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Dear editor, We were interested in reading ‘Femoropatellar radiographic alterations in cases of anterior cruciate ligament failure’ by de Vasconcelos D. P. et al.1 published in the esteemed Revista Brasileira de Ortopedia journal on the year 2015. doi:10.1016/j.rboe.2015.01.005. The objective of the study was to assess the femoropatellar radiographic alterations in 30 patients with anterior cruciate ligament (ACL) failure using three parameters. The authors selected 30 volunteer patients with unilateral isolated ACL tear of> 1duration for the study and compared themwithnormal contralateral knees.1Thepatellarheightwas studied using the Caton-Deshchamps ratio, whereas the patellar tilt and translationwereassessedby lateral inclinationangle and congruence angle, respectively. Although the inclusion criteria states that knees with single ACL tear were included, no mention was made of the medial patellofemoral ligament integrity throughout the text. In fact, themedial patellofemoral ligament deficiency predisposes abnormal patellofemoral alignment.2,3 The exclusion criteria should also have included patellar dislocation as one of its criteria as it can influence the objective of the study. Furthermore, the study employs the paired t-test as the statistical tool tofindout significanceof thevariables.Although the sample size used is 30, which is the minimum needed for the paired t-test, the authors in the textmention that inversion of lateral inclinationwas seen in only 2 knees (2.2°and 4.8°), which substantially makes them outliers in the sample. Outliers in a sample make the assessment of paired t-test improbable, since it is done on basis of normal distribution. The Mann-Whitney test would have been better. Finally, nomention regarding the intraand interobserver coefficient wasmade in the study. It would have been ideal to have the above two parameters, which would increase the strength of the study. To conclude, the statistical analysis performed in the study needs to be verified and the exclusion criteria should also have included knees with medial patellofemoral ligament deficiency and history of patellar dislocation.

Carta ao editor: Alterações Radiográficas Femoropatelares na insuficiência do Ligamento Cruzado Anterior. Rev Bras Ortop 2015;50(1):43–49