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Patellar Height Ratios

A Comparison of Four Measurement Methods

Department of Orthopaedic Surgery, University of South Carolina School of Medicine, Columbia, South Carolina

Steven L. Mason, MD

Department of Orthopaedic Surgery, University of South Carolina School of Medicine, Columbia, South Carolina

Michael J. Lucas, MD

Department of Orthopaedic Surgery, University of South Carolina School of Medicine, Columbia, South Carolina

Three blinded observers on three separate occasions calculated four commonly employed patellar height ra tios on the knees of 15 patients who had three lateral radiographs each. The observers used the same mea surement instrument, a hand-held goniometer ruler, to determine the relative reliability of each patellar height ratio. The measurements by the three observers were examined, and the error and reliability of the four meth ods of measurement were tested statistically. Among the four methods of measuring patellar height that we studied, the Blackburne-Peel method most consis tently reproduced the patellar height index. Interob server measurement error averaged 0.06 for all ratios. Values greater than 0.06 represented real patellar height changes. The ratios were not significantly af fected by the change of knee flexion angle from 30° to 50°. Side-to-side patellar height measurement differ ences averaged 0.16, which suggests that the healthy contralateral limb is not reliable as a control. Mild ar thritic changes decreased variability of measurements by an average of 24% because small osteophytes better defined the articular margins of the patella.

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