Kinematic and dynamic axial computerized tomography of the normal patellofemoral joint

Fourteen normal volunteers with no history suggesting previous or current knee pathology underwent axial computed tomographic examination of the patellofemoral joint. There were 11 men and 3 women, whose ages ranged from 10 to 46 years (average 25 years). Axial images were obtained at 0 degrees, 10 degrees, 20 degrees, 30 degrees, 40 degrees, and 60 degrees flexion both with and without contraction of the thigh muscles. Thus, 12 images were obtained for each individual. The CT scanner was focused at the midpatellar level prior to each image. Three measurements were made on 24 knees for each individual: congruence angle (CA), patellar tilt angle (PTA), and sulcus angle (SA). PTA increased slightly from 0 degrees to 20 degrees, and decreased slightly with more flexion (not significant, NS). The lower limit of PTA was usually 9 degrees-10 degrees; it was not lower than 7 degrees in any knee position. Muscle contraction increased PTA slightly at each degree of flexion (NS). Mean CA was +18.3 degrees (SD 20.8 degrees) at 0 degrees, which means that normal individuals may have CAs as high as +39 degrees at full extension. There was a gradual decrease in CAs with knee flexion. The mean values became negative between 20 degrees and 60 degrees flexion. Contraction of the thigh muscles caused lateralisation of the patella except at 30 degrees and 40 degrees flexion. This lateral pull was statistically significant at full extension (P < 0.01) and at 10 degrees flexion (P < 0.05). The SA decreased gradually as the flexion of the knee increased.(ABSTRACT TRUNCATED AT 250 WORDS)