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The Vastus Medialis Insertion Is More Proximal and Medial in Patients With Patellar Instability: A Magnetic Resonance Imaging Case-Control Study

BACKGROUND: The anatomy and function of the quadriceps muscle play a role in patellofemoral stability. Few studies have evaluated anatomic differences in the vastus medialis between patients with and without patellar instability. PURPOSE: To compare the anatomy of the vastus medialis using magnetic...

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Autores principales: Gobbi, Riccardo Gomes, Hinckel, Betina Bremer, Teixeira, Paulo Renan Lima, Giglio, Pedro Nogueira, Lucarini, Bruno Romano, Pécora, José Ricardo, Camanho, Gilberto Luis, Demange, Marco Kawamura
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6893936/
https://www.ncbi.nlm.nih.gov/pubmed/31840028
http://dx.doi.org/10.1177/2325967119880846
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author Gobbi, Riccardo Gomes
Hinckel, Betina Bremer
Teixeira, Paulo Renan Lima
Giglio, Pedro Nogueira
Lucarini, Bruno Romano
Pécora, José Ricardo
Camanho, Gilberto Luis
Demange, Marco Kawamura
author_facet Gobbi, Riccardo Gomes
Hinckel, Betina Bremer
Teixeira, Paulo Renan Lima
Giglio, Pedro Nogueira
Lucarini, Bruno Romano
Pécora, José Ricardo
Camanho, Gilberto Luis
Demange, Marco Kawamura
author_sort Gobbi, Riccardo Gomes
collection PubMed
description BACKGROUND: The anatomy and function of the quadriceps muscle play a role in patellofemoral stability. Few studies have evaluated anatomic differences in the vastus medialis between patients with and without patellar instability. PURPOSE: To compare the anatomy of the vastus medialis using magnetic resonance imaging in patients with patellar instability to a control group. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: A group of patients with patellar instability were sex-matched with a control group with anterior cruciate ligament tears, meniscal injuries, or sprains; patients younger than 15 years were excluded. The anatomy of the vastus medialis was examined by the distance between the distal origin of the vastus medialis in the femur and the medial femoral condyle, the distance from the proximal pole of the patella to the most distal insertion of the muscle and its ratio to the length of the articular surface of the patella, and a qualitative description of the insertion position of the muscle fibers (directly in the patella or the medial retinaculum). RESULTS: Both groups comprised 78 knees (48 female; 61.5%). The mean age in the control and patellar instability groups was 30.2 ± 7.8 years and 25.6 ± 7.5 years, respectively (P = .001). The distance from the vastus origin to the condyle was 27.52 ± 3.49 mm and 26.59 ± 3.43 mm, respectively (P = .041); the distance from the proximal pole of the patella to the most distal muscle insertion was 17.59 ± 5.54 mm and 15.02 ± 4.18 mm, respectively (P < .001); and the ratio of this distance to the joint surface was 0.586 ± 0.180 and 0.481 ± 0.130, respectively (P < .001). In 75.6% of knees in the patellar instability group, the insertion of the vastus was into the medial retinaculum and not into the patella compared with 52.6% in the control group (P = .003; odds ratio, 2.8). CONCLUSION: The distal insertion of the vastus medialis differed in knees with patellar instability, with a more proximal insertion and less patellar coverage relative to controls, and was more frequently found in the retinaculum instead of directly in the patella.
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spelling pubmed-68939362019-12-13 The Vastus Medialis Insertion Is More Proximal and Medial in Patients With Patellar Instability: A Magnetic Resonance Imaging Case-Control Study Gobbi, Riccardo Gomes Hinckel, Betina Bremer Teixeira, Paulo Renan Lima Giglio, Pedro Nogueira Lucarini, Bruno Romano Pécora, José Ricardo Camanho, Gilberto Luis Demange, Marco Kawamura Orthop J Sports Med Article BACKGROUND: The anatomy and function of the quadriceps muscle play a role in patellofemoral stability. Few studies have evaluated anatomic differences in the vastus medialis between patients with and without patellar instability. PURPOSE: To compare the anatomy of the vastus medialis using magnetic resonance imaging in patients with patellar instability to a control group. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: A group of patients with patellar instability were sex-matched with a control group with anterior cruciate ligament tears, meniscal injuries, or sprains; patients younger than 15 years were excluded. The anatomy of the vastus medialis was examined by the distance between the distal origin of the vastus medialis in the femur and the medial femoral condyle, the distance from the proximal pole of the patella to the most distal insertion of the muscle and its ratio to the length of the articular surface of the patella, and a qualitative description of the insertion position of the muscle fibers (directly in the patella or the medial retinaculum). RESULTS: Both groups comprised 78 knees (48 female; 61.5%). The mean age in the control and patellar instability groups was 30.2 ± 7.8 years and 25.6 ± 7.5 years, respectively (P = .001). The distance from the vastus origin to the condyle was 27.52 ± 3.49 mm and 26.59 ± 3.43 mm, respectively (P = .041); the distance from the proximal pole of the patella to the most distal muscle insertion was 17.59 ± 5.54 mm and 15.02 ± 4.18 mm, respectively (P < .001); and the ratio of this distance to the joint surface was 0.586 ± 0.180 and 0.481 ± 0.130, respectively (P < .001). In 75.6% of knees in the patellar instability group, the insertion of the vastus was into the medial retinaculum and not into the patella compared with 52.6% in the control group (P = .003; odds ratio, 2.8). CONCLUSION: The distal insertion of the vastus medialis differed in knees with patellar instability, with a more proximal insertion and less patellar coverage relative to controls, and was more frequently found in the retinaculum instead of directly in the patella. SAGE Publications 2019-12-04 /pmc/articles/PMC6893936/ /pubmed/31840028 http://dx.doi.org/10.1177/2325967119880846 Text en © The Author(s) 2019 http://creativecommons.org/licenses/by-nc-nd/4.0/ This article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 License (http://www.creativecommons.org/licenses/by-nc-nd/4.0/) which permits non-commercial use, reproduction and distribution of the work as published without adaptation or alteration, without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Article
Gobbi, Riccardo Gomes
Hinckel, Betina Bremer
Teixeira, Paulo Renan Lima
Giglio, Pedro Nogueira
Lucarini, Bruno Romano
Pécora, José Ricardo
Camanho, Gilberto Luis
Demange, Marco Kawamura
The Vastus Medialis Insertion Is More Proximal and Medial in Patients With Patellar Instability: A Magnetic Resonance Imaging Case-Control Study
title The Vastus Medialis Insertion Is More Proximal and Medial in Patients With Patellar Instability: A Magnetic Resonance Imaging Case-Control Study
title_full The Vastus Medialis Insertion Is More Proximal and Medial in Patients With Patellar Instability: A Magnetic Resonance Imaging Case-Control Study
title_fullStr The Vastus Medialis Insertion Is More Proximal and Medial in Patients With Patellar Instability: A Magnetic Resonance Imaging Case-Control Study
title_full_unstemmed The Vastus Medialis Insertion Is More Proximal and Medial in Patients With Patellar Instability: A Magnetic Resonance Imaging Case-Control Study
title_short The Vastus Medialis Insertion Is More Proximal and Medial in Patients With Patellar Instability: A Magnetic Resonance Imaging Case-Control Study
title_sort vastus medialis insertion is more proximal and medial in patients with patellar instability: a magnetic resonance imaging case-control study
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6893936/
https://www.ncbi.nlm.nih.gov/pubmed/31840028
http://dx.doi.org/10.1177/2325967119880846
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