J Knee Surg 2023; 36(13): 1357-1364
DOI: 10.1055/a-1933-3592
Original Article

Evaluation of Anatomical Variations with Morphological Measurements and Their Relationship to Meniscal Injury and Ligament Damage

Gülşen Yücel Oğuzdoğan
1   Department of Radiology, Basaksehir Cam and Sakura City Hospital, İstanbul, Turkey
,
1   Department of Radiology, Basaksehir Cam and Sakura City Hospital, İstanbul, Turkey
› Institutsangaben

Abstract

The purpose of this study was to reveal the anatomical risk factors for anterior and posterior cruciate ligament (ACL and PCL) injuries and menisci injury. We aim to investigate whether there are significant relationships between tibial tubercle-trochlear groove (TT-TG) distance, patella angle, trochlear sulcus angle (TSA), trochlear groove depth (TGD), medial and lateral trochlea length (MT and LT), MT/LT ratio, lateral patellar tilt angle (LPTA), patella-patellar tendon angle (P-PTA), quadriceps-patellar tendon angle (QPA), Insall-Salvati index (ISI), medial and lateral trochlear inclination (MTI and LTI) measurements and important common pathologies such as ACL, PCL, medial and lateral meniscal injuries (MM and LM), peripatellar fat pad edema, chondromalacia, and effusion. Thus, the mechanisms of injury will be better understood by revealing important anatomical variations for meniscus and ligament damage. Three hundred eighty patients with knee magnetic resonance imaging examination were included in this study. Our patients who underwent knee magnetic resonance imaging were divided into groups according to the presence of MM tear, LM tear, ACL tear, PCL tear, peripatellar fat pad edema, chondromalacia and effusion. TT-TG distance, patella angle, TSA, TGD, MT, LT, MT/LT ratio, LPTA, P-PTA, QPA, ISI, MTI, and LTI were measured. In patients with ACL tear, age, LT, ML/LT ratio, and QPA measurements were found to be significantly higher. There was no significant difference between the participants' LPTA value and the presence of ACL tear, MM and LM injury. MT and ML/LT ratio were found to be significantly lower in the group with MM tear (p <0.001). The TT-TG distance was found to be significantly lower in the group with LM tear. Increased age, LT, ML/LT ratio, and QPA are predisposed risk for ACL tear. Decreased MT and ML/LT ratio are among the risk factors for MM tear. The anatomical variations are associated with ligament and meniscal injury.



Publikationsverlauf

Eingereicht: 04. Februar 2022

Angenommen: 26. August 2022

Accepted Manuscript online:
30. August 2022

Artikel online veröffentlicht:
24. Januar 2023

© 2023. Thieme. All rights reserved.

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

 
  • References

  • 1 Resorlu H, Zateri C, Nusran G, Goksel F, Aylanc N. The relation between chondromalacia patella and meniscal tear and the sulcus angle/ trochlear depth ratio as a powerful predictor. J Back Musculoskeletal Rehabil 2017; 30 (03) 603-608
  • 2 Aysin IK, Askin A, Mete BD, Guvendi E, Aysin M, Kocyigit H. Investigation of the relationship between anterior knee pain and chondromalacia patellae and patellofemoral malalignment. Eurasian J Med 2018; 50 (01) 28-33
  • 3 Cilengir AH, Cetinoglu YK, Kazimoglu C. et al. The relationship between patellar tilt and quadriceps patellar tendon angle with anatomical variations and pathologies of the knee joint. Eur J Radiol 2021; 139: 109719
  • 4 Macri EM, Patterson BE, Crossley KM. et al. Does patellar alignment or trochlear morphology predict worsening of patellofemoral disease within the first 5 years after anterior cruciate ligament reconstruction?. Eur J Radiol 2019; 113: 32-38
  • 5 Resorlu M, Doner D, Karatag O, Toprak CA. The relationship between chondromalacia patella, medial meniscal tear and medial periarticular bursitis in patients with osteoarthritis. Radiol Oncol 2017; 51 (04) 401-406
  • 6 Vampertzis T, Barmpagianni C, Nitis G, Papastergiou S. A study of the possible effect of abnormal patella height on meniscal tears. J Orthop 2020; 22: 170-172
  • 7 Lin CF, Wu JJ, Chen TS, Huang TF. Comparison of the Insall-Salvati ratio of the patella in patients with and without an ACL tear. Knee Surg Sports Traumatol Arthrosc 2005; 13 (01) 8-11
  • 8 Singerman R, Davy DT, Goldberg VM. Effects of patella alta and patella infera on patellofemoral contact forces. J Biomech 1994; 27 (08) 1059-1065
  • 9 Watson NA, Duchman KR, Grosland NM, Bollier MJ. Finite element analysis of patella Alta: a patellofemoral instability model. Iowa Orthop J 2017; 37: 101-108
  • 10 Musahl V, Karlsson J. Anterior cruciate ligament tear. N Engl J Med 2019; 380 (24) 2341-2348
  • 11 Pache S, Aman ZS, Kennedy M. et al. Meniscal root tears: current concepts review. Arch Bone Jt Surg 2018; 6 (04) 250-259
  • 12 O'Malley O, Choudhury A, Biggs A. et al. Association between patellofemoral anatomy and chondral lesions of the knee in patellofemoral instability. J Knee Surg 2023; 36: 153-158
  • 13 Englund M, Guermazi A, Gale D. et al. Incidental meniscal findings on knee MRI in middle-aged and elderly persons. N Engl J Med 2008; 359 (11) 1108-1115
  • 14 Haj-Mirzaian A, Guermazi A, Pishgar F. et al. Patellofemoral morphology measurements and their associations with tibiofemoral osteoarthritis-related structural damage: exploratory analysis on the osteoarthritis initiative. Eur Radiol 2020; 30 (01) 128-140
  • 15 Tuna BK, Semiz-Oysu A, Pekar B, Bukte Y, Hayirlioglu A. The association of patellofemoral joint morphology with chondromalacia patella: a quantitative MRI analysis. Clin Imaging 2014; 38 (04) 495-498
  • 16 Kalichman L, Zhang Y, Niu J. et al. The association between patellar alignment and patellofemoral joint osteoarthritis features—an MRI study. Rheumatology (Oxford) 2007; 46 (08) 1303-1308
  • 17 Jibri Z, Jamieson P, Rakhra KS, Sampaio ML, Dervin G. Patellar maltracking: an update on the diagnosis and treatment strategies. Insights Imaging 2019; 10 (01) 65
  • 18 Wolfe S, Varacallo M, Thomas JD, Carroll JJ, Kahwaji CI. Patellar Instability. 2022 May 8. In: StatPearls. Treasure Island FL: StatPearls Publishing; 2022
  • 19 Graf KH, Tompkins MA, Agel J, Arendt EA. Q-vector measurements: physical examination versus magnetic resonance imaging measurements and their relationship with tibial tubercle-trochlear groove distance. Knee Surg Sports Traumatol Arthrosc 2018; 26 (03) 697-704
  • 20 Joseph SM, Cheng C, Solomito MJ, Pace JL. Lateral trochlear inclination angle: measurement via a 2-image technique to reliably characterize and quantify trochlear dysplasia. Orthop J Sports Med 2020; 8 (10) 2325967120958415
  • 21 Shen L, Jin ZG, Dong QR, Li LB. Anatomical risk factors of anterior cruciate ligament injury. Chin Med J (Engl) 2018; 131 (24) 2960-2967
  • 22. Unal M, Kose O, Aktan C, Gumussuyu G, May H, Kati YA. Is there a role of meniscal morphology in the risk of noncontact anterior cruciate ligament rupture? A case-control study. J Knee Surg 2021; 34 (05) 570-580
  • 23. Sanal HT. Diz Eklemi: Menisküs ve Bağlar. TRD Sem 2016; 4: 439-452