The Morphologic Patella Entry Point Into The Proximal Trochlea Is More Lateral in Recurrent Dislocators Than Controls as Measured by Entry Point-Trochlear Groove Angle

Brian G Beitler; Johannes Sieberer; Wasif Islam; Curtis McDonald; Kristin Yu; Steven M Tommasini; John P Fulkerson

doi:10.1016/j.arthro.2024.04.013

The Morphologic Patella Entry Point Into The Proximal Trochlea Is More Lateral in Recurrent Dislocators Than Controls as Measured by Entry Point-Trochlear Groove Angle

Arthroscopy. 2024 Apr 30:S0749-8063(24)00308-6. doi: 10.1016/j.arthro.2024.04.013. Online ahead of print.

Authors

Brian G Beitler¹, Johannes Sieberer², Wasif Islam³, Curtis McDonald⁴, Kristin Yu⁵, Steven M Tommasini⁶, John P Fulkerson⁷

Affiliations

¹ Department of Orthopedics, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place Box 1188 New York, NY 10029. Electronic address: brian.beitler@mountsinai.org.
² Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 47 College Street, New Haven, CT 06510, USA. Electronic address: johannes.sieberer@yale.edu.
³ Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 47 College Street, New Haven, CT 06510, USA. Electronic address: wasif.islam@yale.edu.
⁴ Department of Statistics and Data Science, Yale University, 219 Prospect Street, New Haven, CT 06511. Electronic address: curtis.mcdonald@yale.edu.
⁵ Department of Orthopedic Surgery, Mayo Clinic Orthopedic Surgery, 200 First St. SW, Rochester, MN 55905. Electronic address: yu.kristin@mayo.edu.
⁶ Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 47 College Street, New Haven, CT 06510, USA. Electronic address: steven.tommasini@yale.edu.
⁷ Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 47 College Street, New Haven, CT 06510, USA. Electronic address: john.fulkerson@yale.edu.

PMID: 38697328
DOI: 10.1016/j.arthro.2024.04.013

Abstract

Purpose: The purpose of this work is to create a metric for evaluating the degree of laterality of the patella's entry into the trochlea, the entry point-trochlear groove (EP-TG) angle, and to evaluate if this laterality is associated with recurrent patella instability.

Methods: The time frame of the study was January 2020 to February 2023. The inclusion criteria were patients treated by the senior author (JPF) (with the exception of two patients who were treated by another provider at the institution who was aware of the study) who have been diagnosed with recurrent atraumatic patellar dislocations. Controls without knee pathology were selected from the New Mexico Decedent Imaging Database (NMDID). Simpleware ScanIP was used to create three-dimensional (3D) models of the distal femurs from CT scans. AP images of these 3D models were uploaded to a custom EP-TG angle measuring tool. Three measurers used the tool to measure the EP-TG angle of the distal femurs.

Results: 28 patients were included for the recurrent dislocator group. 24 decedents from NMDID were selected for the control group, each with a left or right knee chosen randomly for measurement. A one-sided Mann-Whitney U test, used to evaluate whether the recurrent dislocators had higher EP-TG angle values, yielded a p value <0.001, demonstrating a high level of significance. A Bayesian mixed effect model, used to determine how different the EP-TG angles are between the two groups, gave a posterior predictive interval (PPI) of [11.93, 19.12] degrees for the EP-TG angle shift of dislocators. The intraclass correlation coefficient was 0.648.

Conclusions: The morphological entry point of the patella into the proximal trochlea is more lateral in recurrent patella dislocators than in controls. This increased laterality can be measured by EP-TG angle, which may be useful information for optimizing treatment of recurrent patella instability.

Level of evidence: Level III Case Control Study.