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Patellar height measurement in trochlear dysplasia.

A J Barnett¹, M Prentice, V Mandalia

¹Department of Orthopaedics, Bristol Royal Infirmary, Bristol BS28HW, UK. andybarnett60@hotmail.com

Knee Surgery, Sports Traumatology, Arthroscopy : Official Journal of the ESSKA

|May 8, 2009

Summary

The patellotrochlear index (PTI) demonstrates good reliability for measuring patellar height in patients with patellofemoral dysplasia. This new index shows weak correlation with other common patellar height measurements, suggesting it may be a more clinically relevant tool.

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Area of Science:

Orthopedics
Radiology
Biomedical Engineering

Background:

Traditional patellar height measurements reference the tibia, potentially limiting accuracy.
The patellotrochlear index (PTI) has been proposed as a more accurate reflection of functional patellar height.
Patellofemoral dysplasia can affect patellar alignment and height measurements.

Purpose of the Study:

To compare the inter- and intra-observer reliability of four patellar height measurements in patients with patellofemoral dysplasia.
To assess the correlation between the patellotrochlear index (PTI), Insall-Salvati (IS), Blackburne-Peel (BP), and Caton-Deschamps (CD) ratios in predicting patella alta.
To determine the clinical relevance of the PTI compared to established measurements.

Main Methods:

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Retrospective analysis of MRI scans from 33 knees in 29 patients diagnosed with patellofemoral dysplasia.

Three blinded observers performed measurements of PTI, IS, BP, and CD ratios on two separate occasions.

Statistical analysis was used to assess inter- and intra-observer reliability and correlations between measurements.

Main Results:

Good inter-observer reliability was found for all measurements (PTI: 0.78, IS: 0.78, BP: 0.73, CD: 0.77).
Good intra-observer reliability was also observed (PTI: 0.80, IS: 0.83, BP: 0.75, CD: 0.78).
The PTI showed weak correlation with IS, BP, and CD ratios in predicting patella alta, while CD and BP had strong correlation (0.96).

Conclusions:

The patellotrochlear index (PTI) exhibits good reliability in patients with patellofemoral dysplasia.
The PTI's weak correlation with other measures suggests it captures different aspects of patellar height.
The study proposes the PTI as a potentially more clinically relevant measure for assessing patellar height in this patient population.