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Radiological Risk Factors for Osteochondral Fractures in Patients With First-Time and Recurrent Patellar Instability:

James J McGinley1,2, Henry B Ellis1,3,2, Bennett Propp4,2

  • 1Center for Excellence in Sports Medicine, Scottish Rite for Children, Frisco, Texas, USA.

The American Journal of Sports Medicine
|February 12, 2025
PubMed
Summary

Radiological risk factors like a high tibial tubercle-trochlear groove (TT-TG) distance increase osteochondral fracture (OCF) odds in patellar instability. Patella alta, however, is protective against OCFs.

Keywords:
imagingkneeosteochondral fracturepatellapatellar tendonpediatric sports medicineradiology

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Area of Science:

  • Orthopedic surgery
  • Radiology
  • Biomechanics

Background:

  • Osteochondral fractures (OCFs) associated with patellar instability are common.
  • Radiological risk factors for OCFs, especially in recurrent instability, are not well-understood.

Purpose of the Study:

  • To identify specific radiological characteristics associated with an increased prevalence of OCFs in patients with patellar instability.
  • To elucidate the relationship between various imaging findings and the occurrence of OCFs.

Main Methods:

  • A case-control study analyzing data from 730 patients in the JUPITER multicenter study.
  • Radiological measurements included trochlear crossing sign, Caton-Deschamps index (CDI), TT-TG distance, patellar tilt, trochlear depth, trochlear bump, sulcus angle, and patellar subluxation.
  • Statistical analysis involved Mann-Whitney test, chi-square test, and multivariate regression to compare patients with and without OCFs.

Main Results:

  • A high tibial tubercle-trochlear groove (TT-TG) distance (2.17x increased odds) and first-time dislocation (4.72x increased odds) were risk factors for OCFs.
  • A high Caton-Deschamps index (CDI) was protective (0.43x decreased odds).
  • Lower CDI, shallower trochlear depth, smaller trochlear bump, and patellar subluxation were more common in patients with OCFs. Recurrent instability showed similar TT-TG and CDI associations.

Conclusions:

  • Patella alta (high CDI) is protective against OCFs in both first-time and recurrent patellar instability.
  • A lateralized tibial tubercle (high TT-TG) is a risk factor for OCFs.
  • Identified radiological characteristics can aid in risk assessment and treatment planning for patellar instability patients to prevent OCFs.