Radiological evaluation of the normal patella position using the Insall-Salvati ratio
DOI:
https://doi.org/10.15584/ejcem.2025.2.24Keywords:
alta, baja, height, insall-salvati ratio, length, patellaAbstract
Introduction and aim. Normal patellofemoral relationship relies on the patella’s location which is vital in the knee’s stability and biomechanics. This research aimed to determine the normal Insall Salvati Ratio (ISR) and the cut-off values that will be useful for diagnosing patella alta and baja in Delta State in Nigeria.
Material and methods. This retrospective cross-sectional study assessed the Insall-Salvati Ratio by dividing the patella tendon length by the patella length. These lengths were measured on lateral knee radiographs of 300 patients (149 males, 151 females) aged 20 years and older using digital calipers calibrated in cm.
Results. With exception to the ISR, the measured variables showed sexual dimorphism and a significant weak negative association with age (p<0.05). Based on the international ISR cut-off values (<0.8 and >1.2), the prevalence of patella baja and alta was 15 (5%) and 64 (21.3%) respectively using the calculated cut-off values (<0.73 and >1.41). A lower prevalence of 6 (2%) and 9 (3%) were recorded correspondingly.
Conclusion. The normal ISR cut-offs provided by this study will aid radiologists and orthopedic specialists in Delta State, Nigeria to precisely diagnose patella alta and baja and ensure proper restoration of the knee’s stability and biomechanics as well as minimizing complications.
Downloads
References
Tunali O, Valiyev N, Karaytug K. Is abnormal patella height a predisposing factor for isolated meniscal tears? J Ist Faculty Med. 2022;85(3):326-331. doi: 10.26650/iuitfd.1102322
Althani S, Shahi A, Tan TL, Al-Belooshi A. Position of the Patella among Emirati Adult Knees. Is Insall-Salvati Ratio Applicable to Middle-Easterners? Arch Bone Jt Surg. 2016;4(2):137-140. doi: 10.22038/abjs.2016.5477
Di TL, Ngoc TH, Ngo DH, et al. Evaluation of the Insall-Salvati Ratio Among the Vietnamese Population: Application for Diagnosis of Patellar Malalignment. Orthopedic Research and Reviews. 2021;13:57-61. doi: 10.2147/ORR.S306316
Rhatomy S, Silalahi K, Putra A, Kresonni N. Characteristics of Patellofemoral Measurement in Indonesian Population Using Magnetic Resonance Imaging. Open Access Maced J Med Sci. 2021;10;9(A):47-51. doi: 10.3889/oamjms.2021.5602
Udoaka AI, Bienonwu EO. Assessment of the Patellar Height Ratios in Normal Adult Nigerians. Asian Journal of Biomedical and Pharmaceutical Sciences. 2013;3(19):1-3. doi: 10.15272/ajbps.v3i19.201
Lum ZC,Said AM, Pereira GC, Meehan JP. Patella Baja in Total Knee Arthroplasty. J Am Acad Orthop Surg. 2020;28:316-323. doi: 10.5435/jaaos-d-19-00422
Eijkenboom JFA, van der Heijden RA, de Kanter JLM, Oei EH, Bierma-Zeinstra SMA, van Middelkoop M. Patellofemoral alignment and geometry and early signs of osteoarthritis are associated in patellofemoral pain population.
Scand J Med Sci Sports. 2020;30:885-893. doi: 10.1111/sms.13641
Kumar AC, Ram GG. Measurement of Insall Salvati ratio and modified Insall Salvati ratio to assess the position of the patella in South Indian population. Int J Res Orthop. 2017;3:23-25. doi: 10.18203/issn.2455-4510.intjresorthop20164503
Djuricic G, Milanovic F, Ducic S, et al. Morphometric Parameters and MRI Morphological Changes of the Knee and Patella in Physically Active Adolescents. Medicina. 2023;59:213. doi: 10.3390/medicina59020213
Konrads C, Schreiner AJ, Cober SS, Schüll D, Ahmad S, Alshrouf MA Evaluation of patella height in native knees and arthroplasty: an instructional review. SICOT-J. 2022;8:36. doi: 10.1051/sicotj/2022037
Biedert RM, Tscholl PM. Patella Alta: A Comprehensive Review of Current Knowledge. Am J Orthop. 2017;46(6):290-300.
Adleberg J, Benitez CL, Primiano N, et al. Fully automated measurement of the Insall-Salvati Ratio with Artificial Intelligence. J Imaging Inform Med. 2024;37(2):601-610. doi: 10.1007/s10278-023-00955-1
Capkin S, Guler S, Sezgin EA. Comparison of five patellar height measurement methods in a Turkish adult cohort.
Ann Med Res. 2021;27(6):1549-1553. doi: 10.5455/annalsmedres.2020.05.425
Insall J, Salvati E. Patella position in the normal knee joint. Radiology. 1971;101(1):101-104. doi: 10.1148/101.1.101
Wambua B, Kitsteen A, Kevin O, James K, Beda O. Gender difference in the modified Insall-Salvati ratio in a black Kenyan population. Anatomy Journal of Africa. 2016;5(1): 686-692.
Lu W, Yang J, Chen S, Zhu Y, Zhu C. Abnormal Patella Height Based on Insall-Salvati Ratio and its Correlation with Patellar Cartilage Lesions: An Extremity-Dedicated Low-Field Magnetic Resonance Imaging Analysis of 1703 Chinese Cases. Scandinavian Journal of Surgery. 2016;105(3):197-203. doi: 10.1177/1457496915607409
Upadhyay S, Raza HK, Srivastava P. Position of the patella in adults in central India: evaluation of the Insall-Salvati ratio. J Orthop Surg. 2013;21(1):23-27. doi: 10.1177/230949901302100108
Degnan AJ, Maldjian C, Adam RJ, Fu FH, Domenica MD. Comparison of Insall-Salvati Ratios in Children with an Acute Anterior Cruciate Ligament Tear and a Matched Control Population. AJR. 2015;204:161-166. doi: 10.2214/ajr.13.12435
Ominde BS, Enakpoya P, Ogheneyoma E, Igbigbi PS. Retrospective study on the radiographic wrist indices in a Nigerian population. Online Journal of Health and Allied Sciences. 2022;21(2):12.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 European Journal of Clinical and Experimental Medicine
This work is licensed under a Creative Commons Attribution 4.0 International License.
Our open access policy is in accordance with the Budapest Open Access Initiative (BOAI) definition: this means that articles have free availability on the public Internet, permitting any users to read, download, copy, distribute, print, search, or link to the full texts of these articles, crawl them for indexing, pass them as data to software, or use them for any other lawful purpose, without financial, legal, or technical barriers other than those inseparable from having access to the Internet itself.
All articles are published with free open access under the CC-BY Creative Commons attribution license (the current version is CC-BY, version 4.0). If you submit your paper for publication by the Eur J Clin Exp Med, you agree to have the CC-BY license applied to your work. Under this Open Access license, you, as the author, agree that anyone may download and read the paper for free. In addition, the article may be reused and quoted provided that the original published version is cited. This facilitates freedom in re-use and also ensures that Eur J Clin Exp Med content can be mined without barriers for the research needs.
