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Patellar Tendinopathy with Intra-tendinous Alteration on MRI may be related to Patellofemoral Dysplasia


Tscholl, Philippe M; Biedert, Roland M; Wanivenhaus, Florian; Fucentese, Sandro F (2018). Patellar Tendinopathy with Intra-tendinous Alteration on MRI may be related to Patellofemoral Dysplasia. Scandinavian Journal of Medicine & Science in Sports, 28(4):1443-1450.

Abstract

Patellar tendinopathy (PT) is a frequent overuse-injury of the extensor knee apparatus whereas as up to 30% of the athletes might suffer from persisting symptoms during their entire career. In the present case-control study, 47 patients (30.8±11.4 years) with PT with intra-tendinous alteration (PTita) of a minimum of ≥ 25% of the axial surface on MRI and minimum Blazina score of II (pain during without limiting sports activity) were included; MR images were analysed for trochlear geometry, patellar height/tilt, and tibial tubercle trochlear groove distance (TT-TG). The control group (CG) comprised 87 age- and gender-matched patients without history of anterior knee pain or lateral patellar instability. It was hypothised that patients with PT might be related to patellofemoral dysplasia. It was found, that the patella was significantly higher in PT patients compared to the CG (patellotrochlear index (PT-I): 0.33 vs 0.37, p=0.014; Insall-Salvati index (InSa): 1.18 vs 1.07, p=0.004). PT-I was above the cut-off value in 10.6% of PT knees (CG 5.7%, p=0.27), and InSa in 42.6% (CG 21.8%, p=0.012). TT-TG was significantly higher in PT patients compared to CG (12.0 mm vs 9.9 mm, p=0.002); however, TT-TG was only pathologic (>20 mm) in one patient. The trochlear facet ratio was above the cut-off value in 55.3% of PT patients and 23% of CG (p<0.001), and was significantly greater in PT patients (0.39±0.09) than CG (0.48±0.1, p<0.001). Knees with PT have significantly more morphological characteristics of patellofemoral instability, which needs to be considered especially in recurrent or treatment-refractive cases. This article is protected by copyright. All rights reserved.

Abstract

Patellar tendinopathy (PT) is a frequent overuse-injury of the extensor knee apparatus whereas as up to 30% of the athletes might suffer from persisting symptoms during their entire career. In the present case-control study, 47 patients (30.8±11.4 years) with PT with intra-tendinous alteration (PTita) of a minimum of ≥ 25% of the axial surface on MRI and minimum Blazina score of II (pain during without limiting sports activity) were included; MR images were analysed for trochlear geometry, patellar height/tilt, and tibial tubercle trochlear groove distance (TT-TG). The control group (CG) comprised 87 age- and gender-matched patients without history of anterior knee pain or lateral patellar instability. It was hypothised that patients with PT might be related to patellofemoral dysplasia. It was found, that the patella was significantly higher in PT patients compared to the CG (patellotrochlear index (PT-I): 0.33 vs 0.37, p=0.014; Insall-Salvati index (InSa): 1.18 vs 1.07, p=0.004). PT-I was above the cut-off value in 10.6% of PT knees (CG 5.7%, p=0.27), and InSa in 42.6% (CG 21.8%, p=0.012). TT-TG was significantly higher in PT patients compared to CG (12.0 mm vs 9.9 mm, p=0.002); however, TT-TG was only pathologic (>20 mm) in one patient. The trochlear facet ratio was above the cut-off value in 55.3% of PT patients and 23% of CG (p<0.001), and was significantly greater in PT patients (0.39±0.09) than CG (0.48±0.1, p<0.001). Knees with PT have significantly more morphological characteristics of patellofemoral instability, which needs to be considered especially in recurrent or treatment-refractive cases. This article is protected by copyright. All rights reserved.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > Balgrist University Hospital, Swiss Spinal Cord Injury Center
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:2018
Deposited On:19 Dec 2017 16:40
Last Modified:13 Mar 2018 02:02
Publisher:Wiley-Blackwell Publishing, Inc.
ISSN:0905-7188
OA Status:Closed
Publisher DOI:https://doi.org/10.1111/sms.13033
PubMed ID:29226423

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