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Fürmetz, J.; Daniel, T.; Sass, J.; Bergsträßer, M.; Degen, N.; Suero, E.; Ahrens, P.; Keppler, A. M.; Böcker, W.; Thaller, P. H. and Prall, W. C. (2021): Three-dimensional assessment of patellofemoral anatomy: Reliability and reference ranges. In: Knee, Vol. 29: pp. 271-279

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Background: Three-dimensional (3D) imaging and analysis offer new possibilities in preoperative diagnostics and surgical planning. Simultaneous 3D analysis of the joint angles and the patellofemoral anatomy allow for a realistic assessment of bony pathologies in patients with patellofemoral complaints. This study aims to develop a standardized and validated assessment of the 3D patellofemoral morphology and to establish reference ranges. Methods: Thirteen patellofemoral anatomic landmarks were defined on 3D bone models of the lower limbs based on computer tomography data and evaluated regarding inter-and intra-observer variability. Further, 60 3D models of the lower limbs of young subjects without any previous knee operation/injury were assessed and rescaled reference values for relevant patellofemoral indices were obtained. Results: The mean inter-and intra-observer deviation of all landmarks was below 2.3 mm. The interobserver intraclass correlation coefficient (ICC) was between 0.8 and 1.0 and the intra-observer ICC between 0.68 and 0.99 for all patellofemoral parameters. The calculated reference ranges are: Insall-Salvati index 1.0-1.4;patella tilt 6-18 degrees;patella shift-4 to 3 mm;patella facet angle 118-131 degrees;sulcus angle 141-156 degrees;trochlear depth 3-6 mm;tibial-tuberosity to trochlear groove distance (TT-TG) 2D 14-21 mm;TT-TG 3D 11-18 mm;lateral trochlear inclination 13-23 degrees;trochlear facet angle 43-65 degrees. Conclusion: The demonstrated 3D analysis of the patellofemoral anatomy can be performed with high inter-and intra-observer correlation. Applying the obtained reference ranges and using existing 3D assessment tools for lower limb alignment, a preoperative 3D analysis and planning for complex knee procedures now is possible. (c) 2021 Elsevier B.V. All rights reserved.

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