Rofo 2003; 175(4): 547-555
DOI: 10.1055/s-2003-38436
Skelett
Originalarbeit
© Georg Thieme Verlag Stuttgart · New York

Postoperative Bestimmung des patellofemoralen Alignements nach Patellaluxation - eine computertomographische Analyse

Computed Tomography of the Patellofemoral Alignement After Arthroscopic Reconstruction Following Patella DislocationR.-J.  Schröder1 , A.  Weiler2 , J.  Höher2 , N.  Hidajat1 , J.  Mäurer1 , R.  Felix1
  • 1Klinik für Strahlenheilkunde, Charité, Campus Virchow-Klinikum, Humboldt-Universität Berlin
  • 2Sektion Sporttraumatologie und Arthroskopie, Klinik für Unfall- und Wiederherstellungschirurgie, Charité, Campus Virchow-Klinikum, Humboldt-Universität Berlin
Further Information

Publication History

Publication Date:
04 April 2003 (online)

Zusammenfassung

Ziel: Evaluation der Aussagekraft verschiedener CT-Vermessungsmethoden des Patellofemoralgelenkes nach arthroskopischer Stabilisierung bei Patellaluxation. Material und Methode: Axiale CT-Vermessung des Patellofemoralgelenkes bei 18 Patienten nach arthroskopischer medialer patellofemoraler Naht ohne oder mit postoperativer Rezidivluxation unter Verwendung sämtlicher in der Literatur bei entspanntem M. quadriceps empfohlenen Messmethoden in 4 Knieflexionsstufen (15 °, 30 °, 45 °, 60 °). Ergebnisse: Postoperativ zeigten nur der laterale Patellofemoralwinkel bei 15 ° und 30 ° und der Kongruenzwinkel bei 15 ° Flexion signifikante Unterschiede hinsichtlich der außerhalb des Normbereichs liegenden Fallzahl zwischen den nie luxierten und den postoperativ nicht reluxierten Patellae. Beide Gruppen unterschieden sich auch hinsichtlich ihrer Mittelwerte nicht signifikant. Außer bei der Patellalateralverschiebung nivellierten sich mit zunehmender Flexion die Unterschiede zwischen Normal- und Luxationsgruppen fast vollständig, Unterschiede zwischen Normal- und Reluxationsgruppe bei jedem Flexionsgrad zeigten nur der laterale Patellofemoralwinkel, der Patellaneigungswinkel und die Patellalateralverschiebung. Eine zunehmende Flexion (> 30 ° und besonders bei 60 °) führt die meisten Messwerte zurück in den Normbereich. Schlussfolgerungen: Bei der CT-Vermessung des Patellofemoralgelenkes nach Stabilisierungsoperation erscheinen der laterale Patellofemoralwinkel und der Kongruenzwinkel am nützlichsten. Die Messungen sollten in mehreren Flexionsgraden durchgeführt werden.

Abstract

Purpose: To evaluate the diagnostic impact of different CT-based measurements to analyze the patellofemoral alignment after arthroscopic reconstruction in patients with patella dislocation. Materials and Methods: In 18 patients with dislocation of the patella, CT of the patellofemoral joint was performed after arthroscopic reconstruction. Various methods recommended in the literature were used to analyze the structure and the alignment of the patellofemoral joint with a relaxed quadriceps muscle. Axial CT scans were taken in four different knee flexion angles (15 °, 30 °, 45 °, 60 °). Results: After arthroscopic stabilization in patients with patella dislocation, only the lateral patellofemoral angle (15 ° and 30 ° knee flexion) and the congruence angle (15 ° knee flexion) showed significant differences between the CT-measurements in the normal and the operated group. The differences of the remaining mean values were not significant due to a high standard deviation. With increasing flexion of the knee, the differences between the normal and the dislocation group almost disappeared. Only the lateral patellofemoral angle, the patella tilt and the lateral patella shift revealed differences between the normal and the group with recurrent dislocation in every degree of knee flexion. With increasing knee flexion above 30 ° and especially at 60 °, the majority of the measured values returned to the normal range. Conclusions: For CT-measurements of the patellofemoral joint after arthroscopic stabilization, the patellofemoral angle and the congruence angle seemed to be most useful. The measurements of the patellofemoral joint should be taken in various degrees of knee flexion.

Literatur

  • 1 Delgado-Martinez A D, Rodriguez-Merchán E C, Ballesteros R, Luna J D. Reproducibility of patellofemoral CT scan measurements.  Int Orthop. 2000;  24 5-8
  • 2 Metin Cubuk S, Sindel M, Karaali K, Arslan A G, Akyildiz F, Ozkan O. Tibial tubercle position and patellar height as indication of malalignment in women with anterior knee pain.  Klin Anat. 2000;  13 199-203
  • 3 Tsujimoto K, Kurosaka M, Yoshiya S, Mizuno K. Radiographic and computed tomographic analysis of the position of the tibial tubercle in recurrent dislocation and subluxation of the patella.  Am J Knee Surg. 2000;  13 83-88
  • 4 Biedert R M, Warnke K. Correlation between the Q angle and the patella position: a clinical and axial computed tomography evaluation.  Arch Orthop Trauma Surg. 2001;  121 346-349
  • 5 Delgado-Martinez A D, Estrada C, Rodriguez-Merchán E C, Atienza M, Ordónez J M. CT scanning of the patellofemoral joint. The quadriceps relaxed or contracted?.  Int Orthop. 1996;  20 159-162
  • 6 Sasaki T, Yagi T. Subluxation of the patella. Investigation by computerized tomography.  Int Orthop. 1986;  10 115-120
  • 7 Schutzer S F, Ramsby G R, Fulkerson J P. Computed tomographic classification of patellofemoral pain patients.  Orthop Clin North Am. 1986;  17 235-248
  • 8 Schutzer S F, Ramsby G R, Fulkerson J P. The evaluation of patellofemoral pain using computerized tomography. A preliminary study.  Clin Orthop. 1986;  204 286-293
  • 9 Fulkerson J P, Shea K P. Disorders of patellofemoral alignment.  J Bone Joint Surg (Am). 1990;  72 1424-1432
  • 10 Walker C, Cassar-Pullicino V N, Vaisha R, McCall I W. The patello-femoral joint: a critical appraisal of its geometric assessment utilizing conventional axial radiography and computed arthro-tomography.  Br J Radiol. 1993;  66 755-761
  • 11 Fulkerson J P, Schutzer S F, Ramsby G R, Bernstein R A. Computerized tomography of the patellofemoral joint before and after lateral release or realignment.  Arthroscopy. 1987;  3 19-24
  • 12 McGinty J B (ed). Operative Arthroscopy. New York; Raven Press 1991: 261-275
  • 13 Merchant A C. Patellofemoral imaging.  Clin Orthop Rel Res. 2001;  389 15-21
  • 14 Merchant A C, Mercer R L, Jacobsen R H, Cool C R. Roentgenographic analysis of patellofemoral congruence.  J Bone Joint Surg (Am). 1974;  56 1391-1396
  • 15 Laurin C A, Lévesque H P, Dussault R, Labelle H, Peides J P. The abnormal lateral patellofemoral angle. A diagnostic roentgenographic sign of recurrent patella subluxation.  J Bone Joint Surg (Am). 1978;  60 55-60
  • 16 Vahasarja V, Lanning P, Lahde Serlo W. Axial radiography or CT in the measurement of patellofemoral malalignment indices in children and adolescents?.  Clin Radiol. 1996;  51 639-643
  • 17 Beaconsfield T, Pintore E, Maffulli N, Petri G J. Radiological measurements in patellofemoral disorders. A review.  Clin Orthop. 1994;  308 18-28
  • 18 Stanciu C, Labelle H B, Morin B, Fassier F, Marton D. The value of computed tomography for the diagnosis of recurrent patellar subluxation in adolescents.  Can J Surg. 1994;  37 319-323
  • 19 Laurin C A, Dussault R, Lévesque H P. The tangential X-ray investigation of the patellofemoral joint: X-ray technique, diagnostic criteria, and their interpretation.  Clin Orthop. 1979;  144 16-26
  • 20 Cusmano F, Adravanti P, Pedrazzini M, Ampollini A, Pavone P. Radiologic assessment of femoro-patellar instability. Personal experience and review of the literature.  Radiol Med (Torino). 2001;  101 66-74
  • 21 Jones R B, Barlett E C, Vainright J R, Carroll R G. CT determination of tibial tubercle lateralization in patients presenting with anterior knee pain.  Skeletal Radiol. 1995;  24 505-509
  • 22 Muneta T, Yamamoto H, Ishibashi T, Asahina S, Furuya K. Computerized tomographic analysis of tibial tubercle position in the painful female patellofemoral joint.  Am J Sports Med. 1994;  22 67-71
  • 23 Biedert R M, Gruhl C. Axial computed tomography of the patello femoral joint with and without quadriceps contraction.  Arch Orthop Trauma Surg. 1997;  116 77-82
  • 24 Guzzanti V, Gigante A, Di Lazzaro A, Fabbriciani C. Patellofemoral malalignment in adolescents. Computerized tomogrpahic assessment with or without quadriceps contraction.  Am J Sports Med. 1994;  22 55-60
  • 25 Brossmann J, Mühle C, Melchert U H, Schröder C, Hassenpflug J, Spielmann R P. The femoropatellar gliding motion during active knee stretching. Imaging using motion-triggered MR tomography.  Fortschr Röntgenstr. 1992;  156 559-563
  • 26 Brossmann J, Mühle C, Schröder C, Melchert U H, Bull C C, Spielmann R P, Heller M. Patella tracking patterns during active and passive knee extension: evaluation with motion-triggered cine MR imaging.  Radiology. 1993;  187 205-212

PD Dr. med. Ralf-Jürgen Schröder

Klinik für Strahlenheilkunde, Charité, Campus Virchow-Klinikum, Humboldt-Universität Berlin

Augustenburger Platz 1

13353 Berlin

Phone: + 49-30-45057002

Fax: + 49-30-45057901

Email: ralf.schroeder@charite.de