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Assessment of demographic and pathoanatomic risk factors in recurrent patellofemoral instability

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The WARPS/STAID classification employs clinical assessment of presenting features and anatomic characteristics to identify two distinct subsets of patients within the patellofemoral instability population. The purpose of this study was to further define the specific demographics and the prevalence of risky pathoanatomies in patients classified as either WARPS or STAID presenting with recurrent patellofemoral instability. A secondary purpose was to further validate the WARPS/STAID classification with the Banff Patella Instability Instrument (BPII), the Marx activity scale and the Patellar Instability Severity Score (ISS).

Methods

A convenience sample of 50 patients with recurrent patellofemoral instability, including 25 WARPS and 25 STAID subtype patients, were assessed. Clinical data were collected including assessment of demographic risk factors (sex, BMI, bilaterality of symptoms, affected limb side and age at first dislocation) and pathoanatomic risk factors (TT-TG distance, patella height, patellar tilt, grade of trochlear dysplasia, Beighton score and rotational abnormalities of the tibia or femur). Patients completed the BPII and the Marx activity scale. The ISS was calculated from the clinical assessment data. Patients were stratified into the WARPS or STAID subtypes for comparative analysis. An independent t test was used to compare demographics, the pathoanatomic risk factors and subjective measures between the groups. Convergent validity was tested with a Pearson r correlation coefficient between the WARPS/STAID and ISS scores.

Results

Demographic risk factors statistically associated with a WARPS subtype included female sex, age at first dislocation and bilaterality. Pathoanatomic risk factors statistically associated with a WARPS subtype included trochlear dysplasia, TT-TG distance, generalized ligamentous laxity, patellar tilt and rotational abnormalities. The independent t test revealed a significant difference between the ISS scores: WARPS subtype (M = 4.4, SD = 1.1) and STAID subtype (M = 2.5, SD = 1.5); t(48) = 5.2, p < 0.001. The relationship between the WARPS/STAID and the ISS scores, measured using a Pearson r correlation coefficient, demonstrated a strong relationship: r = −0.61, n = 50, p < 0.001.

Conclusions

This study has demonstrated statistically significant evidence that certain demographics and pathoanatomies are more prevalent in each of the WARPS and STAID patellofemoral instability subtypes. There was no difference in quality-of-life or activity level between the subtypes. The WARPS/STAID score demonstrated convergent validity to the ISS and divergent validity to the BPII score and the Marx activity scale. This study has further validated both the WARPS/STAID classification and the ISS of patients that present with recurrent patellofemoral instability.

Level of evidence

III.

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Authors and Affiliations

  1. Banff Sport Medicine, PO Box 1300, Banff, AB, T1L 1B3, Canada

    Laurie Anne Hiemstra & Sarah Kerslake

  2. Department of Surgery, University of Calgary, Calgary, Canada

    Laurie Anne Hiemstra

  3. Department of Health and Physical Education, Mount Royal University, Calgary, Canada

    Mark Lafave

  4. Department of Physical Therapy, University of Alberta, Edmonton, Canada

    Sarah Kerslake

Authors
  1. Laurie Anne Hiemstra
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  2. Sarah Kerslake
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  3. Mark Lafave
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Correspondence to Laurie Anne Hiemstra.

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No conflict of interest, financial or other, exist.

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There was no funding sought or received for this study. All authors listed have contributed sufficiently to the project to be included as authors, and all those who are qualified to be authors are listed.

Ethical approval

This study was approved by the University of Calgary Conjoint Health Research Ethics Board and the Child Health Research Office (Ethics ID 24393).

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Informed consent was obtained from all patients.

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Hiemstra, L.A., Kerslake, S. & Lafave, M. Assessment of demographic and pathoanatomic risk factors in recurrent patellofemoral instability. Knee Surg Sports Traumatol Arthrosc 25, 3849–3855 (2017). https://doi.org/10.1007/s00167-016-4346-0

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  • DOI: https://doi.org/10.1007/s00167-016-4346-0

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