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The Ultrasound-Assisted Patellar Glide Test: A Novel Examination Method for Quantifying Patellar Instability.

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Summary

Stress ultrasonography accurately quantifies patellar instability using the delta medial patellofemoral distance (MPFD). A delta MPFD of 2 mm or more reliably identifies knees with symptomatic patellar instability.

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Area of Science:

  • Orthopedics
  • Diagnostic Imaging
  • Biomechanics

Background:

  • Patellofemoral instability presents diagnostic challenges due to its dynamic nature.
  • Current physical examination methods struggle to quantify patellar instability effectively.

Purpose of the Study:

  • To introduce and validate a novel stress ultrasonography technique for quantifying patellar instability.
  • To explore the correlation between stress ultrasonography measurements and known risk factors for patellar instability.

Main Methods:

  • The ultrasound-assisted patellar glide test was performed on knees with symptomatic patellar instability.
  • Medial patellofemoral distance (MPFD) was measured in unloaded and loaded states to determine delta MPFD.
  • Measurements were compared to asymptomatic, postoperative, and control knees; regression and ROC analyses were conducted.

Main Results:

  • A significantly greater delta MPFD was observed in knees with patellar instability (3.3 mm) compared to controls (1.1-1.4 mm).
  • Receiver operating characteristic (ROC) analysis revealed an optimal delta MPFD threshold of 2.0 mm with an area under the curve (AUC) of 0.97.
  • No significant relationships were found between delta MPFD and clinical or morphologic risk factors.

Conclusions:

  • The ultrasound-assisted patellar glide test, with a delta MPFD threshold of ≥2 mm, demonstrates excellent discriminatory ability for identifying symptomatic patellar instability (AUC=0.97).
  • Further research is recommended to standardize and refine this quantitative ultrasound method for patellar instability assessment.