Abstract
Background
Patellar malalignment is a risk factor of patellofemoral pain. Evaluation of the patellar
alignment have mostly used magnetic resonance imaging (MRI). Ultrasound (US) is a
non-invasive instrument that can quickly evaluate patellar alignment. However, the
method for evaluating patellar alignment via US has not been established. This study
aimed to investigate the reliability and validity of evaluating patellar alignment
via US.
Methods
The sixteen right knees were imaged via US and MRI. US images were obtained at two
sites of the knee to measure US-tilt as the index of patellar tilt. Using a single
US image, we measured US-lateral distance and US-angle as the index of patellar shift.
All US images were obtained three times each by two observers to evaluate reliabilities.
Lateral patellar angle (LPA), as the indicators of patellar tilt, and lateral patella
distance (LPD) and bisect offset (BO), as the indicators of patellar shift, were measured
via MRI.
Results
US measurements provided high intra- (within-day and between days) and interobserver
reliabilities with exception of interobserver reliability of US-lateral distance.
Pearson correlation coefficient indicated that US-tilt is significantly positively
correlated with LPA (r = 0.79), and US-angle is significantly positively correlated
with LPD (r = 0.71) and BO (r = 0.63).
Conclusion
Evaluating patellar alignment via US showed high reliabilities. US-tilt and US-angle
showed moderate to strong correlation with MRI indices of patellar tilt and shift
via MRI, respectively. US methods are useful for evaluating accurate and objective
indices of patellar alignment.
Keywords
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References
- The etiology of patellofemoral pain in young, active patients: a prospective study.Clin Orthop Relat Res. 1983; ([Internet]) (Available from:): 129-133
- Anterior knee pain: an update of physical therapy.Knee Surg Sports Traumatol Arthrosc. 2014; 22: 2286-2294
- Is neuromuscular electrical stimulation effective for management of patellofemoral pain syndrome? A Cochrane Review summary with commentary.Musculoskelet Sci Pract. 2019; 44 ([Internet]) (Available from:)102059
- Lateral patellar tilt and its longitudinal association with patellofemoral osteoarthritis-related structural damage: analysis of the osteoarthritis initiative data.Knee [Internet]. 2020; 27 (Available from:): 1971-1979https://doi.org/10.1016/j.knee.2020.11.002
- In-vivo patellar tracking in individuals with patellofemoral pain and healthy individuals.J Orthop Res. 2018; 36: 2193-2201
- Tibiofemoral and patellofemoral mechanics are altered at small knee flexion angles in people with patellofemoral pain.J Sci Med Sport. 2013; 16: 13-17
- Differences in patellofemoral kinematics between weight-bearing and non-weight-bearing conditions in patients with patellofemoral pain.J Orthop Res. 2011; 29 ([Internet]) (Available from:): 312-317
- Patellar height measurements: insall–Salvati ratio is most reliable method. Knee Surgery.Sport Traumatol Arthrosc. 2019; ([Internet]) (Available from:)0123456789https://doi.org/10.1007/s00167-019-05531-1
- Mapping the contact area of the patellofemoral joint: the relationship between stability and joint congruence.Bone Joint Lett J. 2019; 101-B: 552-558
- Imaging of patellofemoral disorders.Clin Radiol. 2004; 59: 543-557
- Which patellofemoral joint imaging features are associated with patellofemoral pain? Systematic review and meta-analysis.Osteoarthritis Cartilage. 2016; 24: 224-236
- Patellar tilt correlates with vastus lateralis: vastus medialis activation ratio in maltracking patellofemoral pain patients.J Orthop Res. 2012; 30 ([Internet]) (Available from:): 927-933
- Predictors of treatment response to strengthening and stretching exercises for patellofemoral pain: an examination of patellar alignment.Knee. 2015; 22 ([Internet]) (Available from:): 494-498https://doi.org/10.1016/j.knee.2014.10.012
- Axial computed tomography of the patellofemoral joint with and without quadriceps contraction.Arch Orthop Trauma Surg. 1997; 116 ([Internet]) (Available from:): 77-82
- Anatomical factors influencing patellar tracking in the unstable patellofemoral joint. Knee Surgery.Sport Traumatol Arthrosc. 2014; 22: 2334-2341
- The influence of medial patellofemoral ligament on patellofemoral joint kinematics and patellar stability.Knee Surg Sports Traumatol Arthrosc. 2013; 21: 2164-2171
- A cadaveric model to evaluate the effect of unloading the medial quadriceps on patellar tracking and patellofemoral joint pressure and stability.J Exp Orthop. 2018; 5
- Patellofemoral joint kinematics in individuals with and without patellofemoral pain syndrome.J Bone Joint Surg Am [Internet]. 2006; 88 (Available from:): 2596-2605
- The effects of weight-bearing conditions on patellofemoral indices in individuals without and with patellofemoral pain syndrome.Skeletal Radiol. 2014; 43 ([Internet]) (Available from:): 157-164
- The role of patellar alignment and tracking in vivo: the potential mechanism of patellofemoral pain syndrome.Phys Ther Sport. 2011; 12 ([Internet]) (Available from:): 140-147https://doi.org/10.1016/j.ptsp.2011.02.008
- A technique for the measurement of patellar tracking during weight-bearing activities using ultrasound.Proc Inst Mech Eng H. 2003; 217 ([Internet]) (Available from:): 449-457
- Active patellar tracking measurement: a novel device using ultrasound.Am J Sports Med. 2004; 32: 1209-1217
- Quantification of patella position by ultrasound scanning and its criterion validity.Ultrasound Med Biol. 2006; 32 ([Internet]) (Available from:): 1833-1836
- Effects of tibial rotation on Ober's test and patellar tracking.Knee. 2016; 23 ([Internet]) (Available from:): 600-603
- The relationship between length of the iliotibial band and patellar position in Asians.Knee. 2014; 21 ([Internet]) (Available from:): 1135-1138
- The effect of hip adduction angle on patellar position measured using real time ultrasound scanning.Knee. 2012; 19 ([Internet]) (Available from:): 709-712
- The measurement of patellar alignment in patellofemoral pain syndrome: are we confusing assumptions with evidence?.J Orthop Sports Phys Ther [Internet]. 2007; 37 (Available from:): 330-341
- Patellar instability: the reliability of magnetic resonance imaging measurement parameters.BMC Musculoskelet Disord. 2019; 20 ([Internet]) (Available from:): 317
- The measurement of observer agreement for categorical data.Biometrics. 1977; 33 ([Internet]) (Available from:): 159-174
- Patellar maltracking is prevalent among patellofemoral pain subjects with patella alta: an upright, weightbearing MRI study.J Orthop Res. 2013; 31: 448-457
- Effects of upright weight bearing and the knee flexion angle on patellofemoral indices using magnetic resonance imaging in patients with patellofemoral instability.Knee Surg Sports Traumatol Arthrosc. 2017; 25: 2405-2413
Article info
Publication history
Published online: March 08, 2023
Accepted:
February 26,
2023
Received in revised form:
February 15,
2023
Received:
July 17,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.
