Medial patellofemoral ligament injury patterns and associated pathology in lateral patella dislocation: an MRI study

Patrick Guerrero, Xinning Li, Ketan Patel, Michael Brown, Brian Busconi, Patrick Guerrero, Xinning Li, Ketan Patel, Michael Brown, Brian Busconi

Abstract

Background: Lateral Patella dislocations are common injuries seen in the active and young adult populations. Our study focus was to evaluate medial patellofemoral ligament (MPFL) injury patterns and associated knee pathology using Magnetic Resonance Imaging studies.

Methods: MRI studies taken at one imaging site between January, 2007 to January, 2008 with the final diagnosis of patella dislocation were screened for this study. Of the 324 cases that were found, 195 patients with lateral patellar dislocation traumatic enough to cause bone bruises on the lateral femoral trochlea and the medial facet of the patella were selected for this study. The MRI images were reviewed by three independent observers for location and type of MPFL injury, osteochondral defects, loose bodies, MCL and meniscus tears. The data was analyzed as a single cohort and by gender.

Results: This study consisted of 127 males and 68 females; mean age of 23 yrs. Tear of the MPFL at the patellar attachment occurred in 93/195 knees (47%), at the femoral attachment in 50/195 knees (26%), and at both the femoral and patella attachment sites in 26/195 knees (13%). Attenuation of the MPFL without rupture occurred in 26/195 knees (13%). Associated findings included loose bodies in 23/195 (13%), meniscus tears 41/195 (21%), patella avulsion/fracture in 14/195 (7%), medial collateral ligament sprains/tears in 37/195 (19%) and osteochondral lesions in 96/195 knees (49%). Statistical analysis showed females had significantly more associated meniscus tears than the males (27% vs. 17%, p = 0.04). Although not statistically significant, osteochondral lesions were seen more in male patients with acute patella dislocation (52% vs. 42%, p = 0.08).

Conclusion: Patients who present with lateral patella dislocation with the classic bone bruise pattern seen on MRI will likely rupture the MPFL at the patellar side. Females are more likely to have an associated meniscal tear than males; however, more males have underlying osteochondral lesions. Given the high percentage of associated pathology, we recommend a MRI of the knee in all patients who present with acute patella dislocation.

Figures

Figure 1
Figure 1
Axial T2 MRI image displays a tear at the patellar attachment (arrowhead).
Figure 2
Figure 2
Axial T2 MRI image indicates tearing at the femoral attachment (large arrow) and bone contrusion at the medial patellar facet (small arrow).
Figure 3
Figure 3
The MPFL is attenuated without a discrete tear noted with a laterally dislocated patella.
Figure 4
Figure 4
There is complete avulsion of the MPFL at the femoral attachment and a tear at the patellar attachment.
Figure 5
Figure 5
Avulsion fracture at the medial attachment of the MPFL.
Figure 6
Figure 6
A loose body at the inter-condylar notch from an osteochondral defect injury after a lateral patellar dislocation.

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