Aksel SEYAHİ, Ata Can ATALAR, Lütfü Özgür KOYUNCU, Bekir Murat ÇINAR, MEHMET SELAHATTİN DEMİRHAN

Blumensaat çizgisi ve patella yüksekliği

Amaç: Blumensaat yönteminin patella yükseklik indeksleri ile uyumu araştırıldı ve patella yüksekliği ölçümündeki kullanılabilirliği değerlendirildi. Çalışma planı: Diz grafileri 30° fleksiyonda çekilen 77 hastanın (23 erkek, 54 kadın; ort. yaş 32; dağılım 21-62) 105 dijital diz grafisi çalışmaya alındı. Bu grafilerde, patella yükseklikleri Blumensaat, Insall-Salvati, modifiye Insall-Salvati ve Blackburne-Peel yöntemlerine göre kalitatif ve kantitatif olarak ölçüldü. Blumensaat çizgisinin femur şaftıyla yaptığı açı standardize edilerek (düzeltmeli Blumensaat yöntemi) ölçümler tekrarlandı. Elde edilen kalitatif sonuçlar açısından yöntemlerin uyumu, kantitatif sonuçlar açısından ise yöntemler arasındaki korelasyon incelendi. Sonuçlar: Kalitatif sonuçlar açısından Blumensaat yöntemi ile Insall-Salvati, modifiye Insall-Salvati ve Blackburne-Peel indeksleri arasında çok zayıf bir uyum saptandı (sırasıyla, kappa= 0.21; -0.14 ve 0.12). Düzeltmeli Blumensaat yöntemiyle indeks sonuçları arasında yapılan karşılaştırmalarda da çok zayıf bir uyum bulundu (sırasıyla, kappa= 0.27; -0.11 ve 0.13). Kantitatif sonuçlara göre analizde, orta veya çok zayıf derecede korelasyonlar bulundu. Nispeten en iyi korelasyon Blumensaat yöntemi ile Insall-Salvati yöntemi arasındaydı (r=0.514, p

Anahtar Kelimeler:

Geriyedönük çalışma, Antropometri, Eklem hastalıkları, Diz eklemi, Patella, Testlerin kestirim değeri

Blumensaat line and patellar height

Objectives: We investigated the agreement between the Blumensaat method and patellar height ratios and evaluated the reliability of the method in patellar height measurements. Methods: We retrospectively evaluated 105 digital knee x-rays of 77 patients (23 males, 54 females; mean age 32 years; range 21 to 62 years), whose radiographs were obtained at 30° of knee flexion. Patellar heights were measured with the use of the Blumensaat, Insall-Salvati, modified Insall-Salvati, and Blackburne-Peel methods. Patellar height was also evaluated after standardization of the angle between the femoral shaft and the Blumensaat’s line (corrected Blumensaat method). Agreement and correlations were sought between the qualitative and quantitative results of the methods, respectively. Results: When the qualitative results were considered, agreement of the Blumensaat method was very weak with the Insall-Salvati, modified Insall-Salvati, and Blackburne-Peel methods (kappa coefficients: 0.21, -0.14, and 0.12, respectively). The corrected Blumensaat method also had a very weak agreement with the other indices (kappa coefficients: 0.27, -0.11, and 0.13, respectively). Correlation analyses of the quantitative results showed very weak to moderate correlations between the methods used. The Blumensaat method was relatively well correlated with the modified Insall-Salvati method (r=0.514, p<0.05). Correlations were weak to moderate between the patellar height indices, the highest correlation being between the modified Insall-Salvati and Blackburne- Peel methods (r=0.557, p<0.05). Conclusion: The results of the patellar height measurements obtained by the Blumensaat method do not agree with widely used patellar height indices.

Keywords:

Retrospective Studies, Anthropometry, Joint Diseases, Knee Joint, Patella, Predictive Value of Tests,

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1. Seil R, Muller B, Georg T, Kohn D, Rupp S. Reliability and interobserver variability in radiological patellar height ratios. Knee Surg Sports Traumatol Arthrosc 2000;8:231-6.
2. Norman O, Egund N, Ekelund L, Runow A. The vertical position of the patella. Acta Orthop Scand 1983;54:908-13.
3. Igbigbi PS, Msamati BC, Ng’Ambi TM. Intercondylar shelf angle in adult black Malawian subjects. Clin Anat 2001; 14:254-7.
4. Carson WG Jr, James SL, Larson RL, Singer KM, Winternitz WW. Patellofemoral disorders: physical and radiographic evaluation. Part II: Radiographic examination. Clin Orthop Relat Res 1984;(185):178-86.
5. Math KR, Ghelman B, Potte HG. Imaging of the patellofemoral joint. In: Scuderi GR, editor. The patella. New York: Springer-Verlag; 1995. p. 83-125.
6. Koshino T, Sugimoto K. New measurement of patellar height in the knees of children using the epiphyseal line midpoint. J Pediatr Orthop 1989;9:216-8.
7. Brattstrom H. Patella alta in non-dislocating knee joints. Acta Orthop Scand 1970;41:578-88.
8. Grelsamer RP, Meadows S. The modified Insall-Salvati ratio for assessment of patellar height. Clin Orthop Relat Res 1992;(282):170-6.
9. de Carvalho A, Holst Andersen A, Topp S, Jurik AG. A method for assessing the height of the patella. Int Orthop 1985;9:195-7.
10. Berg EE, Mason SL, Lucas MJ. Patellar height ratios. A comparison of four measurement methods. Am J Sports Med 1996;24:218-21.
11. Picard F, Saragaglia D, Montbarbon E, Tourne Y, Charbel A. A morphometric study of the femoro-patellar joint from lateral xray view. [Article in French] Rev Chir Orthop Reparatrice Appar Mot 1997; 83:104-11.
12. Egund N, Lundin A, Wallengren NO. The vertical position of the patella. A new radiographic method for routine use. Acta Radiol 1988;29:555-8.
13. Miller TT, Staron RB, Feldman F. Patellar height on sagittal MR imaging of the knee. AJR Am J Roentgenol 1996; 167:339-41.
14. Jozwiak M, Pietrzak S. Evaluation of patella position based on radiologic and ultrasonographic examination: comparison of the diagnostic value. J Pediatr Orthop 1998;18:679-82.
15. Beaconsfield T, Pintore E, Maffulli N, Petri GJ. Radiological measurements in patellofemoral disorders. A review. Clin Orthop Relat Res 1994;(308):18-28.
16. Craig EA. Intercondylar shelf angle: a new method to determine race from the distal femur. J Forensic Sci 1995;40:777- 82.
17. Kadakia NR, Ilahi OA. Interobserver variability of the Insall-Salvati ratio. Orthopedics 2003;26:321-3.