The Dynamic Effect of Anterior Cruciate Ligament Deficiency on Patellar Height

Francesco Luceri; Mattia Basilico; Cécile Batailler; Pietro Simone Randelli; Sébastien Lustig; Elvire Servien

doi:10.1007/s43465-022-00632-5

The Dynamic Effect of Anterior Cruciate Ligament Deficiency on Patellar Height

Indian J Orthop. 2022 Jun 20;56(8):1403-1409. doi: 10.1007/s43465-022-00632-5. eCollection 2022 Aug.

Authors

Francesco Luceri^{1

2}, Mattia Basilico^{2

3}, Cécile Batailler², Pietro Simone Randelli^{4

5}, Sébastien Lustig^{2

6}, Elvire Servien^{2

7}

Affiliations

¹ U.O.C. Clinica Ortopedica e Traumatologica Universitaria CTO, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy.
² FIFA Medical Center of Excellence, Orthopaedics Surgery and Sports Medicine Department, Croix Rousse Hospital, Civil Hospices of Lyon, 103 Boulevard de la Croix Rousse, 69004 Lyon, France.
³ Catholic University of the Sacred Heart School of Medicine, L.go A. Gemelli 1, 00168 Rome, Italy.
⁴ U.O.C. 1a Divisione, Azienda Socio Sanitaria Territoriale Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122 Milan, Italy.
⁵ Laboratorio di Biomeccanica Applicata, Dipartimento di Scienze Biomediche per la Salute, University of Milan, Via Mangiagalli 31, 20133 Milan, Italy.
⁶ LBMC UMR T 9406, Laboratory of Chock Mechanics and Biomechanics, Claude Bernard Lyon 1 University, Lyon, France.
⁷ Interuniversity Laboratory of Biology of Mobility, LIBM, EA 7424, Claude Bernard Lyon 1 University, Lyon, France.

Abstract

Background: The anterior tibial translation (ATT) in case of Anterior Cruciate Ligament (ACL) tear can lead to dynamic alterations of the extensor apparatus biomechanics. The aim of this study is to evaluate the dynamic effect of isolated ACL deficiency on patellar height. The hypothesis is that the ATT of ACL-insufficient knees dynamically reduces patellar height.

Methods: Skeletally mature patients who underwent ACL reconstruction using hamstring graft between January and December 2018 were included in this study. The Posterior Tibial Slope (PTS), Caton-Deschamps (CDI), modified Insall-Salvati (MISI), and Blackburne-Peel (BPI) indices were calculated in standard lateral and TELOS X-rays. The mean of the measurements calculated between two observers was used to compare these parameters.

Results: 95 patients (M: 57; F: 38; 95 knees) were included in the study with a mean age of 31.8 years (16-56 years old). Significant patellar height reduction (CDI: 0.11 [- 0.32; 0.31]; MISI: 0.09 [- 0.66; 0.30]) was reported in TELOS compared with standard lateral knee radiography (p < 0.001). 20.0% of the study knees reported an abnormal CDI and 84.2% (16/19 knees) of them reduced this index to within normal limits in TELOS. 20.0% of the knees with mild patella alta reduced CDI in TELOS but always remained above 1.2.

Conclusions: The abnormal ATT in case of ACL-deficient knees results in a lowering effect of the patella in TELOS X-rays. In patients with ACL tear and anterior pain the reconstructive ligament surgery should be performed to avoid also chronic anterior knee pain.

Level of evidence: Basic Science Study (Case Series).

Clinical relevance: The decrease in patellar height in stress-X-rays compared with standard lateral knee radiography in ACL deficient knees, should be considered as a possible contributing cause of anterior pain in these patients.

Keywords: Anterior Cruciate Ligament; Anterior Knee Pain; Anterior Tibial Translation; Patellar Height.