ArticleKnee surgery, sports traumatology, arthroscopy : official journal of the ESSKA2020
Patellar height measurements: Insall-Salvati ratio is most reliable method.
Article in Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 97 papers, 2 of them syntheses that pooled it.
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Who cites it
97 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Tension band wiring versus suture anchoring for inferior pole patellar fractures: a systematic review and meta-analysis.Journal of orthopaedic surgery and research · 2026Pooled it
- Assessment of the reliability and validity of imaging measurements for patellofemoral instability: an updated systematic review.Skeletal radiology · 2022Pooled it
- Change in patellar height in medial and lateral unicompartmental knee arthroplasty: a clinical trial.Archives of orthopaedic and trauma surgery · 2024Trial
- Lower patella-patellar tendon angle is associated with increased odds of patellofemoral osteoarthritis progression in ACL revision patients: A case control study.Journal of experimental orthopaedics · 2026Article
- Radiographic Changes in Patellar Height Following Rapid Weight Loss After Sleeve Gastrectomy: A Retrospective Observational Study.Journal of clinical medicine · 2026Article
- Modified Multi-Strand Nice Knot Suture Construct Combined with Suture Anchor Fixation Versus Conventional Kirschner Wire Tension Band Fixation for Inferior Patellar Pole Fractures: A Retrospective Comparative Study.Journal of clinical medicine · 2026Article
- Long-term functional and radiologic outcomes following MPFL reconstruction: a 10-year retrospective study.Musculoskeletal surgery · 2026Article
- Patella Alta on X-Ray and MRI: Diagnostic Agreement and Clinical Correlations.Diagnostics (Basel, Switzerland) · 2026Article
- Radiological assessment of patellar instability: comparative analysis of patients with and without instability and the impact of patellar stabilisation surgery.Skeletal radiology · 2026Article
- Insall-Salvati Ratio and Femoral Cartilage Thickness: Ultrasonographic and Clinical Evaluation in Knee Osteoarthritis.Archives of rheumatology · 2026Article
- Relationship of Baseline Physical Activity and Morphologic Factors in Patients With Lateral Patellar Instability.Orthopaedic journal of sports medicine · 2026Article
- Quadriceps tendon autograft with patellar bone block and semitendinosus augmentation demonstrates predictable midterm outcomes for patellar tendon disruption following primary total knee arthroplasty.Journal of experimental orthopaedics · 2026Article
- Differential effects of knee flexion on Caton-Deschamps, patellotrochlear and Insall-Salvati indices: A dynamic magnetic resonance imaging-controlled study.Journal of experimental orthopaedics · 2026Article
- Associations Between Coronal Alignment, Patellar Height, Chondrocalcinosis and Radiographic Severity of Knee Osteoarthritis in a Single-Center Cross-Sectional Clinical Cohort.Medicina (Kaunas, Lithuania) · 2026Article
- Comparison of clinical outcomes between cruciate-retaining and posterior-stabilized total knee arthroplasty in patients with mild to moderate patellofemoral joint osteoarthritis.Frontiers in surgery · 2026Article
- Bilateral Trochleoplasty Procedures Following Bilateral Femoral Rotational Osteotomies for Bilateral Dejour Type D Trochlear Dysplasia.Ochsner journal · 2026Article
- Alteration of Insall-Salvati ratio is associated with complications following fixation of patella fractures.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2025Article
- A modified minimally invasive subvastus approach shows superior early postoperative clinical outcomes compared to the medial parapatellar approach in total knee arthroplasty for osteoarthritis patients: a comparative study.BMC musculoskeletal disorders · 2025Article
- Automatic measurement of Caton index on knee X-ray images using a key point detection model.European journal of radiology open · 2025Article
- A study on the diagnostic value of knee MRI parameters for lateral patellar compression syndrome: clinical application of P-PTA, LP and ISR.Quantitative imaging in medicine and surgery · 2025Article
37 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposePatella alta is a risk factor for patellofemoral pain and instability. Several measurement methods and imaging modalities are in use to measure patellar height. The first aim of this study was to determine the intra- and interrater reliability of different patellar height measurement methods on conventional radiography (CR), CT and MRI. The second aim was to examine the applicability of patellar height measurement methods originally designed for CR on CT and MRI.
methodsForty-eight patients who were treated for patellar instability were included. All patients had undergone a pre-operative conventional radiograph, CT scan and MRI. Five methods for measuring patellar height were performed on radiographs, CT and MRI by four observers. For each measurement, the intra- and interrater reliability was determined by calculating the intra-class correlation coefficient (ICC). A Bland-Altman analysis was performed for measurements with an ICC ≥ 0.70.
resultsThe Insall-Salvati (IS) ratio was the only measurement that showed good intra- and inter-observer reliability on CR, CT and MRI. The intra- and inter-observer reliability of the patellotrochlear index (PTI) for MRI was good to excellent for all observers. The IS ratio showed a moderate to good reliability for comparison of all three imaging modalities with the best agreement between radiography and MRI. The other patellar height measurements showed only poor to moderate inter-method agreement.
conclusionIn this study, the Insall-Salvati ratio shows better intra- and inter-observer reliability than the Blackburne-Peel ratio, the Caton-Deschamps ratio and the modified Insall-Salvati ratio on all imaging modalities. Radiography and CT seem to have better reliability than MRI. The patellotrochlear index, however, shows good inter- and intra-observer reliability on MRI. Only for the IS method was there acceptable agreement between CR and MRI. This means that the established Insall-Salvati normal values could be used for MRI as well. This study shows that the most reliable method to measure patella height is the Insall-Salvati ratio measured on conventional radiographs or the patellotrochlear index on MRI. LEVEL OF EVIDENCE: Level II diagnostic.
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