| Part One Atrophy of the vastus medial oblique and vastus lateral muscles was observed in patients with patellar dislocationBackground and Aims: Patellar dislocation is one of the most common musculoskeletal diseases,which is characterized by changes in patellar position during activities such as sitting,climbing stairs,running and squatting,and some patients may experience pain in the anterior knee area.It is one of the most common outpatient diseases among children,adolescents and adults under 60 years old.Whether vastus medialis obliquus atrophy exists in patients with Patellar dislocation and whether the amount of atrophy differs between the vastus medialis obliquus and vastus lateralis muscles remain unknown.Materials: From June 2016 to March 2019,61 patients with Patellar dislocation were retrospectively included in the study group,and an age-,sex-,and body mass index-matched cohort of 61 patients with normal knees was randomly selected as the control group.All enrolled subjects had undergone CT scans in the supine position.The cross-sectional areas of the vastus medialis obliquus and the vastus lateralis muscle in the sections 0,5,10,15,and 20 mm above the upper pole of the patella were measured,and the vastus medialis obliquus/vastus lateralis muscle area ratio was evaluated.Results: In the study group,the vastus medialis obliquus areas and the vastus lateralis muscle areas in the sections that were 0,5,10,15,and 20 mm above the upper pole of the patella were significantly smaller than the respective areas in the control group(P < 0.05).The vastus medialis obliquus/vastus lateralis muscle area ratio was significantly smaller at the upper pole of the patella(the section 0 mm above the upper pole of the patella)than the corresponding ratio in the control group(P < 0.05).No significant difference was noted between the two groups in t sections 5,10,15,and 20 mm above the upper pole of the patella(P > 0.05).Conclusion: In patients with Patellar dislocation,vastus medialis obliquus and vastus lateralis muscle atrophy existed in sections 0-20 mm above the upper pole of the patella,compared with normal controls,and atrophy of the vastus medialis obliquus was more evident than that of the vastus lateralis muscle at the upper pole of the patella.These findings support the rationale for the use of general quadriceps exercise combined with vastus medialis obliquus strengthening exercise as part of the rehabilitation program for the patients with Patellar dislocation.Part Two The vastus medialis oblique compensates in current patellar dislocation patients with the increased femoral anteversionBackground and Aims: Patellar dislocation of the patella is from the femoral trochlear groove,patellar dislocation is associated with a variety of factors,including abnormal femoral torsion gradually getting the attention of people,abnormal femoral forward can lead to the failure of the medial patellofemoral ligament reconstruction surgery.The purpose of this study was to investigate whether the vastus medialis oblique(VMO)compensates in patella dislocation patients with the increase of femoral anteversion angle(FAA).Methods: From January 2016 to January 2021,a total of 30 knees of 27 patients with recurrent patellar dislocation(RPD Group)were reviewed for this study.Among these patients,13 patients with patellar dislocation and excessive FAA,>30° were assigned to A Group,and 17 patients with the patellar dislocation without excessive FAA ≤30 were assigned to B Group.And 27 age and sex-matched knees without patellofemoral disorders were enrolled as control(C Group).The area of the VMO and vastus lateralis muscle(VLM)was measured 20 mm above the upper edge of the patella,and the ratio of the VMO and VLM area was calculated.The correlation relationship of FAA and VMO,VLM was analyzed.Results: Compared with the C Group,the RPD Group had a significantly larger FAA(30.10 ± 9.61 ° vs 15.00 ± 1.85 °,P< 0.05),and smaller VMO/VLM ratio(3.49±1.00/4.18±1.51,P< 0.05),and the VMO/VLM ratio was significantly greater in A Group than the B Group(3.97±1.11 vs3.12±0.70,P< 0.05).There was no statistically significant difference in VMO/VLM ratio among A Group and C Group(3.12±0.70/3.97±1.11,P> 0.05).And the VMO/VLM ratio was decreased in the B Group compared with the C Group(3.12±0.70/4.18±1.51,P< 0.05).The VMO/VLM ratio was positively correlated with the FAA(r=0.42)in the RPD Group.Conclusion: Compared with the C Group,the patients with recurrent patellar dislocation had a smaller VMO/VLM ratio.Moreover,the FAA was positively correlated with the VMO/VLM in patients with patella dislocation.This finding explained the compensatory thickening of the VMO in response to excessive FAA in patients with patella dislocation.Part Three Medialization of trochlear groove was correlated with extended lateral trochlear in trochlear dysplasia: a transverse CT analysisBackground and Aims: To investigate the difference of trochlear width between normal and dysplastic trochlear,and to analyze whether the medialization of trochlear groove was correlated with abnormal width of trochlear facets in trochlear dysplasia.Methods: This study involved CT scans of fifty knees with trochlear dysplasia(TD group)and fifty knees without obvious trochlear dysplasia(Normal group).The linear distance from the medial femoral epicondyle to the various reference points was measured on axial CT images including the medial edge of medial trochlear facet(d MTE),trochlear groove(d TG),and the lateral edge of lateral trochlear facets(d LTE).The medial and lateral trochlear width was calculated and standardized by the width of the anatomical epicondylar axis.Pearson’s correlation analysis was performed between the d TG and the width of the medial and lateral trochlear.Results: The reliability of the results was good.Intraclass Correlation Coefficient(ICC)ranged from 0.89 to 0.97.The d MTE was significantly greater in the TD group than the normal group(32.7±5.1% vs 29.6±3.5%,p=0.009).There was no significant difference in the d LTE between groups.The d TG was reduced in the TD group compared with the normal group(45.2±4.1% vs 49.1±3.9%,p=0.019).In the TD group,there was a significant reduction in the medial trochlear width(13.9±4.1% vs 19.4±2.9%,p<0.001)and a significant increase in the lateral trochlear width(31.3±4.0% vs26.9±3.6%,p<0.001)compared with the normal group.The d TG was significantly correlated with the lateral trochlear width(r value=-0.693,p<0.001)and not correlated with the medial trochlear width(r value=0.044,p=0.766)in trochlear dysplasia.Conclusion: This study demonstrated that dysplasia of trochlear morphology was related to the reduction of medial trochlear width and increase of lateral trochlear width.The medialization of the trochlear groove was significantly correlated with the increased lateral trochlear width.Part Four Accuracy of tibial tuberosity-trochlear groove distance,tibial tuberosity-posterior cruciate ligament distance in terms of the severity of trochlear dysplasiaPurpose: Increased Tibial Tubercle-Trochlear Groove Distance(TT-TG)was proposed as one of the main risk factors for patellofemoral instability(PFI).The increased TT-TG distance indicated externalization of the tibial tubercle with the reference of the trochlear groove.However,in the case of severe trochlear dysplasia,the reference point on the trochlear groove was indistinct,and the accuracy of TT-TG was controversial.The purpose of this study was to evaluate the accuracy of TT-TG and TT-PCL in consideration of mild and severe trochlear dysplasia.Methods From 2015 to 2020,MRI findings of consecutive knee joints with PFI symptoms diagnosed in our hospital were retrospectively analyzed.All knees with trochlear dysplasia were diagnosed by longitudinal MRI scan and lateral radiograph.The knees were classified according to the four-type classification system described by Dejour et al.20 cases of type A(mild trochlear dysplasia),20 cases of type B,C,and D(severe trochlear dysplasia),and 20 cases of normal type were selected and divided into the normal group(normal trochlea),mild group(type A)and severe group(type B,type C,type D).Tibial Tubercle-Trochlear Groove Distance(TT-TG),Tibial Tubercle-Posterior Cruciate Ligament Distance(TT-PCL),and the Dejour classification of trochlear dysplasia was assessed by 2 experience orthopedics.The reliability of TT-TG distance and TT-PCL distance was tested by intraclass correlation coefficients(ICC).Results: Comparing the differences between TT-TG and TT-PCL in the normal,mild and severe groups,the TT-TG and TT-PCL in the mild group show different meanings.(Normal,8.83±3.62 mm vs.8.44±4.57 mm,P>0.05;mild,17.30±4.81 mm vs.20.09±5.05 mm,P<0.05;severe,10.79±4.24 mm vs.12.31±5.43 mm,P>0.05).The Pearson correlation coefficient of TT-TG and TT-PCL measurements of trochlear dysplasia were r=0.480(mild group,P=0.032),r=0.585(severe group,P<0.001).The Intra-observer ICC of TT-TG was r=0.814(mild group),r=0.739(severe group).The Inter-observer ICC of TT-TG was r=0.810(mild group),r=0.713(severe group).In the normal knee,the Pearson correlation coefficient of TT-TG and TT-PCL was r=0.787(P<0.001),the Intra-observer ICC of TT-TG was r=0.989,and the Inter-observer ICC of TT-TG was r=0.978.Conclusion: Compared with mild trochlear dysplasia,the inter-observer and intra-observer correlations of TT-TG measurements decreased in the group of the severe dysplastic trochlea(Inter-observer ICC,0.810 vs.0.713;Intra-observer ICC,0.814 vs.0.739).In the present study,the determination of TT-TG and TT-PCL distance is of great significance for patients with low-grade trochlear dysplasia.And TT-PCL,without referring to the abnormal trochlear groove,is an effective indicator to measure the lateralization of the tibial tuberosity in patients with severe dysplastic trochlea. |
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