Bisect offset ratio and cartilaginous sulcus angle are good combined predictors of recurrent patellar dislocation in children and adolescents.

ABSTRACT

OBJECTIVES: Recurrent patellar dislocation (RPD) is found most commonly in the juvenile population. While risk factors have been well-established in adults, there remains a paucity in radiographical data to define normal and pathoanatomical juvenile cohorts. The objectives of this paper were to elucidate the differences in the patellofemoral joint between RPD and typically developed (TD) juvenile populations, using MRI measurements, and determine the best independent and combined predictors of RPD. METHODS: A prospective, cross-sectional study was conducted with 25 RPD and 24 TD participants aged between 8 and 19 years. MR images were obtained to assess common measures of lower limb alignment, patellofemoral alignment, and trochlear dysplasia. RESULTS: Significant differences were evident for acetabular inclination, tibial-femoral torsion, tibial tubercle-to-trochlear groove (TT-TG) distance, lateral patellar tilt (LPT), cartilaginous sulcus angle (CSA) and bisect offset ratio (BOR). CSA and BOR were included in the final predictive model, which correctly classified 89.4% of RPD cases. CONCLUSION: Radiographical parameters that stratify risk of RPD in adults are also able to predict RPD in the pediatric population (TT-TG, LPT, CSA and BOR). Together, CSA and BOR accurately identified 89.4% of RPD. These measures should be included in the evaluation of pediatric patients who present with patellar dislocation. LEVEL OF EVIDENCE Level II.