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Assessment of in vivo loading history of the patellofemoral joint: a study combining patellar position, tilt, alignment and bone SPECT/CT

Schön, Stephan ; Afifi, Faik ; Rasch, Helmut ; Amsler, Felix ; Friederich, Niklaus ; Arnold, Markus ; Hirschmann, Michael

In: Knee Surgery, Sports Traumatology, Arthroscopy, 2014, vol. 22, no. 12, p. 3039-3046

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    Titre
    • Assessment of in vivo loading history of the patellofemoral joint: a study combining patellar position, tilt, alignment and bone SPECT/CT
    Auteur
    • Schön, Stephan. Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland-Bruderholz, 4101, Bruderholz, Switzerland
    • Afifi, Faik. Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland-Bruderholz, 4101, Bruderholz, Switzerland
    • Rasch, Helmut. Institute for Radiology and Nuclear Medicine, Kantonsspital Baselland-Bruderholz, 4101, Bruderholz, Switzerland
    • Amsler, Felix. Amsler Consulting, Basel, Switzerland
    • Friederich, Niklaus. Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland-Bruderholz, 4101, Bruderholz, Switzerland
    • Arnold, Markus. Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland-Bruderholz, 4101, Bruderholz, Switzerland
    • Hirschmann, Michael. Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland-Bruderholz, 4101, Bruderholz, Switzerland
    Type de document
    • Postprint
    Langue
    • Anglais
    Publié dans
    • Knee Surgery, Sports Traumatology, Arthroscopy, 2014, vol. 22, no. 12, p. 3039-3046. Springer Berlin Heidelberg
    Autre version électronique
    Identifiant OAI-PMH
    • oai:doc.rero.ch:326271
    Summary
    Purpose: The current study investigates whether patella height and tilt or leg alignment influence the intensity values as well as the distribution pattern of single photon emission computerized tomography/computerized tomography (SPECT/CT) tracer uptake in the patellofemoral joint. Methods: 99mTc-HDP-SPECT/CT and radiographs of consecutive 84 knees were prospectively obtained. Lateral radiographs were analyzed in terms of patellar height, Insall-Salvati index and modified Insall-Salvati index. Skyline views were analyzed for Laurin's lateral patellofemoral angle. On long-leg radiographs, the mechanical leg alignment was classified as varus, valgus or neutral. SPECT/CT was analyzed for each anatomical region using a previously validated SPECT/CT localization and grading algorithm. Mean, standard deviation, minimum and maximum of grading for each area of the localization scheme were recorded. Nonparametric Spearman's correlations were used to correlate patellar height, lateral patellar angle and leg alignment with the tracer uptake intensity. Chi-square statistics were used for categorical data (p<0.05). Results: A patella baja correlated significantly with higher SPECT/CT tracer uptake in all patellar and lateral femoral regions (p<0.001). A higher lateral patellar tilt correlated significantly with higher tracer uptake in the superior lateral femoral parts and the tibial tubercle. In mechanically varus aligned knees, there was significantly higher SPECT/CT tracer uptake on the medial and in valgus knees on the lateral part of the patellofemoral joint (p<0.05). Conclusions: As the intensity and distribution of the SPECT/CT significantly correlated with patella baja and patellar tilt, SPECT/CT might be considered as imaging modality for evaluating patients with patellofemoral disorders and for follow-up of patients after patellofemoral realignment procedures. Level of evidence: Diagnostic study, Level II.