Abstract:Objective To explore the differences of CT image-related anatomical measurements of normal patellofemoral joints between genders in Northwest China, and to provide reference for design of knee prosthesis.Methods CT data of normal knee joints of 78 volunteers (156 sides) recruited in the Second Affiliated Hospital of Xi'an Jiaotong University from May 2017 to August 2017 were collected for cross-sectional study. Using GE revolution CT machine, 78 volunteers were scanned from spina iliace to pelma. After three-dimensional reconstruction, patella thickness, patella facet thickness, patella width, patella lateral facet width, longitudinal length of the whole patella, longitudinal length of the articulating surface of the patella, the mediolateral and anteroposterior sizes of the femur, anterior femoral offset, and sulcus angle were measured respectively. Two-sample t-test for independent samples was used to analyze the differences among different genders. Linear regression model was used to control the bias of age, height and weight, and then the gender differences of measurement parameters were analyzed again. Pearson correlation analysis was performed for all parameters.Results There were significant differences in age, height, weight and BMI between different genders in 78 volunteers (t=6.270, 17.602, 11.366, 4.377, all P values<0.01). Before controlling age, height and weight bias, patella thickness, patella facet thickness, patella width, patella lateral facet width, longitudinal length of the whole patella, longitudinal length of the articulating surface of the patella, the mediolateral and anteroposterior sizes of the femur, and anterior femoral offset in male group were (22.39±1.53)mm,(11.75±0.94)mm,(47.04±2.81)mm,(27.18±2.16)mm,(45.18±2.74)mm,(30.60±2.28)mm,(86.31±3.94)mm,(66.76±3.26)mm,(6.37±1.38)mm, respectively, which were significantly larger than those of females, (19.75±1.29)mm,(10.91±0.95)mm,(40.47±2.30)mm,(23.37±1.61)mm,(38.74±2.51)mm,(26.76±1.70)mm,(74.28±3.00)mm,(60.07±2.89)mm,(5.63±1.36)mm, respectively, and the differences were statistically significant (t=11.692, 5.582, 16.024, 12.518, 15.303, 11.969, 21.545, 13.581, 3.381, P<0.01). After control bias, there was no significant difference in patella facet thickness and anterior femoral offset between males and females (all P values>0.05). The differences of other parameters between males and females were still statistically significant (t=2.057, 6.581, 5.207, 4.673, 3.045, 8.053, 2.331, all P values<0.05). The sulcus angle was 139.43°±4.78° for males and 138.29°±4.22° for females. Regardless of age, height, and weight bias, the difference was not statistically significant (all P values>0.05). Pearson correlation results showed that there was a negative correlation between the sulcus angle and the age, the patella facet thickness, and the anterior femoral offset. There was a positive correlation between other observations. In the positive correlation indexes, the correlation coefficient between the anterior femoral offset and other indicators was less than 0.3, showing a weak correlation; the correlation coefficient between the sulcus angle and the patella lateral facet width was 0.32, and the correlation coefficient between the sulcus angle and other indicators was less than 0.3, showing a weak correlation.Conclusions CT-related anatomical measurements of normal patellofemoral joints were different between different genders. Anterior femoral offset and sulcus angle might have large variability, even in the same size of femur or patella. Therefore, when designing a prosthesis, it is necessary not only to meet the needs of patients according to gender, but also to pay attention to the diversity of the design of the anterior femoral condyle.
李哲, 田润, 李越, 孔宁, 李沂阳, 刘晓辉, 王坤正, 杨佩. 西北地区国人正常髌股关节CT影像解剖学研究[J]. 中华解剖与临床杂志, 2019, 24(1): 39-46.
Li Zhe, Tian Run, Li Yue, Kong Ning, Li Yiyang, Liu Xiaohui, Wang Kunzheng, Yang Pei. The computed tomography anatomy study of normal patellofemoral joints in Northwest China. Chinese Journal of Anatomy and Clinics, 2019, 24(1): 39-46.
Elias DA, White LM. Imaging of patellofemoral disorders[J]. Clin Radiol, 2004, 59(7): 543-557. DOI:10.1016/j.crad.2004.01.004
[3]
Petersen W, Rembitzki IV, Brüggemann GP, et al. Anterior knee pain after total knee arthroplasty: a narrative review[J]. Int Orthop, 2014, 38(2): 319-328. DOI:10.1007/s00264-013-2081-4
[4]
Matz J, Howard JL, Morden DJ, et al. Do changes in patellofemoral joint offset lead to adverse outcomes in total knee arthroplasty with patellar resurfacing? A radiographic review[J]. J Arthroplasty, 2017, 32(3): 783-787.e1. DOI:10.1016/j.arth.2016.08.032
[5]
Stryker LS, Odum SM, Springer BD, et al. Role of patellofemoral offset in total knee arthroplasty: a randomized trial[J]. Orthop Clin North Am, 2017, 48(1): 1-7. DOI:10.1016/j.ocl.2016.08.001
[6]
Mahfouz M, Abdel Fatah EE, Bowers LS, et al. Three-dimensional morphology of the knee reveals ethnic differences[J]. Clin Orthop Relat Res, 2012, 470(1): 172-185. DOI:10.1007/s11999-011-2089-2
[7]
Kim TK, Chung BJ, Kang YG, et al. Clinical implications of anthropometric patellar dimensions for TKA in Asians[J]. Clin Orthop Relat Res, 2009, 467(4): 1007-1014. DOI:10.1007/s11999-008-0557-0
[8]
Muhamed R, Saralaya VV, Murlimanju BV, et al. In vivo magnetic resonance imaging morphometry of the patella bone in South Indian population[J]. Anat Cell Biol, 2017, 50(2): 99-103. DOI:10.5115/acb.2017.50.2.99
[9]
Yue B, Varadarajan KM, Ai S, et al. Differences of knee anthropometry between Chinese and white men and women[J]. J Arthroplasty, 2011, 26(1): 124-130. DOI:10.1016/j.arth.2009.11.020
Tanikawa H, Tada M, Harato K, et al. Influence of total knee arthroplasty on patellar kinematics and patellofemoral pressure[J]. J Arthroplasty, 2017, 32(1): 280-285. DOI:10.1016/j.arth.2016.06.044
Zhang X, Eyles JP, Makovey J, et al. Is the effectiveness of patellofemoral bracing modified by patellofemoral alignment and trochlear morphology?[J]. BMC Musculoskelet Disord, 2017, 18(1): 168. DOI:10.1186/s12891-017-1524-2
[18]
Rauh MA, Bayers-Thering M, Buyea CM, et al. Reliability and validity of a new caliper for measuring patellar thickness[J]. J Arthroplasty, 2002, 17(1): 105-107
[19]
Yoo JH, Yi SR, Kim JH. The geometry of patella and patellar tendon measured on knee MRI[J]. Surg Radiol Anat, 2007, 29(8): 623-628. DOI:10.1007/s00276-007-0261-x
[20]
Baldwin JL, House CK. Anatomic dimensions of the patella measured during total knee arthroplasty[J]. J Arthroplasty, 2005, 20(2): 250-257
[21]
Chmell MJ, McManus J, Scott RD. Thickness of the patella in men and women with osteoarthritis[J]. Knee, 1995, 2(4): 239-241. DOI:10.1016/0968-0160(96)00027-0
[22]
Hitt K, Shurman JR 2nd, Greene K, et al. Anthropometric measurements of the human knee: correlation to the sizing of current knee arthroplasty systems[J]. J Bone Joint Surg Am, 2003, 85-A Suppl 4: 115-122
[23]
Rooney N, Fitzpatrick DP, Beverland DE. Intraoperative knee anthropometrics: correlation with cartilage wear[J]. Proc Inst Mech Eng H, 2006, 220(6): 671-675. DOI:10.1243/09544119H00605
Glogaza A, Schröder C, Woiczinski M, et al. Medial stabilized and posterior stabilized TKA affect patellofemoral kinematics and retropatellar pressure distribution differently[J]. Knee Surg Sports Traumatol Arthrosc, 2018, 26(6): 1743-1750. DOI:10.1007/s00167-017-4772-7
[27]
Bracey DN, Brown ML, Beard HR, et al. Effects of patellofemoral overstuffing on knee flexion and patellar kinematics following total knee arthroplasty: a cadaveric study[J]. Int Orthop, 2015, 39(9): 1715-1722. DOI:10.1007/s00264-015-2715-9
[28]
Beldman M, Breugem SJ, van Jonbergen HP. Overstuffing in total knee replacement: No effect on clinical outcomes or anterior knee pain[J]. Int Orthop, 2015, 39(5): 887-891. DOI:10.1007/s00264-014-2548-y
[29]
Dejour H, Walch G, Nove-Josserand L, et al. Factors of patellar instability: an anatomic radiographic study[J]. Knee Surg Sports Traumatol Arthrosc, 1994, 2(1): 19-26
Tanamas SK, Teichtahl AJ, Wluka AE, et al. The associations between indices of patellofemoral geometry and knee pain and patella cartilage volume: a cross-sectional study[J]. BMC Musculoskelet Disord, 2010, 11: 87. DOI:10.1186/1471-2474-11-87
[32]
Stefanik JJ, Zumwalt AC, Segal NA, et al. Association between measures of patella height, morphologic features of the trochlea, and patellofemoral joint alignment: the MOST study[J]. Clin Orthop Relat Res, 2013, 471(8): 2641-2648. DOI:10.1007/s11999-013-2942-6.