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MRI of patellar stabilizers: Anatomic visibility, inter-reader reliability, and intra-reader reproducibility of primary and secondary ligament anatomy

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Abstract

Objective

To compare MRI features of medial and lateral patellar stabilizers in patients with and without patellar instability.

Methods

Retrospective study of 196 patients (mean age, 33.1 ± 18.5 years; 119 women) after diagnosis of patellar instability (cohort-1, acute patellar dislocation; cohort-2, chronic patellar maltracking) or no patellar instability (cohort-3, acute ACL rupture; cohort-4, chronic medial meniscus tear). On MRI, four medial and four lateral stabilizers were evaluated for visibility and injury by three readers independently. Inter- and intra-reader agreement was determined.

Results

Medial and lateral patellofemoral ligaments (MPFL and LPFL) were mostly or fully visualized in all cases (100%). Of the secondary patellar stabilizers, the medial patellotibial ligament was mostly or fully visualized in 166 cases (84.7%). Other secondary stabilizers were mostly or fully visualized in only a minority of cases (range, 0.5–32.1%). Injury scores for all four medial stabilizers were higher in patients with acute patellar dislocation than the other 3 cohorts (p < .05). Visibility inter- and intra-reader agreement was good for medial stabilizers (κ 0.61–0.78) and moderate-to-good for lateral stabilizers (κ 0.40–0.72). Injury inter- and intra-reader agreement was moderate-to-excellent for medial stabilizers (κ 0.43–0.90) and poor-to-moderate for lateral stabilizers (κ 0–0.50).

Conclusion

The MPFL and LPFL were well visualized on MRI while the secondary stabilizers were less frequently visualized. The secondary stabilizers were more frequently visualized medially than laterally, and patellotibial ligaments were more frequently visualized compared to the other secondary stabilizers. Injury to the medial stabilizers was more common with acute patellar dislocation than with chronic patellar maltracking or other knee injuries.

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Abbreviations

MRI:

Magnetic resonance imaging

ACL:

Anterior cruciate ligament

MPFL:

Medial patellofemoral ligament

MPTL:

Medial patellotibial ligament

MPML:

Medial patellomeniscal ligament

MQTFL:

Medial quadriceps tendon femoral ligament

LPFL:

Lateral patellofemoral ligament

LPML:

Lateral patellomeniscal ligament

LPTL:

Lateral patellotibial ligament

ICD:

International Classification of Disease

PACS:

Picture archiving and communication system

TR:

Repetition time

TE:

Time to echo

PD:

Proton density

FS:

Fat-suppressed

ANOVA:

Analysis of variance

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Authors and Affiliations

  1. Department of Radiology, Stanford University School of Medicine, 300 Pasteur Dr, Stanford, CA, 94305, USA

    Eddy D. Zandee van Rilland, Shelby R. Payne & Robert D. Boutin

  2. Department of Radiology, Einstein Medical Center, Sidney Kimmel Medical College at Thomas Jefferson University, 5501 Old York Rd, Philadelphia, PA, 19141, USA

    Tetyana Gorbachova

  3. Department of Orthopaedic Surgery, Stanford University School of Medicine, 300 Pasteur Dr, Stanford, CA, 94305, USA

    Kevin G. Shea & Seth L. Sherman

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  1. Eddy D. Zandee van Rilland
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Correspondence to Robert D. Boutin.

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Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflict of interest

The authors declare no competing interests, while noting disclosures for two authors:

• Disclosures for K.G. Shea: Advisory board for Sarcio, Inc., nView, Inc, and Medeloop, Inc.

• Disclosures for S.L. Sherman: Board or committee member of AAOS, ACL Study Group, American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America, Biologics Alliance, Icarus Bracing, International Cartilage Regeneration & Joint Preservation Society, International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine, International Sports Medicine Fellows Conference, Patellofemoral Foundation, Reparel, Sarcio, Sparta Biomedical, and Vericel; paid consultant or paid speaker for Arcuro, Inc, Arthrex, Inc, CONMED, Depuy J&J, Joint Restoration Foundation, Kinamed, LifeNet, Linksys, NewClip, Ostesys, and Smith & Nephew; stock options in Vivorte, Reparel, and Sarcio; editorial or governing board member for Arthroscopy, Current Reviews in Musculoskeletal Medicine, and Video Journal of Sports Medicine.

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Zandee van Rilland, E., Payne, S.R., Gorbachova, T. et al. MRI of patellar stabilizers: Anatomic visibility, inter-reader reliability, and intra-reader reproducibility of primary and secondary ligament anatomy. Skeletal Radiol 53, 555–566 (2024). https://doi.org/10.1007/s00256-023-04432-2

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