Next speaker, Dr. Lutu Ferro, will talk about patella dislocation in adolescent patients. Influence on patellofemoral and tibiofemoral cartilage based on T1 row relaxation times. So this is not my talk, so while we wait to get my talk up, thanks to the AOSSM and NISCCOS for having me. Thanks to our moderators as well as our course directors. My talk is actually, we're speaking about T1 row in adolescent patient status post-dislocation. So this was brought to us in part by grants from the DOD as well as the OREF, and certainly There we go, excellent. So thanks to my co-authors. These are our disclosures. So patellar instability is quite common. We know that patients who have patellar dislocations have an increased risk of patellofemoral osteoarthritis following dislocation. That has been seen as high as 8 times. In adolescent, less than 18 years old, 4 times the risk of subsequent patellofemoral OA after an index dislocation. And for patients who have multiple dislocations, the risk of OA is 4.5 times compared to those who have not dislocated. And so we wanted to look at early cartilage degradation following index and multiple dislocators in a population. This is a patient who had an NPFL reconstruction by one of my partners when she was a teenager. She had bilateral patellar instability. One side was not fixed, and she saw me in her early 30s. And this is what her unfixed patella looked like at that time. So she had developed patellofemoral OA and subsequently went on to have a knee arthroplasty when she was in her 30s. And so certainly knowing what happens to this cartilage is of utmost importance. We know that proteoglycans are an indicator of cartilage health. And when we're talking about T1 row relaxation time, there's an inverse relationship. So high T1 row means low proteoglycans, which means poor cartilage health. Vice versa, low T1 row relaxation times means high proteoglycans and healthy cartilage. And so just kind of keep that in mind as we move forward with the presentation. The purpose of this study, we wanted to compare post-dislocation T1 row relaxation times and first-time dislocators, people who have dislocated multiple times, and then healthy adolescent controls. Our hypothesis was that T1 row relaxation times will be elevated throughout the patellofemoral articular cartilage after an acute dislocation. And then these would be higher for patients who have undergone multiple dislocations. This is an IRB-approved study. And we looked at unilateral patellofemoral dislocations, so just one-sided dislocations. In our cohort, 13 were first-time dislocators, 10 were multiple dislocators, and then we had 10 healthy controls. And there was no significant difference with respect to the demographics in our population. These were all done on 3T MRI scan with knee coil. T1 relaxation times were mapped to a chondrosurfaces using AI-based technology. Lateral, medial, central patella, and trochlear groove were the regions in the patellofemoral joint. But we also looked at the condyles on both the femur and the tibia for these patients. So average T1 row values were quantified within each region. Statistical analysis was undergone to compare the three groups with ANOVA, Student, Newman, and Croyle's post-hoc analysis, and a p-value less than 0.5 was set for significance. So T1 row relaxation times, as suspected, are higher for single and multiple dislocators. And we can see that here. And the magnitude in the patellofemoral joint was a difference of 20, which was high. And then in the other areas, such as the lateral tibia, it was somewhat lower. The difference was 10. So the greatest magnitude in the patellofemoral joint. As we explain this, we understand that the impact injury from the medial patella is the primary contributor to early cartilage degradation. And then early additional dislocation did not further increase T1 row relaxation times. And recurring dislocations may be less traumatic. So as we saw in the last presentation, as you sort of disrupt these soft tissue restraints, there may be less violence to subsequent dislocations. Could this also be related to the inflammatory response that occurs following dislocation? This may be related to pathologic anatomy, as we know patients who have patellar instability are more likely to be in valgus. And that may explain the higher values in the lateral compartment. And these things may play a larger role in OA other than just the repeated impact injuries. So in conclusion, early articular cartilage degradation could initiate the progression of OA following patellar dislocation. In the acute phase, similar in both single as well as multiple dislocators. The long-term effects may be worse for multiple dislocations, but we need to evaluate this in a long-term fashion. Thank you.

patella dislocation

adolescent patients

cartilage

T1 row relaxation times

patellofemoral osteoarthritis