Radiological evaluation of patellofemoral instability and possible causes of assessment errors

Patellofemoral instability (PI) is the disruption of the patella's relationship with the trochlear groove as a result of abnormal movement of the patella. To identify the presence of PI, conventional radiographs (anteroposterior, lateral, and axial or skyline views), magnetic resonance imaging, and computed tomography are used. In this study, we examined four main instability factors: Trochlear dysplasia, patella alta, tibial tuberosity-trochlear groove distance, and patellar tilt. We also briefly review some of the other assessment methods used in the quantitative and qualitative assessment of the patellofemoral joint, such as patellar size and shape, lateral trochlear inclination, trochlear depth, trochlear angle, and sulcus angle, in cases of PI. In addition, we reviewed the evaluation of coronal alignment, femoral anteversion, and tibial torsion. Possible causes of error that can be made when evaluating these factors are examined. PI is a multi-factorial problem. Many problems affecting bone structure and muscles morphologically and functionally can cause this condition. It is necessary to understand normal anatomy and biomechanics to make more accurate radiological measurements and to identify causes. Knowing the possible causes of measurement errors that may occur during radiological measurements and avoiding these pitfalls can provide a more reliable road map for treatment. This determines whether the disease will be treated medically and with rehabilitation or surgery without causing further complications

Evaluation of the foot posture, subtalar joint supination resistance and general gait parameters in individuals without foot disorders

Ayak postürü ve ark yapısının alt ekstremite biyomekanikleri ile ilişkisi özellikle klinisyenler için önem arz etmektedir. Bu çalışmada grup I (düz taban) ve grup II (normal ayak) tespit edilmiştir. Elde edilen gruplarda bazı genel yürüme parametreleri ve subtalar eklemin supinasyon rezistansının değerlendirilmesi amaçlanmıştır. Çalışmamıza gönüllülük esasına bağlı olarak ayak basma kusuru olmayan 18-30 yaş aralığında 61 kişi (30 kadın, 31 erkek) katıldı. Kişilerin ilgili demografik bilgileri toplandı. Sol ayak baz alınarak 6'lı ayak postür indeksi'ne (APİ-6) göre normal ayak (0-5 arası değerler) ve pronasyonda ayak (6-12 arası değerler) tipleri ile navikular yükseklik oranına göre düşük arklı (0,05). Ancak APİ-6 ve navikular yükseklik oranı arasında negatif bir ilişki olduğu görüldü (p0,05). Grup I ve grup II arasında genel yürüme parametreleri ve supinasyon rezistansının istatistiksel olarak anlamlı bir şekilde farklılaşmadığı gösterildi (p>0,05).The relationship between foot posture and arch structure with lower extremity biomechanics is especially important for clinicians. In this study, group I (flat foot) and group II (normal foot) were detected. It was aimed to evaluate some of the general gait parameters and supination resistance of the subtalar joint in these groups. 61 volunteers (30 females, 31 males) aged 18-30 years were participated in the study. Related demographic information of the individuals were collected. Based on the left foot, according to the 6-foot posture index (FPI-6), normal foot (values between 0-5) and pronated foot (values between 6-12) types were determined and according to the navicular height ratio, low arch ( 0.05). However, there was a negative correlation between FPI-6 and navicular height ratio (p 0.05). It has shown that general gait parameters and supination resistance did not differ significantly between group I and group II (p>0,05)

The relationship between patellar volume and trochlear volume in patients with patellofemoral instability

AIM: To investigate a possible relationship between both the volume and morphology of the patella and the volume of the trochlea in trochlear dysplasia (TD). MATERIALS AND METHODS: Eighteen patients with TD and 18 controls were evaluated retrospectively in two groups using computed tomography (CT). Patellar morphology was evaluated with the standard measurement methods described in the literature. Additionally trochlear sulcus volume (TV) and patellar volume (PV) were measured quantitatively using the three-dimensional volume-rendering method. The relationship between patella dimensions and volume and trochlea volume was evaluated. RESULTS: The length of the medial patellar facet (lMP), patellar width (PW), TV and PV were significantly lower in the patient group. When compared according to Dejour types, PW was statistically significantly lower than the control group in those with high-grade and those with low-grade dysplasia. A positive correlation was found between the TV and PV in both groups (patient group: r=0.583 p=0.011; control group: r=0.485 p=0.042). CONCLUSI_ONS: PV and the TV are related. Therefore, PV can be used as a determining parameter in the evaluation of TD. This technique can also be used for prosthesis construction and more accurate surgical planning