Arthroscopic Patellofemoral Measurements Can Reliably Assess Patellar Instability

Abstract

To arthroscopically describe patellar position based on lateralization, tilt, and engagement, and compare measurements in normal, medial patellofemoral complex-(MPFC) deficient, and MPFC-reconstructed knees. In 10 cadaveric knees, arthroscopic patellar position was assessed by performing digital measurements on arthroscopic images obtained through a standard anterolateral portal. Lateralization was measured as millimeters overhang of the patella past the lateral edge of the lateral femoral condyle, viewing from the lateral gutter. Patellar tilt was calculated as the difference in medial and lateral distances from the patella to the trochlea, viewing from the sunrise view. Patellotrochlear distance was measured as the anteroposterior distance between the central trochlear groove and patella on the sunrise view. Measurements were obtained at 10° intervals of knee flexion from 0° to 90°, in intact knees (group 1), after arthroscopically transecting the MPFC fibers (group 2), and after MPFC reconstruction (group 3). Optimal cutoff values were identified to distinguish between intact versus MPFC-deficient states. When compared to group 1, group 2 demonstrated increased patellar lateralization by 22.5% at 0°-40° knee flexion (P= .006), which corrected to baseline in group 3 (P= .006). Patellar tilt measurements demonstrated no differences between groups. Patellotrochlear distance increased by 21.0% after MPFC transection (P= .031) at 0°-40° knee flexion, with correction to baseline after MPFC reconstruction (P= .031). More than 7 mm of lateral overhang at 20°-30° flexion and >6 mm of patellotrochlear distance at 10°-20° flexion were found to indicate MPFC deficiency. Utilizing standardized arthroscopic views, we identified significant increases in patellar lateralization and patellotrochlear distance in early knee flexion angles after MPFC transection, and these changes normalized after MPFC reconstruction. Arthroscopic assessments of patellar position may be useful in evaluating patellofemoral stability during patellar stabilization surgery.