Differences in the Severity and Location of Patellofemoral Cartilage Damage Between Instability Patients With and Without Patella Alta

Emma E Johnson; Michael P Campbell; Manoj Reddy; Ryan W Paul; Brandon J Erickson; Fotios P Tjoumakaris; Kevin B Freedman; Meghan E Bishop

doi:10.1177/23259671231186823

Differences in the Severity and Location of Patellofemoral Cartilage Damage Between Instability Patients With and Without Patella Alta

Orthop J Sports Med. 2023 Jul 31;11(7):23259671231186823. doi: 10.1177/23259671231186823. eCollection 2023 Jul.

Authors

Emma E Johnson¹, Michael P Campbell¹, Manoj Reddy¹, Ryan W Paul¹, Brandon J Erickson¹, Fotios P Tjoumakaris¹, Kevin B Freedman¹, Meghan E Bishop¹

Affiliation

¹ Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA.

Abstract

Background: Patella alta is a risk factor for recurrent patellar instability. Differences in chondral injury in patients with patellar instability between patella alta and patella norma have not been evaluated.

Purpose: To analyze whether preoperative cartilage damage differs in severity and location between patellar instability patients with and without patella alta.

Study design: Cohort study; Level of evidence, 3.

Methods: Patients with patellar instability who underwent patellar realignment surgery at a single institution with preoperative magnetic resonance imaging (MRI) scans were included. After measurement of Caton-Deschamps index (CDI) on MRI, patients were divided into patella alta (CDI ≥1.3) and patella norma groups. The area measurement and depth and underlying structures (AMADEUS) score was used to quantify cartilage defect severity on MRI.

Results: A total of 121 patients were divided into patella alta (n = 50) and patella norma (n = 71) groups. The groups did not differ significantly in sex ratio, age at MRI, body mass index, mean reported number of previous dislocations, or mean interval between first reported dislocation and date of MRI. A total of 34 (68%) of the patella alta group and 44 (62%) of the patella norma group had chondral defects (P = .625) with no significant between-group differences in defect size (P = .419). In both groups, chondral injuries most affected the medial patellar facet (55% in patella alta vs 52% in patella norma), followed by the lateral facet (25% vs 18%), and lateral femoral condyle (10% vs 14%). A smaller proportion of patients had full-thickness defects in the patella alta compared with the patella norma group (60% vs 82%; P = .030). The overall AMADEUS score was higher for the patella alta versus the patella norma group (68.9 vs 62.1; P = .023), indicating superior articular cartilage status.

Conclusion: Patients with patella alta had less severe cartilage injury after patellar instability, including a lower proportion with full-thickness defects and better overall cartilage grade. The location of injury when present was similar between alta and norma, with most defects affecting the medial facet, lateral facet, and lateral femoral condyle in descending frequency.

Keywords: chondral injury; patella alta; patellar chondrosis; patellar instability.