Objective To identify related anatomical parameters and the strongest risk predictor leading to patients with recurrent patellar instability.Methods 52 young patients with recurrent patellar instability that failed of conservative treatment were retrospec-tively evaluated by MRI.Measurements included parameters of patellar tracking,which was characterized by bisect offset index (BSO),trochlear congruence angle (CA)and patellar lateral tilt (PTA),and anatomical parameters of patellofemoral joint,which were characterized by the sulcus angle (SA),lateral trochlear inclination (LTI),trochlear facet asymmetry,trochlear depth,Insall-Salvati Ratio (ISR),Caton-Deschamps index (C-D)and tibial tuberosity-trochlear groove (TT-TG)distance.The collection data were analyzed including the Pearson's correlation and multiple stepwise regression analysis.Results The patellofemoral joint ma-lalignment was significantly correlated with LTI,TT-TG distance and ISR,but not or partly with the trochlear depth,SA,trochlear facet asymmetry and C-D.Linear regression models including LTI,TT-TG distance and ISR explained 0.58,0.47 and 0.43 of the va-riance in BSO,CA and PTA,respectively (P<0.001).And the standardized beta coefficient was largest for LTI,then were TT-TG distance and ISR.Conclusion At full extension of the knee,anatomical related factors measured on MRI explain some degree of re-current lateral patella shift and tilt,the strongest predictor among anatomical related factors that could lead to maltracking is LTI, and then are TT-TG distance and ISR.

Objective:To assess the value of cerebral small vessel disease (CSVD) burden in predicting prognosis in acute ischemic stroke (AIS) patients with anterior circulation large vessel occlusion (LVO) after endovascular therapy (EVT).Methods:The study was a cross-sectional study. A total of 242 patients with AIS due to anterior circulation LVO received EVT in the First Affiliated Hospital of Nanjing Medical University from February 2018 to September 2022. The clinical and imaging data of all patients were analyzed retrospectively. On follow-up MRI within 7 days after EVT, CSVD features [white matter hyperintensity (WMH), lacune, perivascular space, cerebral microbleed, cerebral atrophy] and CSVD burden score (0-5) was evaluated. Modified Rankin scale (mRS) score at 90 days after EVT was assessed. Patients were categorized into a mild burden group (0-1 points) and a moderate-severe burden group (2-5 points) based on CSVD burden score. Meanwhile, patients were categorized into a good prognosis group (0-2 points) and a bad prognosis group (3-6 points) based on mRS score at 90 days after EVT. Mann-Whitney U test and χ2 test were used to compare the difference of clinical and imaging indexes between the 2 groups, and variables with P<0.1 in the univariate analysis were included in the multifactorial logistic regression to screen for independent factors to predict the prognosis. Results:There were 169 patients in the good prognosis group and 73 patients in the bad prognosis group out of 242 patients. Compared with the good prognosis group, age, incidence of hyperlipidemia, baseline National Institutes of Health Stroke Scale (NIHSS) scores, incidence of hemorrhagic conversion, CSVD burden scores, incidence of periventricular WMH scores of 3 and/or deep WMH scores≥2, and incidence of moderate-severe cerebral atrophy of patients in the bad prognosis group were higher, and the incidence of complete recanalization was lower (all P<0.05). Multivariate analysis showed hyperlipemia ( OR=8.438, 95% CI 1.691-42.119, P=0.009), baseline NIHSS score ( OR=1.103, 95% CI 1.047-1.162, P<0.001), complete recanalization ( OR=0.131, 95% CI 0.038-0.454, P=0.001) and hemorrhage transformation ( OR=1.952, 95% CI 1.031-3.697, P=0.040) were independent factors for the prognosis of EVT in patients with LVO AIS. There were 157 cases in the mild burden group and 85 cases in the moderate-severe burden group. The 90-day mRS score was higher in the moderate-severe burden group compared with the mild burden group ( Z=-2.24, P=0.025). Conclusion:CSVD burden has some clinical implications in predicting the prognosis of EVT in patients with anterior circulation LVO AIS.