title: Axial MRI index of patellar engagement: a new method to assess patellar instability.
abstract: BACKGROUND
  The aim of this study was to define a new index to measure lateral patellar displacement (LPD) using nuclear magnetic resonance imaging (MRI), an axial index of engagement of the patella (AEI) obtained from two different axial MRI views then to validate its use in a prospective series of patients presenting an objective patellar instability (OPI).
  
  
  METHODS
  One hundred and thirty-five patients with OPI and no history of surgery of the patella were included in a prospective study organized by the French Society of Arthroscopy performed between June 2010 and August 2012. All patients underwent axial and sagittal MRI. The AEI was obtained by projecting predefined patellar and trochlear landmarks (cartilaginous landmarks) on 2 different axial MRI views (one trochlear and one patellar). The results were compared with a series of controls (n=45).
  
  
  RESULTS
  The preoperative AEI of the patella was 0.94 ± 0.09 for the control group and 0.84 ± 0.16 for OPI group (P=0.000016). The AEI could be obtained in 100% of the cases if it was measured on 2 MRI views while it could not be measured in 38.5% of the cases if the measurement was only obtained from one MRI view or whenever the widest part of the patella was not across from the femoral trochlea. The AEI did not significantly depend on dysplasia or the presence of a supratrochlear spur. The lowest AIE values were associated with trochlear dysplasia with a supratrochlear spur (P=0.0023) and a more prominent trochlea (P=0.0016). The AEI was correlated with patellar tilt (P<0.000001) and TT-TG on MRI (P<0.000001).
  
  
  CONCLUSIONS
  AEI is a new index to measure LPD. It can be obtained in all cases because it is obtained from two different MRI views. The normal value is close to 1. It can be used to measure patellar instability on the axial plane in patients with OPI, especially in the most severe cases.
authors.affiliation: Pôle Santé Oréliance, Maison des consultations, 551, avenue Jacqueline-Auriol, 45770 Saran, Orléans, France. Electronic address: docteur.guilbert@gmail.com.
authors.forename: S
authors.initials: S
authors.lastname: Guilbert
authors.forename: V
authors.initials: V
authors.lastname: Chassaing
authors.forename: C
authors.initials: C
authors.lastname: Radier
authors.forename: C
authors.initials: C
authors.lastname: Hulet
authors.forename: F
authors.initials: F
authors.lastname: Rémy
authors.forename: J
authors.initials: J
authors.lastname: Chouteau
authors.forename: F
authors.initials: F
authors.lastname: Chotel
authors.forename: P
authors.initials: P
authors.lastname: Boisrenoult
authors.forename: A
authors.initials: A
authors.lastname: Sebilo
authors.forename: P
authors.initials: P
authors.lastname: Ferrua
authors.forename: F P
authors.initials: FP
authors.lastname: Ehkirch
authors.forename: D
authors.initials: D
authors.lastname: Bertin
authors.forename: D
authors.initials: D
authors.lastname: Dejour
mesh_terms: D000328:Adult; D001182:Arthroscopy / Q000379:methods; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000175:diagnosis* / Q000601:surgery; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D031222:Patellar Dislocation / Q000175:diagnosis* / Q000601:surgery; D011182:Postoperative Care / Q000379:methods; D011300:Preoperative Care / Q000379:methods; D011379:Prognosis; D011446:Prospective Studies; D012016:Reference Values; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: Knee; Lateral patellar displacement; MRI; Patellar instability