Comparison of five patellar height measurement methods in a Turkish adult cohort
Comparison of five patellar height measurement methods in a Turkish adult cohort
Aim: The aim of this study was to investigate the correlation between the methods traditionally used for patellar height measurements[Insall-Salvati (IS), Modified Insall-Salvati (MIS), Blackburne-Peel (BP), Caton-Deschamps (CD)] and the plateau-patellar angle (PPA)in Turkish adult population.Material and Methods: A cross-sectional retrospective study was conducted. A total of 100 lateral knee radiographs in 30° flexionwere analyzed by two blinded orthopedist independently to each other’s measurements. The average IS ratio, MIS ratio, BP ratio, CDratio and PPA measurement were calculated by taking the average of the measurement values of both observers. The inter-observerreliability for two observers was determined using intraclass correlation coefficients (ICC). Spearman rank correlation analysis wasperformed to analyze correlations between mean ratios/angle measurements.Results: The mean age at the time of the radiographs was 30.18 ± 5.78 (range:20-40) years, 60% were female, and 58 radiographswere of the right knee. The mean and standard deviations of the patella height measurements were found 1.05 ± 0.12 accordingto the IS ratio; 1.66 ± 0.29 according to the MIS ratio; 0.91 ± 0.15 according to the CD ratio; 0.84 ± 0.14 according to the BP ratio;24.74° ± 2.87° according to PPA measurement. There was highest inter-observer agreement between the two observers with an ICCof 0.926 (95% confidence interval: 0.89-0.950), excellent reliability, for the PPA measurement. Inter-observer agreement between twoobservers was good reliability for other measurements (IS, MIS, CD, BP). The highest correlation was between CD ratio and BP ratio,strong correlation, with a Pearson's correlation coefficient of 0.790.Conclusion: The PPA appears to be a feasible tool that can assess patellar height with higher reliability compared to the four mostcommonly used methods, in a Turkish adult population.
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- 1. Igoumenou VG, Dimopoulos L, Mavrogenis AF. Patellar height assessment methods: An update. JBJS Rev 2019;71:4.
- 2. Eijkenboom JF, van der Heijden RA, de Kanter JL, et al. Patellofemoral alignment and geometry and early signs of osteoarthritis are associated in patellofemoral pain population. Scand J Med Sci Sports 2020;30:885- 93.
- 3. Karakaşlı A, İrey S, Demirkıran ND, ve ark. Patellofemoral Ağrı Sendromu. Balıkesir Sağlık Bilimleri Dergisi 2014;3:174-8.
- 4. Papp M, Zsákai Z, Gömöri A. Comparison of total knee arthroplasty after combined high tibial osteotomy with a matched group of primary total knee arthroplasty. Eklem Hastalik Cerrahisi 2019;30:79-84.
- 5. Neogi DS, Bae JH, Seok CW, et al. Impact of patellar height on unicompartment knee arthroplasty: does patella baja lead to an inferior outcome?. J Orthop Traumatol 2014;15:47-54.
- 6. Demirkiran ND, Ozmanevra R. Neutrophil to lymphocyte ratio of patients who underwent bilateral versus unilateral unicompartmental knee arthroplasty. Med Science 2020;9:227-30.
- 7. Insall J, Salvati E. Patella position in the normal knee joint. Radiology 1971;101:101-4.
- 8. Grelsamer RP, Meadows S. The modified Insall-Salvati ratio for assessment of patellar height. Clin Orthop Relat Res 1992;282:170-6.
- 9. Blackburne JS, Peel TE. A new method of measuring patellar height. J Bone Joint Surg Br 1977;59:241-2.
- 10. Caton J, Deschamps G, Chambat P, et al. Patella infera. Apropos of 128 cases. Rev Chir Orthop Reparatrice Appar Mot 1982;68:317-25.
- 11. Portner O, Pakzad H. The evaluation of patellar height: a simple method. J Bone Joint Surg Am 2011;93:73- 80.
- 12. Shrout PE, Fleiss JL. Intraclass correlations: uses in assessing rater reliability. Psychol Bull 1979;86:420- 8.
- 13. Behrendt C, Zaluski A, E Albuquerque RP, et al. Comparative evaluation of patellar height methods in the Brazilian population. Rev Bras Ortop 2015;51:53- 7.
- 14. Berg EE, Mason SL, Lucas MJ. Patellar height ratios. A comparison of four measurement methods. Am J Sports Med 1996;24:218-21.
- 15. Verhulst FV, van Sambeeck JDP, Olthuis GS, et al. Patellar height measurements: Insall-Salvati ratio is most reliable method. Knee Surg Sports Traumatol Arthrosc 2020;28:869-75.
- 16. van Duijvenbode D, Stavenuiter M, Burger B, et al. The reliability of four widely used patellar height ratios. Int Orthop 2016;40:493-7.
- 17. Nizic D, Pervan M, Kovacevic B. A new reference line in diagnosing a high-riding patella on routine digital lateral radiographs of the knee. Skelet Radiol 2014;43:1129-37.
- 18. Chareancholvanich K, Narkbunnam R. Novel method of measuring patellar height ratio using a distal femoral reference point. Int Orthop 2012;36:749-53.
- 19. M Ellington, B Robin, D Jupiter, B Allen. Plateau-patella angle in evaluation of patellar height in osteoarthritis. Knee 2014;21:699-702.
- 20. Phillips CL, Silver DAT, Schranz PJ, et al. The measurement of patellar height: a review of the methods of imaging. J Bone Joint Surg Br 2010;92:1045-53.
- 21. Gracitelli GC, Pierami R, Tonelli TA, et al. Assessment of patellar height measurement methods from digital radiography. Rev Bras Ortop 2012;47:210-3.
- 22. Seyahi A, Atalar AC, Koyuncu LO, et al. Blumensaat line and patellar height. Acta Orthop Traumatol Turc 2006;40:240-7.
- 23. 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.
- 24. Narkbunnam R, Chareancholvanich K. Effect of patient position on measurement of patellar height ratio. Arch Orthop Trauma Surg 2015;135:1151-6.