Femoral avulsion of the MPFL is a predictor of chronic instability and may be a surgical indication in some patients with acute injury. The objective of this paper was to describe the anatomy of the stifle joint (Articulatio genus) of the pampas deer (Ozotoceros bezoarticus, Linnaeus, 1758) by dissection and imaging studies. The medial patellar retinaculum and MPFL are best seen on MRI on the axial fluid-sensitive sequences. A tear of the retinaculum is mostly seen after dislocation of the patella. Stress and shear forces that follow can result in cartilage damage and the development and evolution of osteoarthritis [57]. On the other hand, there are static MRI measurements that are routinely used as indicators of patellofemoral alignment during knee movement [30, 31]. Skeletal Radiol 30:484495, Tsujimoto K, Kurosaka M, Yoshiya S, Mizuno K (2000) Radiographic and computed tomographic analysis of the position of the tibial tubercle in recurrent dislocation and subluxation of the patella. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Stretching this ligament keeps the patella in place and the ligament healthy. Surgical management procedures can broadly be categorized as soft tissue procedures (lateral release, medial imbrication, and MPFL repair or reconstruction) and bony procedures (tibial tubercle transfer procedures and trochleoplasty). (5a) An axial T1-weighted image demonstrates the low blending fibers of the VMO and transverse MPFL at their attachment along the upper patella. Less than 3-mm trochlear depth is indicative of trochlear dysplasia [24]. Google Scholar, Miller TT, Staron RB, Feldman F (1996) Patellar height on sagittal MR imaging of the knee. (Figs.1-A 1-A also and1-B). Skeletal Radiol. In patients without osseous malalignment, MPFL reconstruction and plication of the medial restraints is reported to decrease re-dislocation rates to 5%. Lateral Patellar Dislocation. Thus, imaging at positions both less than and greater than 30 can be used to avoid missing maltracking that might be captured at only certain degrees of flexion [64]. Transient medial patellar dislocation: injury patterns at US and MR The anatomy of the medial patellofemoral ligament. A small osseous avulsion (arrowhead) is seen in this region. 2012;40(4):837-844. Medial patellofemoral ligament MRI abnormalities in the - Springer The patellar tendon may tear when the knee is bent and the foot planted, like when landing from a jump or . Patients who experience multiple patellar dislocations are more likely to have anatomical variants of the trochlea, patellar alta, or tibial tubercle lateralization. (22a) In this patient with an acute first time patellar dislocation injury, typical bone bruises were not apparent. Patellofemoral friction syndrome: MRI findings of an - Eurorad A Focal Defect at the Lateral Patellar Retinaculum on Clinical Knee MRI Medial Patellofemoral Ligament (MPFL) - Physiopedia Risk factors for recurrent instability include female sex, family history of patellar instability, and various anatomic risk factors such as patella alta, increased femoral anteversion, external tibial rotation, genu valgum, trochlear dysplasia, increased tibial tubercletrochlear groove (TT-TG) distance, and patellar tilt [13, 21,22,23]. This can provide a road map for formulating a treatment strategy that would be primarily aimed at stabilizing the patellofemoral joint to halt or slow the progression of articular cartilage loss. It is a ratio between the patellar tendon length (along the inner surface of the tendon) and the diagonal patellar height [27]. 5 Carrillon Y, Abidi H, Dejour D, et al. Kamel S, Kanesa-Thasan R, Dave J et al. Retinaculum - Differential Diagnosis of the Knee Jumping. (20a) A fat-suppressed proton density-weighted sagittal image in a patient following patellar dislocation reveals an osteochondral injury with a chondral defect (arrows) at the lateral weightbearing surface of the lateral femoral condyle, a finding seen in only 5% of patients. Areas of scarring and osteochondral lesions become more common as the frequency of patellar dislocation increases. 2012 Feb;41(2):137-48. doi: 10.1007/s00256-011-1291-3. HHS Vulnerability Disclosure, Help 6 Cone R. Patella Alta and Baja. Alimorad Farshchian M. D.. Farshchian's Orthopedic Regenerative Series. The degree of patellar tilt can be evaluated by measuring the patella tilt angle, which is the angle between the posterior condylar line and the maximal patella width line [47] (Fig. An increased tibial tubercletrochlear groove (TT-TG) indicates a lateralized tibial tuberosity, or a medialized trochlear groove [38]. Phys Ther 69:897901, Atkin DM, Fithian DC, Marangi KS, Stone ML, Dobson BE, Mendelsohn C (2000) Characteristics of patients with primary acute lateral patellar dislocation and their recovery within the first 6 months of injury. Before Cochrane Database Syst Rev 2:CD008106, Woo R, Busch MT (1998) Management of patellar instability in children. Other indicated structures: gracilis (G), semitendinosus (ST), and adductor magnus (AM) tendons. AJR Am J Roentgenol. Fractures may be caused either by excessive force through the extensor mechanism or by a direct blow. Radiology 189:905907, Warren LF, Marshall JL (1979) The supporting structures and layers on the medial side of the knee: an anatomical analysis. The average annual incidence for patellar dislocation injuries ranged between 5.8 and 7.0 per 100,000 person-years in the civilian population, and up to 29 per 100,000 person-years in the 10-17 year age . The lateral retinaculum provides significant additive support to the medial stabilizers. Eur J Trauma Emerg Surg. Focal herniation of Hoffa's fat pad through a retinaculum defect The latter distinction is important to recognize among both radiologists and surgeons. The patella remains laterally shifted (blue arrow) and an osteochondral injury of the medial patella (arrowheads) is apparent. PubMed (6a) A more distal T1-weighted image reveals fibers of the oblique decussation of the MPFL which blend with the medial collateral ligament (MCL). Lateral patellar retinaculum. Epub 2023 Feb 7. These measurements are not routinely recorded in the MRI report, but in select situations may be helpful in quantifying low-grade versus high-grade dysplasia. On the other hand, the PTI is significantly altered with knee flexion [37]. Acute lateral patellar dislocation at MR imaging: injury patterns of medial patellar soft-tissue restraints and osteochondral injuries of the inferomedial patella. Crossref, Medline, Google Scholar; 32 Starok M, Lenchikl L, Trudell D, Resnick D. Normal patellar retinaculum: MR and sonographic imaging with cadaveric correlation. A Focal Defect at the Lateral Patellar Retinaculum on Clinical Knee MRI (1a) A single fat-suppressed proton density-weighted coronal image is provided. A ratio of >1.3 is considered indicative of patella alta [34] (Fig. Medial patellofemoral ligament injury patterns and associated pathology The lateral patellar retinaculum is a fibrous expansion comprising of superficial and deep layers. It is the angle between a line tangential to the subchondral bone of the posterior aspect of the femoral condyles and a line along the lateral trochlear facet. 9 Lippacher S, Dejour S, Elsharkawi M, et al. Quinn described the MRI findings following acute patellar dislocation as contusion or impaction of the medial patellar facet and lateral femoral condyle, along with injury of the medial retinaculum and/or medial patellofemoral ligament (MPFL) (Quinn, 1993). Given the lack of history of direct trauma, a reliable diagnosis can be made. Terms and Conditions, For first-time dislocators without intra-articular loose bodies or chondral injury, a trial of nonoperative therapy is indicated. a Sagittal PD knee MRI showing the method of assessing the InsallSalvati index, calculated as the ratio of the patellar tendon length at its inner aspect (white dashed line) to the greatest diagonal length of the patella (white line). Federal government websites often end in .gov or .mil. Pathology At the time the article was last revised Mohamed Saber had Patellar maltracking occurs as a result of imbalance of this relationship often secondary to anatomic morphologic abnormality. government site. Bethesda, MD 20894, Web Policies Femoral osteochondral injuries, when present, typically involve the lateral weightbearing surface. Macroscopic Anatomy of the Stifle Joint in the Pampa's Deer Am J Knee Surg 13:8388, Izadpanah K, Weitzel E, Vicari M et al (2014) Influence of knee flexion angle and weight bearing on the Tibial Tuberosity-Trochlear Groove (TTTG) distance for evaluation of patellofemoral alignment. It has been shown that damage to the medial patellar stabilizers including medial patellar retinaculum and the medial patellofemoral ligament (MPFL) injuries are prevalent in 70100% of cases of lateral patellar dislocation [5, 27, 49,50,51]. 6). As an example, although the InsallSalvati ratio is one of the most commonly used methods and does not depend on the degree of knee flexion, it is affected by the patellar shape particularly its inferior point and measurement does not change after tibial tubercle distalization procedure [25]. Lateral patellar dislocation. In eight of 17 patients, the mechanism of injury was a patellar tendon tear (n = 1) or valgus hyperextension (n = 7). Abnormalities of the medial retinaculum and MPFL are seen in 82-100% of MRI examinations following patellar dislocation. 7 Balcarek P, Jung K, Frosch KH, Sturmer KM. From 10 to 20 of flexion, the patella engages the trochlear groove with the contact area being the inferior most portion of the medial and lateral facets. Magnetic Resonance Imaging Findings After Acute Patellar Dislocation in Starok M, Lenchik L, Trudell D, Resnick D. Normal patellar retinaculum: MR and sonographic imaging with cadaveric correlation. a Axial CT image demonstrating MPFL reconstruction (arrow heads). Trochleoplasty is rarely performed in this country and is reserved for significant dysplasias or when other surgical options have been insufficient in restoring patellofemoral stability. The angle between the two lines is the lateral trochlear inclination (LTI). The transverse band attaches to the upper pole of the patella, and this component originates on a bony groove that lies between the adductor tubercle and the medial epicondyle, slightly posterior to the epicondyle. Cookies policy. In a series of 474 patients with anterior knee pain, patellar tilt or subluxation was present in 40% of the cases on axial MRI [46]. {"url":"/signup-modal-props.json?lang=us"}, Moodaley P, Hng J, Hacking C, et al. (26a) An axial proton density-weighted image reveals trochlear dysplasia (line, indicating facet asymmetry and a shallow trochlear groove), ossification in the medial retinaculum and MPFL attachment anteriorly (short arrow) and diffuse scarring of the medial retinaculum (arrowheads)--these findings indicate chronic patellofemoral instability. 2010 Aug;36(4):353-60. doi: 10.1007/s00068-010-9165-2. Prior lateral patellar dislocation: MR imaging findings. Objective: This prospective study is designed to detect changes in the treatment of ruptured intracranial aneurysms over a period of 17 years. Radiology 1993; 189:905-907. Surgical indications following patellar dislocation include the presence of a chondral or osteochondral body, significant rupture of the medial stabilizers most importantly the MPFL, a persistent laterally subluxed patella, or a second dislocation injury in a patient with malalignment or dysplasia. Another study noted an association between abnormal trochlear morphology and high-grade patellofemoral cartilage damage [58]. Patellar maltracking is a disorder that often affects the young active individuals. It is the angle between a line tangential to the subchondral bone of the posterior aspect of the femoral condyles and a line along the lateral trochlear facet subchondral bone (Fig. They include: pain with compression of patella and moderate lateral facet tenderness, inability to evert the lateral edge of the patella, mainstay of treatment and should be done for extensive period of time, closed chain short arc quadriceps exercises, pain refractory to extensive rehabilitation, ideal candidate has no symptoms of instability, medial patellar glide of less than one quadrant, lateral patellar glide of less than three quadrants, only elevate 1 cm or else risk of skin necrosis, indicated only for instability with lateral translation (not isolated lateral tilt), viewing through superior portal will show medial facet does not articulate with trochlea at 40 degrees of knee flexion, postoperatively the patella should be able to be, patellar instability with medial translation, Spontaneous Osteonecrosis of the Knee (SONK), Osgood Schlatter's Disease (Tibial Tubercle Apophysitis), Anterior Superior Iliac Spine (ASIS) Avulsion, Anterior Inferior Iliac Spine Avulsion (AIIS), Proximal Tibiofibular Joint Ganglion Cysts, Pre-Participation Physical Exam in Athlete, Concussions (Mild Traumatic Brain Injury). Clin Radiol 59:543557, Ali SA, Helmer R, Terk MR (2010) Analysis of the patellofemoral region on MRI: association of abnormal trochlear morphology with severe cartilage defects. Google Scholar, Sanders TG, Paruchuri NB, Zlatkin MB (2006) MRI of osteochondral defects of the lateral femoral condyle: incidence and pattern of injury after transient lateral dislocation of the patella. Thawait SK, Soldatos T, Thawait GK, Cosgarea AJ, Carrino JA, Chhabra A. Skeletal Radiol. 1997 Jan;168(1):117-22. doi: 10.2214/ajr.168.1.8976933. Nearly 50% of all first-time dislocators will sustain further dislocations. Lateral patellar compression syndrome is the improper tracking of the patella in the trochlear groove generally caused by a tight lateral retinaculum. There is agreement, however, that the MPFL is almost always injured with lateral patellar dislocations4. Lateral patellar retinaculum | Radiology Reference Article Lateral Retinaculum - an overview | ScienceDirect Topics 0000293749 00000 n Injury 4:126130, 1972. The close association of the MR with the MCL is also apparent. Nine of 17 patients showed MR evidence of a patellar dislocation. Biomechanical evaluation of lateral patellar dislocations. 8600 Rockville Pike The stifle joint of the pampas deer . J Orthop Sports Phys Ther 2017;47(10):815. doi:10.2519/ jospt.2017.6616 . the patellar retinaculum at the dynamic examination (Fig. Levy B, Tanaka M, Fulkerson J. The patellar usually relocates, and the typical bone contusions are the key MRI features to diagnose transient lateral patellar dislocation (Fig. MRI is the imaging modality of choice in the assessment of patellar maltracking, as a virtue of what it can reveal (Table1). 3.1 ). Tibial tubercletrochlear groove distance (TT-TG) assessment. J Bone Joint Surg Am 61:5662, Jerabek SA, Asnis PD, Bredella MA, Ouellette HA, Poon SK, Gill TJ 4th (2009) Medial patellar ossification after patellar instability: a radiographic finding indicative of prior patella subluxation/dislocation. What is the treatment for a patellar retinaculum tear? e-Anatomy, the Anatomy of Imaging - IMAIOS Clin Orthop Relat Res 144:1626, Elias DA, White LM, Fithian DC (2002) Acute lateral patellar dislocation at MR imaging: injury patterns of medial patellar soft-tissue restraints and osteochondral injuries of the inferomedial patella. Am J Sports Med 14:3945, Ward SR, Powers CM (2004) The influence of patella alta on patellofemoral joint stress during normal and fast walking. Sonographic Appearances of Medial Retinacular Complex Injury in High resolution magnetic resonance imaging of the patellar retinaculum: normal anatomy, common injury patterns, and pathologies. Prevalence of Lateral Patellofemoral Maltracking and Associated Complications in Patients with Osgood Schlatter Disease. There are several different techniques described in the literature to assess patella alta and many of these are reviewed in detail in the MRI Web Clinic, August 20106. It is reported in surgical literature that 50-75% of recurrent dislocators, have some form of dysplasia, malalignment or generalized joint laxity. When the knee moves slightly out of place or becomes tilted in the joint, it can cause tension and pain in the lateral retinaculum. Courtesy of Daniel Bodor, MD, Radsource. MR imaging can help define patellar retinacular and associated osteochondral injuries, which may be clinically useful information. In general realignment surgery such as tibial tubercle transfer should be strongly considered in patients with TT-TG > 15mm (borderline) and typically should be performed in patients with TT-TG > 20mm. Division of Sports Trauma, Department of Orthopaedics, Aarhus University Hospital, Aarhus, Denmark. lateral patellar retinacular sleeve, mak-ing this particular avulsion a rare oc-currence. Patellar maltracking: an update on the diagnosis and treatment strategies. 3). This injury has been described in conjunction with numerous sports activities, particularly snow skiing. Int Orthop. It takes a very strong force to tear the patellar tendon. Distally, it attaches to the tibial tubercle via the patellar tendon. Both knees are scanned simultaneously. 2023 BioMed Central Ltd unless otherwise stated. Curr Rev Musculoskelet Med 11:253260, Article A Focal Defect at the Lateral Patellar Retinaculum on Clinical Knee MRI Additional passive stabilizers include the medial patellotibial ligament (MPTL) and the medial patellomeniscal ligament (MPML). Discussion. Med Sci Sports Exerc 35:20432047, Steiner T, Parker RD (2009) Patella: subluxation and dislocation. Note the edema in the superolateral aspect of Hoffas fat pad (arrow). Radiology 225:736743, Kirsch MD, Fitzgerald SW, Friedman H, Rogers LF (1993) Transient lateral patellar dislocation: diagnosis with MR imaging. Patella alta is considered an important factor in patellar instability. 2015 Sep 30;9:463-74. doi: 10.2174/1874325001509010463. eCollection 2015. 2. Seventeen patients with patellar retinacular ligament injuries were evaluated with magnetic resonance (MR) imaging. Clin Sports Med 21:521546 x, Article It has been shown that ossification in the medial patellar stabilizers correlates with prior injury to these structures [53]. Tibial Tubercle Osteotomy to Aid Exposure for Revision Total Knee J Pediatr Orthop 37:484490, Parikh SN, Lykissas MG, Gkiatas I (2018) Predicting risk of recurrent patellar dislocation. Am J Sports Med. Less common predisposing factors to be aware of include laterally tilted patella, VMO dysplasia and generalized joint laxity. The Insall-Salvati index is the most widely accepted measurement and is easily performed on radiographs and MRI examinations. Rheumatology (Oxford) 46:13031308, Sanders TL, Pareek A, Johnson NR, Stuart MJ, Dahm DL, Krych AJ (2017) Patellofemoral arthritis after lateral patellar dislocation: a matched population-based analysis. The injured retinaculum had an indistinct, irregular appearance associated with edema and hemorrhage. 4 Sanders TG, Morrison WB, Singleton BA, Miller MD, Cornum KG. Patellar dislocation accounts for ~3% of all knee injuries and is commonly seen in those individuals who participate in sports activities. Sports Med Arthrosc Rev 25:7277, Gillespie H (2012) Update on the management of patellar instability. The medial patellar retinaculum is part of the anterior third of the medial joint capsule. Complete dislocation of the knee: spectrum of associated soft-tissue injuries depicted by MR imaging. It is measured at the mid-point of the patella on the axial slices [48]. Radiographics. AJR Am J Roentgenol 195:13671373, Jarraya M, Diaz LE, Roemer FW, Arndt WF, Goud AR, Guermazi A (2018) MRI findings consistent with peripatellar fat pad impingement: how much related to patellofemoral maltracking? PDF Painful patellar swelling - dipot.ulb.ac.be Various parameters can be used in assessing and predicting the presence of patellar maltracking. 20,61 This is attributable to a medial retinacular injury, specifically, avulsion or tearing of the medial patellofemoral ligament. Burks RT, Desio SM, Bachus KN, Tyson L, Springer K. Spritzer CE, Courneya DL, Burk DL Jr, Garrett WE, Strong JA. This procedure involves removal of cancellous bone beneath the trochlea followed by fixation of the articular surface [88, 89]. Sanders T, Paruchuri N, Zlatkin M. MRI of Osteochondral Defects of the Lateral Femoral Condyle: Incidence and Pattern of Injury After Transient Lateral Dislocation of the Patella. MRI Web Clinic, August 2010. https://radsource.us/patella-alta-and-baja/. The trochlear depth is calculated by measuring the mean of the maximum anteroposterior (AP) distance of the medial and lateral femoral condyles minus the distance between the deepest point of the trochlear groove and the line paralleling the posterior femoral condyles surfaces (Fig. 35 Dislocation typically occurs in the setting of internal rotation of the femur on a fixed, externally rotated tibia. Falls. Laxity of the medial stabilizers will lead to increasing instability over time. Patellofemoral Pain Syndrome - OrthoInfo - AAOS Characterization of the type of medial restraint injury is crucial for surgical planning. CAS Trochlear geometry, including slope of the lateral wall and depth, is an important factor. The patella remains laterally subluxed and tilted, and the patient has an abnormally shallow trochlear groove (line). AJR Am J Roentgenol 161:109113, Lance E, Deutsch AL, Mink JH (1993) Prior lateral patellar dislocation: MR imaging findings. The medial patellofemoral ligament (MPFL) is a condensation of the medial capsule of the knee joint. The most obvious presentation of patellar maltracking is that of the first time lateral patellar instability or recurrent instability thereafter. Diagnosis is made clinically with pain with compression of the patella and moderate lateral facet tenderness and sunrise knee radiographs will often show patellar tilt in the lateral direction. Another method is the CatonDeschamps index. A focused history of the mechanism, number, and circumstances of instability to date is essential. a Axial PDFS right knee MR image at the level of the trochlear groove. Clin Orthop Relat Res 471:26412648, Laurin CA, Dussault R, Levesque HP (1979) The tangential x-ray investigation of the patellofemoral joint: x-ray technique, diagnostic criteria and their interpretation. The patellar apprehension test is used to assess for lateral instability and is positive when pain or discomfort occurs with lateral translation of the patella. In addition, symptomatic knees may demonstrate normal engagement between the patella and trochlea beyond 30 of flexion. PubMedGoogle Scholar. official website and that any information you provide is encrypted Osteochondral injuries of the inferomedial patella are seen in up to 70% of patellofemoral dislocations. Am J Sports Med. The Anterolateral Ligament of the Knee: MRI Appearance, Association Do a thorough work-up of the patient at the clinic to determine the need for a redesign total knees arthroplasty (Figs. National Library of Medicine The MCL is composed of the superficial layer (layer 2 of the medial supporting structures) and the deep layer (layer 3 of the medial . Despite this, there remains considerable variation in surgical technique including graft choice, position, and tension making the literature difficult to compare [8, 15, 79,80,81,82,83,84,85,86]. The distance from the tibial tubercle to the trochlear groove (TT-TG) provides a quantitative evaluation of excessive lateralization of the tibial tuberosity.7, (10a) Axial image of the knee with superimposition of the tibial tubercle from another slice (yellow outline). 2 Baldwin JL. . From the inside of the knee the lateral retinaculum is incised, from the inside, allowing the kneecap to untilit itself. Am J Sports Med 32:11141121, Tsavalas N, Katonis P, Karantanas AH (2012) Knee joint anterior malalignment and patellofemoral osteoarthritis: an MRI study. A bone bruise of the lateral femoral condyle (asterisk) and an abnormally shallow trochlear groove (red line) are also indicated. Lastly, a sulcus-deepening procedure known as trochleoplasty may be indicated in the patient with significant trochlear dysplasia and recurrent instability. In these patients, a triad of findings that included focal impaction injuries involving the lateral femoral condyle, osteochondral injuries of the medial patellar facet, and injuries of the medial retinacular ligament were seen. This short surgical video demonstrates an arthroscopic lateral release as seen from inside the knee. Predisposing factors to patellofemoral dislocation include patella alta, excessive lateral distance between the tibial tubercle and trochlear groove and a congenitally shallow trochlear groove5, any of which significantly increase a patients likelihood for dislocation. Distances between 15 and 20 mm are borderline, and distances of more than 20 mm indicate significant lateralization of the tuberosity.5. A commonly used one is the InsallSalvati ratio of patellar tendon length: patellar length. It thickens as it inserts onto the lateral border of the patella, quadriceps tendon and patellar ligament. It was shown that certain features of patellar maltracking (increased sulcus angle, lateral patellar tilt, and a higher patellar tendon to patellar length ratio) are associated with cartilage loss and bone marrow lesions [59]. Imaging assessment can start with the radiograph including anteroposterior and lateral views of the knee and skyline view of the patella. However, in the setting of osseous malalignment, MPFL reconstruction alone leads to higher rates of recurrent instability. If the lateral retinaculum tendon is tight enough to pull the patella out of the trochlear groove, a lateral release procedure can loosen the tissue and correct the patellar malalignment. Unauthorized use of these marks is strictly prohibited. At the time the article was created Aditya Shetty had no recorded disclosures. Rev Bras Ortop 46:160164, LeGrand AB, Greis PE, Dobbs RE, Burks RT (2007) MPFL reconstruction. MRI and operative studies have revealed that it is almost . 2021;50(7):1399-409. The pattern of bone bruising seen in a transient lateral patellar dislocation is easy to understand if one considers the mechanism of injury. From this insertion, it extends posteriorly to blend with the lateral margin of the knee capsule and inferior surface of the lateral tibial condyle 1,2. A ratio > 1.3 indicates patella alta. Lateral Retinacular Release - Surgery Information Correspondence to In type A, the trochlear preserves its concave shape but has shallow trochlear groove; type B is flattened or convex trochlea; in type C, the medial facet is hypoplastic (facet asymmetry) with high lateral facet, resulting in flattened joint surface in an oblique plane; and type D shows a cliff pattern with type C features and a vertical link between the medial and lateral facets. 2). Patellar maltracking: an update on the diagnosis and treatment strategies, https://doi.org/10.1186/s13244-019-0755-1, http://creativecommons.org/licenses/by/4.0/. Trochlear depth assessment. MRI and CT are superior modalities in looking for predisposing factors associated with patellar maltracking [26,27,28]. [Google Scholar] 6. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. With knee extension and subsequent reduction, the patella bounces back into position and in doing so, the medial patella impacts against the non-weightbearing anterolateral aspect of the lateral femoral condyle, resulting in the characteristic marrow edema pattern.
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