002