title: Patellar malalignment: a new method on knee MRI.
abstract: OBJECTIVE
  The medial patellofemoral ligament (MPFLL)/lateral patellar retinaculum (LPR) ratio were assessed in knees as a means to detect patellar malalignment. We also aimed to evaluate the prevalence of the various types of trochlear dysplasia in patients with patellar malalignment.
  
  
  METHODS
  After approval of our institutional ethics committee, we conducted a retrospective study that included 450 consecutive patients to evaluate them for the presence of patellar malalignment. Parameters investigated were the trochlear type, sulcus angle, presence of a supratrochlear spur, MPFLL, LPR, patella alta, and patella baja by means of 1.5T magnetic resonance imaging (MRI). Overall, 133 patients were excluded because of the presence of major trauma, multiple ligament injuries, bipartite patella, and/or previous knee surgery. The Dejour classification was used to assess trochlear dysplasia. Two experienced radiologists (HKY, EEE) evaluated the images. Their concordance was assessed using the kappa (κ) test.
  
  
  RESULTS
  The frequencies of patellar malalignment and trochlear dysplasia were 34.7 and 63.7 %, respectively. The frequency of trochlear dysplasia associated with patellar malalignment was 97.2 %. An MPFLL/LPR ratio of 1.033-1.041 had high sensitivity and specificity for malalignment. The researchers' concordance was good (κ = 0.89, SE = 0.034, P < 0.001).
  
  
  CONCLUSIONS
  Trochlear dysplasia is frequently associated with patellar malalignment. An increased MPFLL/LPR ratio is useful for detecting patellar malalignment on knee MRI, which is a novel quantitative method based on ligament length.
authors.affiliation: Radiology Department, Gaziosmanpaşa Taksim Training and Research Hospital, Istanbul, Turkey.
authors.forename: Hülya
authors.initials: H
authors.lastname: Kurtul Yildiz
authors.affiliation: Radiology Department, Gaziosmanpaşa Taksim Training and Research Hospital, Istanbul, Turkey.
authors.forename: Elif Evrim
authors.initials: EE
authors.lastname: Ekin
keywords: Knee MRI; Medial patellofemoral ligament; Patella alta- MPFLL/LPR; Trochlear dysplasia