Patellanın Morfolojik Yapısı ile Ön Diz Ağrısı Arasındaki İlişki: Sagital ve Aksiyel Plan Değerlendirmeleri

Öz

Özet Amaç: Bu çalışmanın amacı, diz önü ağrısı ile başvuran hastalarda patellanın sagittal ve aksiyel düzlemdeki morfolojik ölçümleri ile ağrı düzeyi arasındaki ilişkiyi araştırmaktır. Metod : Çalışmaya anterior diz ağrısı şikayeti bulunan hastalar dahil edildi. Sagittal planda Insall-Salvati indeksi gibi ölçümler ile aksiyel düzlemde Wiberg sınıflaması gibi morfolojik parametreler değerlendirildi. Ağrı düzeyi, Görsel Analog Skala (VAS) ile ölçüldü. Patellar morfolojik ölçümler ile ağrı düzeyi arasındaki korelasyonlar istatistiksel olarak analiz edildi. Bulgular: Insall-Salvati indeksi ile patellar kalınlık ve genişlik arasında negatif yönde anlamlı korelasyon saptandı. Wiberg Tip 3 patellaya sahip hastaların VAS skorları diğer tiplere göre anlamlı düzeyde yüksek bulundu. Ayrıca, patellar kalınlık ile VAS skoru arasında negatif korelasyon bulunması, daha kalın patellaların daha düşük ağrı düzeyiyle ilişkili olabileceğini göstermektedir. Sonuç: Bu çalışmada sagittal düzlemde yapılan morfolojik ölçümlerin, aksiyel plan değerlendirmeleri ve klinik semptomlarla anlamlı ilişkili olduğu gösterilmiştir. Patella morfolojisinin sistematik değerlendirilmesi, anterior diz ağrısının tanı ve tedavi sürecine katkı sağlayabilir. Bulguların doğrulanması amacıyla ileriye dönük, dinamik görüntülemeler içeren daha kapsamlı çalışmalara ihtiyaç vardır. Anahtar Kelimeler: patella morfolojisi, diz önü ağrısı, Insall-Salvati indeksi, Wiberg sınıflaması.

Anahtar Kelimeler

• patella morfolojisi
• diz önü ağrısı
• Insall-Salvati indeksi
• Wiberg sınıflaması.

The Relationship Between Morphological Structure of the Patella and Anterior Knee Pain: Sagittal and Axial Plane Assessments

Abstract

Aim: This study aims to investigate the relationship between sagittal and axial morphological measurements of the patella and anterior knee pain in patients presenting with such complaints. Material and Methods: A cross-sectional analysis was conducted on patients experiencing anterior knee pain. Sagittal plane measurements, including the Insall-Salvati index, were obtained, alongside axial morphological assessments such as Wiberg classification. Visual Analog Scale (VAS) scores were recorded to quantify pain levels. Statistical analyses were performed to determine correlations between morphological parameters and pain intensity. Results: A significant negative correlation was found between the Insall-Salvati index and both patellar thickness and width, suggesting that higher patellar positioning is associated with smaller patellar dimensions. Additionally, patients with Wiberg Type 3 patellae exhibited significantly higher VAS scores compared to those with other morphologies, indicating a link between patellar dysplasia and increased pain. An inverse relationship was also observed between patellar thickness and VAS scores, implying that thicker patellae may be associated with reduced pain levels. Conclusion: The study demonstrates that sagittal plane measurements can provide valuable insights into axial patellar morphology and its association with anterior knee pain. The findings suggest that incorporating sagittal assessments into routine evaluations may enhance the understanding and management of patellofemoral disorders. Further research with larger sample sizes and dynamic assessments is recommended to validate these results.

Keywords

• patella morphology
• anterior knee pain
• Insall-Salvati index
• Wiberg classification.

References

1. Mason, J.J.,F Leszko, T Johnson, R D Komistek, Patellofem oral joint forces. J Biomech, 2008. 41(11): p. 2337-48.
2. Meier, M.P.,Hochrein Y.,Seitz M.T.,Roch P.J.,Jäckle K.,Hosseini A.S.A., et al., MRI analysis of the physiological pa- tellofemoral joint morphology of adult knees. Skeletal Radiol, 2025. 54(5): p. 1001-1009.
3. Bump, J.M. and L. Lewis, Patellofemoral Syndrome, in StatPearls. 2025, StatPearls Publishing Copyright © 2025, StatPearls Publishing LLC.: Treasure Island (FL).
4. van Paassen, R.,Tümer N.,Heijden R.V.D.,EijkenboomJ.F.A.,Zadpoor A.A.,Zeinstra S.M.A.B., et al., Knee alignment and patella shape are not associated with the persistence of patellofemoral pain. J isakos, 2025. 12: p. 100849.
5. Eijkenboom, J.F.A.,HeijdenR.V.D.,Kanter J.L.M.,Oei E.H.,Zeinstra S.M.A.B.,Middelkoop M.V. Patellofemoral align- ment and geometry and early signs of osteoarthritis are associated in patellofemoral pain population. Scand J Med Sci Sports, 2020. 30(5): p. 885-893.
6. Dey, P.,Callaghan M.,Cook N.,Sephton R.,Sutton C.,Hough E., et al., A questionnaire to identify patellofemoral pain in the community: an exploration of measurement properties. BMC Musculoskelet Disord, 2016. 17: p. 237.
7. Qiu, L., Li J.,Sheng B.,Yang H.,Xiao Z.,Lv F.,et al., Patellar shape is associated with femoral trochlear morphology in individuals with mature skeletal development. BMC Musculoskelet Disord, 2022. 23(1): p. 56.
8. Øye, C.R., K.J. Holen, and O.A. Foss, Mapping of the femoral trochlea in a newborn population: an ultrasonographic study. Acta Radiol, 2015. 56(2): p. 234-43.

9. Li, M.,Ji G.,Fan L.,Fan C.Y.,Lin W.,Yang G.M., et al., Assessment of Patellar Morphology in Trochlear Dysplasia on Computed Tomography Scans. Orthop Surg, 2021. 13(2): p. 458-465.
10. Huang, A.B.,Luo X.,Song C.H.,Zhang J.Y.,Yang Y.Q.,Yu Y.K., Comprehensive assessment of patellar morphology using computed tomography-based three-dimensional computer models. Knee, 2015. 22(6): p. 475-80.
11. Li, J.,Yuan M.,Qiu L.,Sheng B.,Yu F.,Yang H., et al., The SPET index is a new index for assessing the vertical position of patella. Insights Imaging, 2022. 13(1): p. 152.
12. Munch, J.L.,Sullivan J.P.,NguyenJ.T.,Mintz D.,Green D.W.,Stein B.S., et al., Patellar Articular Overlap on MRI Is a Simple Alternative to Conventional Measurements of Patellar Height. Orthop J Sports Med, 2016. 4(7): p. 2325967116656328.
13. Wang, Y., Lu J.,Wang Z.,Li Z.,Pan F.,Zhang M.,et al., The association between patella alignment and morphology and knee osteoarthritis. J Orthop Surg Res, 2024. 19(1): p. 509.
14. Kim, H.K.,Shiraj S.,Anton C.G.,Horn P.S.,Dardzinski B.J., Age and sex dependency of cartilage T2 relaxation time mapping in MRI of children and adolescents. AJR Am J Roentgenol, 2014. 202(3): p. 626-32
15. Abelleyra Lastoria, D.A.,Hutchinson K.,Tapadar T.,Ahmad S.,Smith T.,Nicolaou N. et al., Patho-morphology of patellar instability in children and adolescents: A systematic review and meta-analysis. Knee, 2024. 48: p. 166-196.
16. Ali, S.A., R. Helmer, and M.R. Terk, Patella alta: lack of correlation between patellotrochlear cartilage congruence and commonly used patellar height ratios. AJR Am J Roentgenol, 2009. 193(5): p. 1361-6.
17. Sun, Y.J.,Liu N.,Huang L.,Chen X.Y.,Li C.,Feng S., The influence of patellar morphology on clinical outcomes af- ter unicompartmental knee arthroplasty. Int Orthop, 2024. 48(12): p. 3075-3082.
18. van der Heijden, R.A.,Kanter J.L.M.,Zeinstra S.M.A.B.,Verhaar J.A.N.,Veldhoven P.L.J.V.,Krestin G.P., et al., Structural Abnormalities on Magnetic Resonance Imaging in Patients With Patellofemoral Pain: A Cross-sectional Case-Control Study. Am J Sports Med, 2016. 44(9): p. 2339-46.
19. Nguyen, J.C.,Patel V.Kiani S.N.,Guzek R.,Williams B.A.,Ganley T.J., Patellar osteochondritis dissecans: matu- ration-dependent patellofemoral joint characteristics. Pediatr Radiol, 2024. 54(6): p. 977-987.
20. Ali, K., D. Berin Tuğtağ, and Ç. Fatih, Evaluation of patellar tendon morphology in Turkish population: a cross-sectional study. Journal of health sciences and medicine (Online), 2023. 6(3): p. 650-655.