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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.
Background:
Radiological risk factors for an osteochondral fracture (OCF) associated with patellar instability are rarely studied, particularly in patients with recurrent instability.
Purpose:
To identify specific radiological characteristics that relate to the increased prevalence of OCFs associated with patellar instability.
Study Design:
Case-control study; Level of evidence, 3.
Methods:
Patient data (n = 730) from the Justifying Patellar Instability Treatment by Early Results (JUPITER) multicenter study were reviewed for radiological findings. Trochlear crossing sign, Caton-Deschamps index (CDI), tibial tubercle-trochlear groove (TT-TG) distance, patellar tilt, trochlear depth, trochlear bump, sulcus angle, and patellar subluxation were measured on radiography or magnetic resonance imaging and classified into 2 categories based on pathological thresholds for general patellar instability. Patients were grouped according to the presence or absence of an OCF and analyzed with the Mann-Whitney test, chi-square test, and multivariate regression.
Results:
A high CDI was associated with a 0.43 decreased odds of an OCF, while a high TT-TG distance was a risk factor for an OCF, with a 2.17 times increased odds. Although a first-time dislocation increased the odds of an OCF by 4.72 times, recurrent instability was found to have the same predictive relationship of CDI and TT-TG distance with fracture incidence. A lower CDI, a shallower trochlear depth, a smaller trochlear bump, and the presence of a patellar subluxation were more common in patients with OCFs. A lower CDI, positive trochlear crossing sign, and shallower trochlear depth were more common in the subset of patients with recurrent instability and associated OCFs.
Conclusion:
Patella alta was protective of OCFs in patients with first-time and recurrent instability, while a lateralized tibial tubercle was a risk factor. These radiological characteristics should guide health care professionals on the risk of future OCFs during treatment planning after a patellar instability event.
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