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The Bone & Joint Journal
Vol. 103-B, Issue 10 | Pages 1586 - 1594
1 Oct 2021
Sharma N Rehmatullah N Kuiper JH Gallacher P Barnett AJ

Aims

The Oswestry-Bristol Classification (OBC) is an MRI-specific assessment tool to grade trochlear dysplasia. The aim of this study is to validate clinically the OBC by demonstrating its use in selecting treatments that are safe and effective.

Methods

The OBC and the patellotrochlear index were used as part of the Oswestry Patellotrochlear Algorithm (OPTA) to guide the surgical treatment of patients with patellar instability. Patients were assigned to one of four treatment groups: medial patellofemoral ligament reconstruction (MPFLr); MPFLr + tibial tubercle distalization (TTD); trochleoplasty; or trochleoplasty + TTD. A prospective analysis of a longitudinal patellofemoral database was performed. Between 2012 and 2018, 202 patients (233 knees) with a mean age of 24.2 years (SD 8.1), with recurrent patellar instability were treated by two fellowship-trained consultant sports/knee surgeons at The Robert Jones and Agnes Hunt Orthopaedic Hospital. Clinical efficacy of each treatment group was assessed by Kujala, International Knee Documentation Committee (IKDC), and EuroQol five-dimension questionnaire (EQ-5D) scores at baseline, and up to 60 months postoperatively. Their safety was assessed by complication rate and requirement for further surgery. The pattern of clinical outcome over time was analyzed using mixed regression modelling.


The Journal of Bone & Joint Surgery British Volume
Vol. 94-B, Issue 9 | Pages 1202 - 1208
1 Sep 2012
Howells NR Barnett AJ Ahearn N Ansari A Eldridge JD

We report a prospective analysis of clinical outcome in patients treated with medial patellofemoral ligament (MPFL) reconstruction using an autologous semitendinosus graft. The technique includes superolateral portal arthroscopic assessment before and after graft placement to ensure correct graft tension and patellar tracking before fixation. Between October 2005 and October 2010, a total of 201 consecutive patients underwent 219 procedures. Follow-up is presented for 211 procedures in 193 patients with a mean age of 26 years (16 to 49), and mean follow-up of 16 months (6 to 42). Indications were atraumatic recurrent patellar dislocation in 141 patients, traumatic recurrent dislocation in 50, pain with subluxation in 14 and a single dislocation with persistent instability in six. There have been no recurrent dislocations/subluxations. There was a statistically significant improvement between available pre- and post-operative outcome scores for 193 patients (all p < 0.001). Female patients with a history of atraumatic recurrent dislocation and all patients with history of previous surgery had a significantly worse outcome (all p < 0.05). The indication for surgery, degree of dysplasia, associated patella alta, time from primary dislocation to surgery and evidence of associated cartilage damage at operation did not result in any significant difference in outcome.

This series adds considerably to existing evidence that MPFL reconstruction is an effective surgical procedure for selected patients with patellofemoral instability.


The Journal of Bone & Joint Surgery British Volume
Vol. 94-B, Issue 7 | Pages 889 - 894
1 Jul 2012
Burston BJ Barnett AJ Amirfeyz R Yates PJ Bannister GC

We prospectively followed 191 consecutive collarless polished tapered (CPT) femoral stems, implanted in 175 patients who had a mean age at operation of 64.5 years (21 to 85). At a mean follow-up of 15.9 years (14 to 17.5), 86 patients (95 hips) were still alive. The fate of all original stems is known. The 16-year survivorship with re-operation for any reason was 80.7% (95% confidence interval 72 to 89.4). There was no loss to follow-up, with clinical data available on all 95 hips and radiological assessment performed on 90 hips (95%). At latest follow-up, the mean Harris hip score was 78 (28 to 100) and the mean Oxford hip score was 36 (15 to 48). Stems subsided within the cement mantle, with a mean subsidence of 2.1 mm (0.4 to 19.2). Among the original cohort, only one stem (0.5%) has been revised due to aseptic loosening. In total seven stems were revised for any cause, of which four revisions were required for infection following revision of the acetabular component. A total of 21 patients (11%) required some sort of revision procedure; all except three of these resulted from failure of the acetabular component. Cemented acetabular components had a significantly lower revision burden (three hips, 2.7%) than Harris Galante uncemented components (17 hips, 21.8%) (p < 0.001).

The CPT stem continues to provide excellent radiological and clinical outcomes at 15 years following implantation. Its results are consistent with other polished tapered stem designs.


Orthopaedic Proceedings
Vol. 91-B, Issue SUPP_III | Pages 413 - 413
1 Sep 2009
Barnett AJ Prentice M Mandalia V Wakeley C Eldridge J
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A number of measurements of patella height exist all of which use a position on the tibia as a reference. The Patellotrochlear Index has recently been proposed as a more accurate reflection of the functional height of the patella and described in normal knees.

Aim: A comparison of patellar height measurements in patients with patellofemoral dysplasia.

Method: A retrospective analysis of the MRI scans of 33 knees in 29 patients with patellofemoral dysplasia to assess the inter- and intraobserver reliability of four patellar height measurements: the Patellotrochlear Index (PTI), Insall-Salvati (IS), Blackburne-Peel (BP) and Caton-Deschamps (CD) ratios. We also assessed the correlation between the different measurements in predicting patella alta. Three blinded observers on two separate occasions performed the measurements.

Results: There were 21 females and 8 males with a mean age of 21.4 years (13–33).

Statistical analysis revealed good inter-observer reliability for all measurements (0.78 for PTI, 0.78 for IS, 0.73 for BP and 0.77 for CD). Intra-observer reliability was also good (0.80, 0.83, 0.75, 0.78 respectively). When comparing the different measurements for patella alta there was a weak correlation between the PTI and the others. There was a strong correlation between the CD and BP ratios (0.96) and a moderate correlation between IS and CD and IS and BP ratios (0.594 and 0.539 respectively).

Conclusion: All measurements are reproducible. The PTI however suggests patella alta exists in different patients to that suggested by the established measures. We propose the PTI as a more clinically relevant measure.


The Journal of Bone & Joint Surgery British Volume
Vol. 89-B, Issue 6 | Pages 761 - 765
1 Jun 2007
Barnett AJ Gardner ROE Lankester BJA Wakeley CJ Eldridge JDJ

We retrospectively analysed the MR scans of 25 patients with patellofemoral dysplasia and ten control subjects, to assess whether there was any change in the morphology of the patella along its vertical length. Ratios were calculated comparing the size of the cartilaginous and subchondral osseous surfaces of the lateral and medial facets. We also classified the morphology using the scoring systems of Baumgartl and Wiberg. There were 18 females and seven males with a mean age of 20.2 years (10 to 29) with dysplasia and two females and eight males with a mean age of 20.4 years (10 to 29) in the control group.

In the patient group there was a significant difference in morphology from proximal to distal for the cartilaginous (Analysis of variance (ANOVA) p = 0.004) and subchondral osseous surfaces (ANOVA, p = 0.002). In the control group there was no significant difference for either the cartilaginous (ANOVA, p = 0.391) or the subchondral osseous surface (ANOVA, p = 0.526).

Our study has shown that in the dysplastic patellofemoral articulation the medial facet of the patella becomes smaller in relation to the lateral facet from proximal to distal. MRI is needed to define clearly the cartilaginous and osseous morphology of the patella before surgery is considered for patients with patellofemoral dysplasia.


The Journal of Bone & Joint Surgery British Volume
Vol. 88-B, Issue 5 | Pages 688 - 691
1 May 2006
van Huyssteen AL Hendrix MRG Barnett AJ Wakeley CJ Eldridge JDJ

Trochlear dysplasia is an important anatomical abnormality in symptomatic patellar instability. Our study assessed the mismatch between the bony and cartilaginous morphology in patients with a dysplastic trochlea compared with a control group.

MRI scans of 25 knees in 23 patients with trochlear dysplasia and in 11 patients in a randomly selected control group were reviewed retrospectively in order to assess the morphology of the cartilaginous and bony trochlea. Inter- and intra-observer error was assessed.

In the dysplastic group there were 15 women and eight men with a mean age of 20.4 years (14 to 30). The mean bony sulcus angle was 167.9° (141° to 203°), whereas the mean cartilaginous sulcus angle was 186.5° (152° to 214°; p < 0.001). In 74 of 75 axial images (98.7%) the cartilaginous contour was different from the osseous contour on subjective assessment, the cartilage exacerbated the abnormality.

Our study shows that the morphology of the cartilaginous trochlea differs markedly from that of the underlying bony trochlea in patients with trochlear dysplasia. MRI is necessary in order to demonstrate the pathology and to facilitate surgical planning.