The role of the sulcus angle in patellar dislocation: The importance of measuring four magnetic resonance imaging axial levels and utilising corresponding cutoff values

IF 2.7 Q2 ORTHOPEDICS

Journal of Experimental Orthopaedics Pub Date : 2025-09-05 DOI:10.1002/jeo2.70425

Jason D. Brenner, Steven M. Henick, Leila Mehraban Alvandi, Edina Gjonbalaj, Yungtai Lo, Jacob Schulz, Eric D. Fornari, Benjamin J. Levy, Mauricio Drummond Junior

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Abstract

Purpose

The primary purpose was to assess sulcus angle (SA) magnetic resonance imaging (MRI) measurements and determine diagnostic cutoff values along four axial levels on cartilaginous and osseous surfaces comparing those with patellar dislocations (PD) versus controls. A secondary aim was to identify differences in SA between patients with one-time dislocation (OTD) versus recurrent patellar dislocations (RPDs).

Methods

Paediatric patients with a history of PD were retrospectively grouped into those with an OTD versus RPDs. Age and sex frequency matching controls (ACL injuries without PD history) were identified. The SA was recorded at four levels in the trochlear groove (TG) on cartilaginous and osseous surfaces. Differences between sample means (PDs vs. controls; RPDs vs. OTDs) were assessed; cutoff values for discriminating PDs from controls were identified utilising Youden′s index.

Results

There were 173 PDs (106 RPDs, 67 OTDs) and 100 controls. There were differences in mean SA between PD and controls throughout the trochlear groove for both cartilaginous (PD vs. control: SA1 166.1° vs. 152.5°, SA2 161.0° vs. 148.5°, SA3 155.7° vs. 145.9°, SA4 150.7° vs. 142.5°) and osseous surfaces (PD vs. control: SA1 160.2° vs. 146.6, SA2 153.8° vs. 140.2°, SA3 147.2° vs. 134.8°, SA4 142.1° vs. 132.6°) (p < 0.001). Diagnostic cutoffs were higher for cartilaginous versus osseous measurements (SA1 159.6° vs. 153.1°, SA2 153.8° vs. 148.0°, SA3 152.5° vs. 141.6°, SA4 148.1° vs. 137.4°). RPD patients had greater cartilaginous SA than OTDs throughout the TG (SA1p = 0.014, SA2p = 0.004, SA3p = 0.027, SA4p = 0.007), while osseous SA measurements did not differ (SA1p = 0.057, SA2p = 0.070, SA3p = 0.185, SA4p = 0.175).

Conclusions

SA was greater in PDs than controls at all four levels in the TG for both cartilaginous and osseous measurements. Cartilaginous SA was greater among RPDs than OTDs at all levels; however, osseous SA was not different between cohorts. The diagnostic cutoff of dysplastic SA differed by axial level and surface.

Level of Evidence

Level III.

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沟角在髌骨脱位中的作用：测量四个磁共振成像轴向水平和利用相应截止值的重要性

主要目的是评估沟角（SA）磁共振成像（MRI）测量值，并确定沿软骨和骨表面四个轴向水平的诊断截止值，比较髌骨脱位（PD）与对照组。第二个目的是确定一次性脱位（OTD）患者与复发性髌骨脱位（RPDs）患者之间SA的差异。方法回顾性地将有PD病史的儿童患者分为OTD组和rpd组。确定年龄和性别频率匹配对照（无PD病史的ACL损伤）。在软骨和骨表面的滑车沟（TG）上记录四个水平的SA。评估样本均值（pd与对照组、rpd与OTDs）之间的差异；利用约登指数确定区分pd与对照的截止值。结果pd 173例（rpd 106例，OTDs 67例），对照组100例。PD与对照组在整个滑车沟内的平均SA差异均为软骨（PD与对照组：SA1 166.1°vs. 152.5°，SA2 161.0°vs. 148.5°，SA3 155.7°vs. 145.9°，SA4 150.7°vs. 142.5°）和骨表面（PD与对照组：SA1 160.2°vs. 146.6, SA2 153.8°vs. 140.2°，SA3 147.2°vs. 134.8°，SA4 142.1°vs. 132.6°）（p < 0.001）。与骨性测量相比，软骨测量的诊断临界值更高（SA1 159.6°vs. 153.1°，SA2 153.8°vs. 148.0°，SA3 152.5°vs. 141.6°，SA4 148.1°vs. 137.4°）。在整个TG期间，RPD患者的软骨SA高于OTDs (SA1p = 0.014, SA2p = 0.004, SA3p = 0.027, SA4p = 0.007)，而骨性SA测量值无差异（SA1p = 0.057, SA2p = 0.070, SA3p = 0.185, SA4p = 0.175）。结论：在软骨和骨性TG的所有四个水平上，pd患者的SA均高于对照组。软骨SA在所有水平的RPDs中均大于OTDs；然而，骨性SA在队列之间没有差异。发育不良SA的诊断界限因轴向水平和表面不同而不同。证据等级三级。

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