The introduction of a new MRI index to evaluate sagittal patellofemoral engagement

Patella alta is one of the primary factors of patellofemoral instability and its importance lies in the reduced engagement between patella and trochlea during the early degrees of flexion. The evaluation of patellar height is based on conventional x-rays, CT scan and, more recently, MRI. The objective of this multicentric prospective study is to describe a novel index to assess in the sagittal plane the functional engagement between patella and trochlea.

One hundred and thirty-five patients with objective patellar dislocation were prospectively enrolled between April 2010 and September 2011 and were compared with a second group of 45 controls. All patients underwent a standard MRI and a complete radiographic study. Sagittal engagement was measured as the ratio between the articular cartilage of the patella and the trochlear cartilage length measured on two different MRI slices.

The mean Sagittal Patellofemoral Engagement (SPE) index was 0.43 ± 0.18 and ranged from 0.02 to 0.913 in the Objective Patellar Dislocation group versus 0.42 ± 0.11 range 0.22 to 0.55 in controls. In the Patellar Dislocation group the mean Caton-Deschamps index was 1.18 ± 0.21 (range 0.71 to 1.91). There were 58 patients with patella alta, in whom the mean SPE was 0.39 ± 0.18 (range 0.02 to 0.87). Sagittal engagement was significantly higher when compared with patients in the Patellar Dislocation group who had no patella alta (mean 0.46 ± 0.16, range 0.1-0.913).

The present study introduces a new method to measure the SPE with the use of MRI. The evaluation of the functional engagement of the patella with the femoral trochlea in the sagittal plane can serve as a supplementary tool to the existing methods of evaluating patellar height, and may help to better identify the cases where inadequate engagement is recorded despite the absence of patella alta, so that the need for tibial tuberosity osteotomy may be re-assessed.