Zusammenfassung
Die patellofemorale Instabilität stellt aufgrund ihrer multifaktoriellen Genese eine diagnostische und therapeutische Herausforderung dar. Aufgabe der Bildgebung ist es, anlagebedingte Risikofaktoren wie Trochleadysplasie, Patellahochstand, Torsionsfehlstellungen der unteren Extremität, TTTG-Abstand und Patellatilt systematisch zu analysieren. Um die ätiologischen Faktoren mit einer ausreichenden diagnostischen Genauigkeit zu bewerten, sind standardisierte und umfangreich evaluierte Messverfahren sowie der gezielte Einsatz verschiedener bildgebender Modalitäten erforderlich.
Die Diagnose einer traumatischen, oftmals klinisch inapparenten Patellaluxation kann anhand der charakteristischen Befundkonstellation in der MRT gestellt werden. Der Schädigung des medialen patellofemoralen Ligaments (Elogantion/Ruptur) im Rahmen einer akuten Luxation wird, ähnlich wie den anlagebedingten Risikofaktoren, eine große Bedeutung im Hinblick auf die Entstehung einer chronischen Instabilität beigemessen.
Abstract
Patellofemoral instability remains a diagnostic and therapeutic challenge due to its multifactorial genesis. The purpose of imaging is to systematically analyze predisposing factors, such as trochlear dysplasia, patella alta, tibial tuberosity-trochlear groove (TT-TG) distance, rotational deformities of the lower limb and patellar tilt. In order to evaluate anatomical abnormalities with a sufficient diagnostic accuracy, standardized measurement methods and implementation of various imaging modalities are necessary.
Diagnosis of acute and often overlooked lateral patellar dislocation can be established with magnetic resonance imaging (MRI) because of its characteristic patterns of injury. Damage to the medial patellofemoral ligament (MPFL) has a significance just as high as the predisposing risk factors in relation to the cause of chronic instability.
Literatur
Amis A (2007) Current concepts on anatomy and biomechanics of patellar instability. Sports Med Arthrosc Rev 15:48–56
Atkin DM, Fithian DC, Marangi KS et al (2000) Characteristics of patients with primary acute lateral patellar dislocation and their recovery within the first six months of injury. Am J Sports Med 28:472–479
Bernageau J, Goutallier D, Debeyre J et al (1961) Nouvelle technique d’exploration de l’articulation fémoropatellaire. Incidences axiales quadriceps contracté et décontracté. Rev Chir Orthop Reparatrice Appar Mot 61(Suppl 2):286–290
Blackburne JS, Peel TE (1977) A new method of measuring patellar height. J Bone Joint Surg [Br] 59-B:241–242
Brattstroem H (1964) Shape of the intercondylar groove normally and in recurrent dislocation of patella. A clinical and X-ray-anatomical investigation. Acta Orthop Scand 68(Suppl):1–148
Bruderer J, Servien E, Neyret P (2010) Patellat height: which index? In: Zaffagnini S, Dejour D, Arendt EA (eds) Patellofemoral pain, instability and Arthritis. Springer, Berlin Heidelberg New York, pp 60–67
Caton J, Deschamps G, Chambat P et al (1982) Patella infera. Apropos of 128 cases. Rev Chir Reparatrice Appar Mot 68:317–325
Dejour D, Lecoultre B (2007) Osteotomies in patellofemoral instabilities. Sports Med Arthrosc 15:39–46
Dejour D, Reynaud P, Lecoultre B (1998) Doleurs et instabilité rotulienne. Essay de Classification. Med Hyg Juillet 1466–1471
Dejour D, Saggin PR, Meyer X et al (2010) Standard X-ray examination: patellofemoral disorders. In: Zaffagnini S, Dejour D, Arendt EA (eds) Patellofemoral pain, instability and Arthritis. Springer, Berlin Heidelberg New York, pp 51–60
Dejour H, Walch G, Nove-Josserand L et al (1994) Factors of patellar instability: an anatomic-radiographic study. Knee Surg Sport Traumatol Arthroscopy 2:19–26
Desio SM, Burks RT, Bachus KN (1998) Soft tissue restraints to lateral patellar dislocation in the human knee. Am J Sports Med 26:59–65
Elias DA, White LM, Fithian DC (2002) Acute lateral patellar dislocation at MR imaging: injury patterns of medial patellar soft-tissue restraints and osteochondral injuries of the inferomedial patella. Radiology 225:736–743
Goutallier D, Bernageau J, Lecudonnec B (1978) Measurement of the tibial tuberosity-patellar groove distance. Technique and results. Rev Chir Reparatrice Appar Mot 64:423–428
Hawkins RJ, Bell RH, Anisette G (1986) Acute patellar dislocations. The natural history. Am J Sorts Med 14:117–120
Hinterwimmer S, Rosenstiel N, Lenich A et al (2012) Femorale Osteotomien bei patellofemoraler Instabilität. Unfallchirurg 115:410–416
Insall J, Salvati E (1971) Patella position in the normal knee joint. Radiology 101:101–107
Insall J, Goldberg V, Salvati E (1972) Recurrent dislocation and the high-riding patella. Clin Orthop 88:67–69
Laurin CA, Levesque HP, Labelle H et al (1978) The abnormal lateral patellofemoral angle. J Bone Joint Surg [Am] 60:55–60
Malghem J, Maldague B (1989) Depth insufficiency of the proximal trochlear groove on lateral radiographs of the knee: relation to patellar dislocation. Radiology 170:507–510
Merchant AC, Mercer RL, Jacobsen RH et al (1974) Roentgenographic analysis of patellofemoral congruence. J Bone Joint Surg [Am] 56:1391–1396
Nomura E (1999) Classification of lesions of the medial patello-femoral ligament in patellar dislocation. Internat Orthop 23:260–263
Murphy SB, Simon SR, Kijewski PK et al (1987) Femoral anteversion. J Bone Joint Surg [Am] 69:1169–1176
Saggin PR, Saggin JI, Dejour D (2012) Imaging in patellofemoral instability: an abnormality based approach. Sports Med Arthrosc 20:145–151
Sanders TG, Medynski MA, Feller JF, Lawhorn KW (2000) Bone contusion patterns of the knee at MR imaging: footprint of the mechanism of injury. RadioGraphics 20:135–151
Schoettle PB, Zanetti M, Seifert B et al (2006) The tibial tuberosity-trochlear groove distance: a comparative study between CT and MRI scanning. Knee 13:26–31
Schneider B, Laubenberger J, Jemlich S et al (1997) Measurement of femoral antetorsion and tibial torsion by magnetic resonance imaging. Br J Radiol 70:575–579
Smith TO, Davies L, Toms AP et al (2011) The reliability and validity of radiological assessment for patellar instability. A systematic review and meta-analysis. Skeletal Radiol 40:399–414
Strecker W, Keppler P, Gebhard F et al (1997) Length and torsion of the lower limb. J Bone Joint Surg 79:1019–1023
Tomczak R, Guenther KP, Rieber A et al (1997) MR imaging measurement of the femoral antetorsional angle as a new technique: comparison with CT in children and adults. Am J Roentgenol 168:791–794
Wagenaar FCBM, Koeter S, Anderson PG et al (2007) Conventional radiography cannot replace CT scanning in detecting tibial tubercle lateralization. Knee 14:51–54
Waldt S, Wörtler K, Eiber M (2011) Messverfahren und Klassifikationssysteme in der muskuloskelettalen Radiologie. Thieme, Stuttgart
Wörtler K (2007) MRT des Kniegelenks. Radiologe 47:1131–1146
Zaffagnini S, Giodano G, Bruni D et al (2010) Pathophysiology of lateral patellar dislocation. In: Zaffagnini S, Dejour D, Arendt EA (eds) Patellofemoral pain, instability and arthritis. Springer, Berlin Heidelberg New York, pp 17–28
Interessenkonflikt
Die korrespondierende Autorin gibt für sich und ihren Koautor an, dass kein Interessenkonflikt besteht.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Waldt, S., Rummeny, E. Bildgebung der patellofemoralen Instabilität. Radiologe 52, 1003–1011 (2012). https://doi.org/10.1007/s00117-012-2367-3
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00117-012-2367-3