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Wilson LAB, Lynch JT, Ménard JM, Galvin CR, Smith PN. Sex differences in patellar facet shape among healthy and osteoarthritic cohorts. Osteoarthritis Cartilage 2024:S1063-4584(24)01272-X. [PMID: 38986836 DOI: 10.1016/j.joca.2024.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 05/18/2024] [Accepted: 06/29/2024] [Indexed: 07/12/2024]
Abstract
OBJECTIVE Patellofemoral osteoarthritis (OA) may be more common in females than males. Reasons for this are not fully understood, but sex differences in patellar morphology may help explain this phenomenon. We quantified differences in patellar morphology between males and females in healthy and patellofemoral OA populations. DESIGN A total of 97 (50F, 47M) healthy and 67 (40F, 27M) OA knees were scanned via computed tomography. OA individuals were on a waitlist for total knee replacement. Patella 3D models were segmented and 2D measurements were recorded: patellar width and height, lateral and medial facet width, and surface area. Medial and lateral facet surface topography was mapped using 81 points to describe 3D articular surface shape. Sex and group differences were assessed using Procrustes analysis of variance (ANOVA). Data were ordinated using Principal Component Analysis. RESULTS Differences in patellar 2D measurements between healthy and OA individuals were smaller than were differences between males and females from healthy and OA groups. Sex and healthy/OA differences were most pronounced for medial facet shape, which featured a posteriorly-curving facet and taller, narrower facet shape in males compared to females. Lateral facet shape variance was higher in OA cohorts compared to healthy groups. CONCLUSIONS Medial and lateral facet shapes showed different patterning of variation by sex and healthy/OA status. Lateral facet shape may be of interest in future models of OA risk in the patellofemoral joint, here showing increased magnitudes of variance associated with increased severity of disease (patellofemoral Kellgren and Lawrence score).
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Affiliation(s)
- Laura A B Wilson
- School of Archaeology and Anthropology, The Australian National University, Canberra, ACT 2601, Australia; School of Biological, Earth and Environmental Sciences, UNSW Sydney, Sydney, NSW 2052, Australia; ARC Training Centre for M3D Innovation, The Australian National University, Canberra, ACT 2601, Australia.
| | - Joseph T Lynch
- School of Medicine, The Australian National University, Canberra, ACT 2601, Australia; Trauma and Orthopaedic Research Unit, The Canberra Hospital, Canberra, ACT 2606, Australia
| | - Jo M Ménard
- School of Archaeology and Anthropology, The Australian National University, Canberra, ACT 2601, Australia
| | - Catherine R Galvin
- School of Engineering, The Australian National University, Canberra, ACT 2601, Australia
| | - Paul N Smith
- School of Medicine, The Australian National University, Canberra, ACT 2601, Australia; Trauma and Orthopaedic Research Unit, The Canberra Hospital, Canberra, ACT 2606, Australia
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Vidhani FR, Woo JJ, Zhang YB, Olsen RJ, Ramkumar PN. Automating Linear and Angular Measurements for the Hip and Knee After Computed Tomography: Validation of a Three-Stage Deep Learning and Computer Vision-Based Pipeline for Pathoanatomic Assessment. Arthroplast Today 2024; 27:101394. [PMID: 39071819 PMCID: PMC11282415 DOI: 10.1016/j.artd.2024.101394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/17/2024] [Accepted: 04/01/2024] [Indexed: 07/30/2024] Open
Abstract
Background Variability in the bony morphology of pathologic hips/knees is a challenge in automating preoperative computed tomography (CT) scan measurements. With the increasing prevalence of CT for advanced preoperative planning, processing this data represents a critical bottleneck in presurgical planning, research, and development. The purpose of this study was to demonstrate a reproducible and scalable methodology for analyzing CT-based anatomy to process hip and knee anatomy for perioperative planning and execution. Methods One hundred patients with preoperative CT scans undergoing total knee arthroplasty for osteoarthritis were processed. A two-step deep learning pipeline of classification and segmentation models was developed that identifies landmark images and then generates contour representations. We utilized an open-source computer vision library to compute measurements. Classification models were assessed by accuracy, precision, and recall. Segmentation models were evaluated using dice and mean Intersection over Union (IOU) metrics. Contour measurements were compared against manual measurements to validate posterior condylar axis angle, sulcus angle, trochlear groove-tibial tuberosity distance, acetabular anteversion, and femoral version. Results Classifiers identified landmark images with accuracy of 0.91 and 0.88 for hip and knee models, respectively. Segmentation models demonstrated mean IOU scores above 0.95 with the highest dice coefficient of 0.957 [0.954-0.961] (UNet3+) and the highest mean IOU of 0.965 [0.961-0.969] (Attention U-Net). There were no statistically significant differences for the measurements taken automatically vs manually (P > 0.05). Average time for the pipeline to preprocess (48.65 +/- 4.41 sec), classify/retrieve landmark images (8.36 +/- 3.40 sec), segment images (<1 sec), and obtain measurements was 2.58 (+/- 1.92) minutes. Conclusions A fully automated three-stage deep learning and computer vision-based pipeline of classification and segmentation models accurately localized, segmented, and measured landmark hip and knee images for patients undergoing total knee arthroplasty. Incorporation of clinical parameters, like patient-reported outcome measures and instability risk, will be important considerations alongside anatomic parameters.
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Affiliation(s)
- Faizaan R. Vidhani
- Brown University/The Warren Alpert School of Brown University, Providence, RI, USA
| | - Joshua J. Woo
- Brown University/The Warren Alpert School of Brown University, Providence, RI, USA
| | - Yibin B. Zhang
- Harvard Medical School/Brigham and Women’s, Boston, MA, USA
| | - Reena J. Olsen
- Sports Medicine Institute, Hospital for Special Surgery, New York, NY, USA
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Sheehan FT, Shah P, Boden BP. The Importance of Medial Patellar Shape as a Risk Factor for Recurrent Patellar Dislocation in Adults. Am J Sports Med 2024; 52:1282-1291. [PMID: 38557261 DOI: 10.1177/03635465241233732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
BACKGROUND Research on the cause of lateral patellar dislocation (LPD) has focused on trochlear morphologic parameters, joint alignment, and patellofemoral soft tissue forces. A paucity of information is available regarding how patellar morphologic parameters influence the risk for LPD. PURPOSE/HYPOTHESIS The purpose was to assess whether patellar morphology is a risk factor for recurrent LPD. It was hypothesized that (1) patients with recurrent LPD would have decreased patellar width and volume and (2) patellar morphologic parameters would accurately discriminate patients with recurrent LPD from controls. STUDY DESIGN Cohort study (diagnosis); Level of evidence, 3. METHODS A total of 21 adults with recurrent LPD (age, 29.7 ± 11.1 years; height, 170.8 ± 9.9 cm; weight, 76.1 ± 17.5 kg; 57% female) were compared with 21 sex- and height-matched controls (age, 27.2 ± 6.7 years; height, 172.0 ± 10.6 cm; weight, 71.1 ± 12.8 kg; 57% female). Three-dimensional axial fat-saturated magnetic resonance imaging scans were used to measure patellar medial, lateral, and total width; patellar volume; patellar medial and lateral facet length; the Wiberg index; and previously validated knee joint alignment and femoral shape measurements (eg, tibial tuberosity to trochlear groove distance, trochlear dysplasia). RESULTS The LPD group demonstrated reduced medial patellar width (Δ = -3.6 mm; P < .001) and medial facet length (Δ = -3.7 mm; P < .001) but no change in lateral width or facet length. This resulted in decreased total patellar width (Δ = -3.2 mm; P = .009), decreased patellar volume (Δ = -0.3 cm3; P = .025), and an increased Wiberg index (Δ = 0.05; P < .001). No significant differences were found for all other patellar shape measures between cohorts. Medial patellar width was the strongest single discriminator (83.3% accuracy) for recurrent LPD. Combining medial patellar width, patellofemoral tilt, and trochlear groove length increased the discrimination to 92.9%. CONCLUSION The medial patellar width was significantly smaller in patients with recurrent LPD and was the single most accurate discriminator for recurrent LPD, even compared with traditional trochlear shape and joint alignment measures (eg, trochlear dysplasia, patella alta). Therefore, medial patellar morphology should be assessed in patients with LPD as a risk factor for recurrence and a potential means to improve treatment.
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Affiliation(s)
- Frances T Sheehan
- Department of Rehabilitation Medicine, National Institutes of Health, Bethesda, Maryland, USA
| | - Paras Shah
- Department of Rehabilitation Medicine, National Institutes of Health, Bethesda, Maryland, USA
| | - Barry P Boden
- The Orthopaedic Center, a Division of CAO, Rockville, Maryland, USA
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Banach A, Hata N, Crawford R, Piontek T. Supratrochlear Rim is Correlated with Isolated Patellar Chondromalacia on Magnetic Resonance Imaging of the Knee. Arthrosc Sports Med Rehabil 2024; 6:100855. [PMID: 38328532 PMCID: PMC10847026 DOI: 10.1016/j.asmr.2023.100855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 11/22/2023] [Indexed: 02/09/2024] Open
Abstract
Purpose To investigate the relationship between the supratrochlear rim and isolated patellar chondromalacia (PC) using magnetic resonance imaging (MRI) scans of the knee. Methods Patients without patellofemoral pain (control group) and patients with patellofemoral pain and diagnosed with stage III or IV PC based on MRI (defect group) were retrospectively identified. Patients with a history of patellar subluxation were excluded. We used patient MRI scans to perform 20 anatomical measurements of the patellofemoral joint. We also performed 2 measurements of the anterior femoral curvature. A total of 30 patients (29 ± 8.7 years) were in the control group, and 20 patients were in the defect group (29.4 ± 9.7 years). Results The maximum curvature (P < .001) and mean curvature (P < .001) of the anterior femoral condyle were found statistically significantly different between the groups. Patellotrochlear index (P = .03) and Insall-Salvati index (P < .001) were also found statistically significantly different between the 2 groups. Patella type III and trochlear dysplasia grade B were found more common in the defect group. Conclusions In this Level III prognostic, case-control study, we have shown through MRI knee measurements that the isolated patellar chondromalacia in patients without a history of patellar subluxation and dislocation is correlated with the increased anterior femoral curvature in combination with patella alta.
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Affiliation(s)
- Artur Banach
- National Center for Image-guided Therapy, Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Nobuhiko Hata
- National Center for Image-guided Therapy, Department of Radiology, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Ross Crawford
- Queensland University of Technology, Brisbane, Australia The Prince Charles Hospital, Brisbane, Australia
| | - Tomasz Piontek
- Department of Spine Disorders and Pediatric Orthopedics, University of Medical Sciences, Poznan, Poland
- Rehasport Clinic, Poznan, Poland
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Macri EM, Whittaker JL, Toomey CM, Jaremko JL, Galarneau JM, Ronsky JL, Kuntze G, Emery CA. Patellofemoral joint geometry and osteoarthritis features 3-10 years after knee injury compared with uninjured knees. J Orthop Res 2024; 42:78-89. [PMID: 37291985 DOI: 10.1002/jor.25640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 03/03/2023] [Accepted: 06/07/2023] [Indexed: 06/10/2023]
Abstract
In this cross-sectional study, we compared patellofemoral geometry in individuals with a youth-sport-related intra-articular knee injury to uninjured individuals, and the association between patellofemoral geometry and magnetic resonance imaging (MRI)-defined osteoarthritis (OA) features. In the Youth Prevention of Early OA (PrE-OA) cohort, we assessed 10 patellofemoral geometry measures in individuals 3-10 years following injury compared with uninjured individuals of similar age, sex, and sport, using mixed effects linear regression. We also dichotomized geometry to identify extreme (>1.96 standard deviations) features and assessed likelihood of having extreme values using Poisson regression. Finally, we evaluated the associations between patellofemoral geometry with MRI-defined OA features using restricted cubic spline regression. Mean patellofemoral geometry did not differ substantially between groups. However, compared with uninjured individuals, injured individuals were more likely to have extremely large sulcus angle (prevalence ratio [PR] 3.9 [95% confidence interval, CI: 2.3, 6.6]), and shallow lateral trochlear inclination (PR 4.3 (1.1, 17.9)) and trochlear depth (PR 5.3 (1.6, 17.4)). In both groups, high bisect offset (PR 1.7 [1.3, 2.1]) and sulcus angle (PR 4.0 [2.3, 7.0]) were associated with cartilage lesion, and most geometry measures were associated with at least one structural feature, especially cartilage lesions and osteophytes. We observed no interaction between geometry and injury. Certain patellofemoral geometry features are correlated with higher prevalence of structural lesions compared with injury alone, 3-10 years following knee injury. Hypotheses generated in this study, once further evaluated, could contribute to identifying higher-risk individuals who may benefit from targeted treatment aimed at preventing posttraumatic OA.
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Affiliation(s)
- Erin M Macri
- Department Orthopaedics and Sports Medicine, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department General Practice, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Family Practice, University of British Columbia, Vancouver, Canada
| | - Jackie L Whittaker
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Canada
- Arthritis Research Canada, Vancouver, Canada
| | - Clodagh M Toomey
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Canada
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Jacob L Jaremko
- Department Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Canada
| | | | - Janet L Ronsky
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Canada
- Department Mechanical and Manufacturing Engineering and Biomedical Engineering, Schulich School of Engineering, University of Calgary, Calgary, Canada
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Canada
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Gregor Kuntze
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | - Carolyn A Emery
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Canada
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Department of Pediatrics and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
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Yuen J, Esfandiarpour F, Lebrun CM, Dhillon S. Using Dual-Orthogonal Fluoroscopy and CT to Assess the Relationship Between Knee Morphology and Patellar Kinematics in Patients With Patellofemoral Pain. Cureus 2023; 15:e44139. [PMID: 37753041 PMCID: PMC10518526 DOI: 10.7759/cureus.44139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2023] [Indexed: 09/28/2023] Open
Abstract
INTRODUCTION Patellofemoral pain (PFP) is one of the most common knee overuse injuries, with studies suggesting PFP as a precursor for early knee osteoarthritis. The etiology of PFP is multi-factorial; however, patellar mal-tracking has been regarded as a primary mechanism. Details of this multi-factorial mechanism have been unclear because of the limitations in evaluating in-vivo, three-dimensional (3D) patellofemoral joint movement during dynamic activities accurately. Alternatively, studies have demonstrated the high accuracy and repeatability of dual fluoroscopy and CT/MRI for measuring knee joint motion. OBJECTIVE This study uses dual fluoroscopy and CT to investigate the associations between joint morphology and patellar kinematics in healthy controls and subjects with PFP. METHODS Eight PFP females (29.7±10.6 years) and 10 healthy females (25.0±7.7 years) were recruited and screened by a sports medicine physician. CT imaging was performed on participants in a supine with the knee extended, and ankle and hip in neutral alignment. Dual-orthogonal fluoroscopy measured patellar movement while participants performed a lunge task. A calibration algorithm was used to register the 3D CT model to 2D fluoroscopy image to calculate the relative position and angles of the patella based on the clinical definition of patellar motion. Measures of patellar and trochlear morphology were generated and correlated to kinematic data. RESULTS AND CONCLUSION There was a significant difference in the patellar-to-trochlear width ratio; however, no other significant differences in CT morphology measurements were present between groups. For PFP patients in the weight-bearing extended position, there was a moderate positive correlation between the patellar-to-trochlear width ratio and medial-lateral patellar shift (τ = 0.643, p = 0.026). Healthy controls in this position demonstrated a moderate positive correlation between the lateral-trochlear inclination angle and medial-lateral patellar shift (τ = 0.600, p = 0.016) and moderate negative correlation between medial trochlear inclination angle and medial-lateral patellar shift (τ = -0.511, p = 0.040). The findings suggest that, for this cohort, there is correlation between morphology and patellar kinematics. Passive and active stabilizers likely have a role in mal-tracking.
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Affiliation(s)
- Joanna Yuen
- Department of Radiology, University of British Columbia, Vancouver, CAN
| | | | - Constance M Lebrun
- Department of Family Medicine, University of Alberta, Edmonton, CAN
- Department of Sport and Exercise Medicine, MacEwan University Health Center, Edmonton, CAN
| | - Suki Dhillon
- Department of Radiology, University of Alberta, Edmonton, CAN
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Dai Y, Yin H, Xu C, Zhang H, Guo A, Diao N. Association of patellofemoral morphology and alignment with the radiographic severity of patellofemoral osteoarthritis. J Orthop Surg Res 2021; 16:548. [PMID: 34481492 PMCID: PMC8418017 DOI: 10.1186/s13018-021-02681-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/19/2021] [Indexed: 11/10/2022] Open
Abstract
Background Risk factors for the severity of patellofemoral osteoarthritis (PFOA) are poorly understood. This research aims to evaluate the association between patellofemoral joint (PFJ) morphology and alignment with the radiographic severity of PFOA. Methods A retrospective analysis of CT scan and lateral radiograph data were acquired in patients with PFOA. The radiographic grade of PFOA and tibiofemoral osteoarthritis (TFOA), lateral and medial trochlear inclination angle, sulcus angle, and the Wiberg classification of patella morphology, the congruence angle, patellar tilt angle, and lateral patellar angles, and tibial tubercle trochlear groove distance (TT-TG) and patella height (i.e., Caton-Deschamps index) were assessed using CT scans and sagittal radiographs of the knee. All the PFJ morphology and alignment data were divided into quarters, and the relationships between each of these measures and the severity of PFOA were investigated. Results By studying 150 patients with PFOA, we found a U-shaped relationship between the Caton-Deschamps index and the severity of PFOA (P < 0.001). A lower value of sulcus angle and lateral patellar angle, a higher value of congruence angle, and type III patella were associated with more severity of lateral PFOA. Compared with the highest quarter of each measure, the adjusted odds ratios (OR) of the severity of PFOA in the lowest quarter of sulcus angle, lateral patellar angle, and congruence angle; and type I patella was 8.80 (p = 0.043), 16.51 (P < 0.001), 0.04 (P < 0.001), and 0.18 (p = 0.048) respectively. Conclusions Extreme value of patella height, a higher value of lateral patellar displacement and lateral patellar tilt, lower value of sulcus angle, and type III patella were associated with more severity of PFOA.
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Affiliation(s)
- Yike Dai
- Department of Orthopedic, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong'an Road, Xicheng, Beijing, 100050, People's Republic of China
| | - Heyong Yin
- Department of Orthopedic, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong'an Road, Xicheng, Beijing, 100050, People's Republic of China
| | - Chongyang Xu
- Department of Orthopedic, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong'an Road, Xicheng, Beijing, 100050, People's Republic of China
| | - Hongrui Zhang
- Department of Orthopedic, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong'an Road, Xicheng, Beijing, 100050, People's Republic of China
| | - Ai Guo
- Department of Orthopedic, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong'an Road, Xicheng, Beijing, 100050, People's Republic of China
| | - Naicheng Diao
- Department of Orthopedic, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong'an Road, Xicheng, Beijing, 100050, People's Republic of China.
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Gupta H, Kataria H, Batta NS, Yadav S, Jain V. Assessment of validity and reliability of femoral shaft-patellar tendon angle measured on MRI. Skeletal Radiol 2021; 50:927-936. [PMID: 33026478 DOI: 10.1007/s00256-020-03636-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/29/2020] [Accepted: 09/29/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Clinically measured Quadriceps angle (Q-angle) has low reliability. Measurement of angle between femoral shaft and patellar tendon (FSPT angle) on routine knee MRI was described in this study to represent the lateral vector forces of quadriceps mechanism. The cross-sectional study was designed to compare this angle between subjects with objective patellofemoral instability (PFI) versus those without PFI, to assess its reliability, and to assess its validity in terms of its ability to differentiate between PFI and non-PFI subjects using the "Receiver Operating Characteristic" (ROC) curve. MATERIALS AND METHODS MRI scans of 20 subjects with PFI and 20 without PFI were obtained. FSPT angle was measured in each MRI by three different raters. In addition, the clinical Q-angle was also measured in the control group. RESULTS The FSPT angle was significantly higher in PFI group as compared with the non-PFI group (p < 0.001). It had substantial inter-rater reliability of 0.82 (95% CI = 0.67-0.92) in the non-PFI group and 0.89 (95% CI = 0.78-0.95) in the PFI group. Test-retest reliability was more than 0.90. The AUC for the ROC curve was 0.86 (95% CI = 0.74-0.97). The clinical Q-angle measured in non-PFI subjects had inter-rater reliability of only 0.48 (95% CI = 0.21-0.72), and showed a fair correlation of 0.58 with the MRI angle. CONCLUSION Measurement of FSPT angle was described on MRI with substantial intra-rater and inter-rater reliability. The angle was significantly higher in PFI versus non-PFI subjects and also showed a good ability to differentiate between these two groups in the ROC curve.
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Affiliation(s)
- Himanshu Gupta
- Department of Sports Injury Centre, VMMC & Safdarjung Hospital, New Delhi, 110029, India.
| | - Himanshu Kataria
- Department of Sports Injury Centre, VMMC & Safdarjung Hospital, New Delhi, 110029, India
| | | | - Sunil Yadav
- Department of Sports Injury Centre, VMMC & Safdarjung Hospital, New Delhi, 110029, India
| | - Vineet Jain
- Department of Sports Injury Centre, VMMC & Safdarjung Hospital, New Delhi, 110029, India
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Liao TC, Jergas H, Tibrewala R, Bahroos E, Link TM, Majumdar S, Souza RB, Pedoia V. Longitudinal analysis of the contribution of 3D patella and trochlear bone shape on patellofemoral joint osteoarthritic features. J Orthop Res 2021; 39:506-515. [PMID: 32827327 PMCID: PMC8915432 DOI: 10.1002/jor.24836] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 08/02/2020] [Accepted: 08/18/2020] [Indexed: 02/04/2023]
Abstract
To explore bone shape features that are associated with patellofemoral joint (PFJ) osteoarthritic features. Thirty subjects with PFJ degeneration (six males, 53.2 ± 9.8 years) and 23 controls (12 males, 48.1 ± 10.6 years) were included. Magnetic resonance (MR) assessment was performed to provide bone segmentation, morpholgocial grading, and cartilage relaxation times. In addition, subject self-reported symptoms were reported. Logistic regressions were used to identify the shape features that were associated with the presence and worsening of PFJ morphological lesions over 3 years, and worsening of self-reported symptoms. Statistical parametric mapping was used to evaluate the associations between shape features and cartilage relaxation times at 3 years. Results indicated that subjects with PFJ degeneration exhibited a trochlea with longer lateral condyle and shallower trochlear groove (adjusted odds ratio [OR] = 0.30; 95% confidence interval [CI]: 0.10, 0.86; P = .025). Subjects with worsening of PFJ degeneration exhibited a patella with equally distributed facets (adjusted OR = 3.14; 95% CI: 1.05, 9.37; P = .040) and lateral bump (adjusted OR = 0.14; 95% CI: 0.02, 0.83; P = .030). No shape features were associated with worsening of self-reported symptoms. Elevated T1ρ and T2 times at 3 years were associated with a patella with a lateral hook, equally distributed facets, round and thick as well as a trochlea larger in size (R = 0.38~0.46, P = .015~.025). The study demonstrated the ability of 3D statistical shape modeling to quantify patella and trochlear bone shape features that are associated with the presence and progression of PFJ osteoarthritic features.
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Affiliation(s)
- Tzu-Chieh Liao
- Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, CA, USA
| | - Hannah Jergas
- Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, CA, USA
| | - Radhika Tibrewala
- Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, CA, USA
| | - Emma Bahroos
- Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, CA, USA
| | - Thomas M. Link
- Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, CA, USA
| | - Sharmila Majumdar
- Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, CA, USA
| | - Richard B. Souza
- Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, CA, USA,Department of Physical Therapy and Rehabilitation Science, University of California-San Francisco, CA, USA
| | - Valentina Pedoia
- Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, CA, USA
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Tabary M, Esfahani A, Nouraie M, Babaei MR, Khoshdel AR, Araghi F, Shahrezaee M. Relation of the chondromalatia patellae to proximal tibial anatomical parameters, assessed with MRI. Radiol Oncol 2020; 54:159-167. [PMID: 32324164 PMCID: PMC7276644 DOI: 10.2478/raon-2020-0021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 03/18/2020] [Indexed: 02/08/2023] Open
Abstract
Background Magnetic resonance imaging (MRI) is a non-invasive highly sensitive tool for diagnosing chondromalacia patellae in the early stages. Many studies have evaluated patellar and trochlear morphology with different radiologic indices. We aimed to assess the discriminative power of tibial, patellar, and femoral indices in MRI for chondromalacia patellae. Patients and methods 100 cases of chondromalacia, as well as 100 age-matched controls among the patients who underwent knee MRI between February 2017 and March 2019, were included. The standard protocol of knee MRI was applied and the diagnosis of chondromalacia was made on MRI findings. Chondromalacia subjects were also classified as grade 1 to 4 according to the Modified Outerbridge's MRI grading system. We measured 25 MRI parameters in the knee and adjacent structures to determine the relation between chondromalacia patellae and anatomical MRI parameters. Results Tibial slope, trochlear depth, lateral trochlear inclination, and lateral patellar tilt angle had significant correlation with chondromalacia. Any increase in lateral trochlear inclination and lateral patellar tilt angle could increase the probability of the disease (Odds ratio [OR] 1.15, 1.13; 95% CI: 1.03-1.30; 1.02-1.26, respectively), while any increase in medial tibial slope and trochlear depth could decrease the probability of chondromalacia (OR 0.85, 0.06; 95% CI: 0.73-0.98, 0.02-0.17, respectively). We also designed a model for the severity of disease by using the patellar height index (relative odds ratio: 75.9). Conclusions The result of this study showed the novelty role of tibial anatomy in developing chondromalacia and its mechanism. We also concluded that patellar height might be an important factor in defining disease severity.
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Affiliation(s)
- Mohammadreza Tabary
- Department of Science and Research Branch, AJA University of Medical Sciences, Tehran, Iran
| | | | - Mehdi Nouraie
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mohammad Reza Babaei
- Department of Interventional Radiology, Firouzgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Reza Khoshdel
- Modern Epidemiology Research Center, AJA University of Medical Sciences, Tehran, Iran
| | - Farnaz Araghi
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mostafa Shahrezaee
- Department of Science and Research Branch, AJA University of Medical Sciences, Tehran, Iran
- Department of Orthopedics, AJA University of Medical Sciences, Tehran, Iran
- Mostafa Shahrezaee, M.D., Professor of Orthopedics, Department of Science and Research Branch, AJA University of Medical Sciences, Etemadzadeh St., Tehran, Iran.
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DURAN S, GÜNAYDIN E. Relationship between trochlear morphology and lateral patellar cartilage defect using MR Imaging. ARCHIVES OF CLINICAL AND EXPERIMENTAL MEDICINE 2020. [DOI: 10.25000/acem.612100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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12
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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. [PMID: 32096249 PMCID: PMC7187437 DOI: 10.1111/sms.13641] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 02/03/2020] [Accepted: 02/06/2020] [Indexed: 12/20/2022]
Abstract
Background Patellofemoral pain (PFP) patients show increased prevalence of patellar malalignment. Structural and alignment abnormalities of the patellofemoral joint (PFJ) may play a role in development of PFP and patellofemoral osteoarthritis (PFOA). Objectives Evaluating associations of patellofemoral alignment and femoral geometry with bony and cartilaginous abnormalities in PFP patients and healthy control subjects. Methods Data from a case‐control study were used (64 PFP subjects, 70 control subjects, 57% female, age 23.2 (6.4)). Alignment and femoral geometry measures in the PFJ were determined using MRI. Structural abnormalities in the PFJ associated with OA (bone marrow lesions, osteophytes, minor cartilage defects and Hoffa‐synovitis), quantified cartilage composition (T1ρ relaxation times) in the PFJ and perfusion within the patellar bone were examined using different MRI techniques. Associations were analyzed using regression analyses, adjusted for potential confounders. Results Lateral patellar tilt was negatively associated with presence of osteophytes on both patella (OR 0.91; 95% CI 0.84 to 0.98), anterior femur (OR 0.92; 95% CI 0.84 to 0.99) and minor cartilage defects on patella (OR 0.91; 95% CI 0.84 to 0.99). Patella alta was positively associated with the presence of bone marrow lesions in the patella and minor cartilage defects (OR 48.33; 95% CI 4.27 to 547.30 and OR 17.51; 95% CI 1.17 to 262.57, respectively). Patella alta and medial patellar translation were positively associated with T1ρ relaxation times within trochlear cartilage (β 5.2; 95% CI 0.77 to 9.58, and 0.36; 95% CI 0.08 to 0.64, respectively). None of the alignment and geometry measures were associated with bone perfusion. Conclusion Our study implies that associations between patellofemoral alignment and geometry and structural joint abnormalities linked to OA are already present in both PFP patients and healthy control subjects.
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Affiliation(s)
- Joost F A Eijkenboom
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Rianne A van der Heijden
- Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Janneke L M de Kanter
- Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Edwin H Oei
- Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Sita M A Bierma-Zeinstra
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Marienke van Middelkoop
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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Fick CN, Grant C, Sheehan FT. Patellofemoral Pain in Adolescents: Understanding Patellofemoral Morphology and Its Relationship to Maltracking. Am J Sports Med 2020; 48:341-350. [PMID: 31834811 PMCID: PMC8167821 DOI: 10.1177/0363546519889347] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Developing bone is highly adaptable and, as such, is susceptible to pathological shape deformation. Thus, it is imperative to quantify if changes in patellofemoral morphology are associated with adolescent-onset patellofemoral pain, as a pathway to improve our understanding of this pain's etiology. PURPOSE To quantify and compare patellofemoral morphology in adolescent patients with patellofemoral pain with matched healthy adolescent controls and determine if a relationship exists between patellofemoral shape and kinematics (measured during active flexion-extension). STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS Using 3-dimensional static magnetic resonance images acquired during a previous study, we measured patellar, trochlear, and lateral patellar width; trochlear and patellar depth; Wiberg index; patellar-height ratio; lateral trochlear inclination; cartilage length; and lateral femoral shaft length. Student t test was used to compare shape parameters between adolescents with patellofemoral pain and controls. Pearson correlations and stepwise linear regression models were used to explore the relationship among morphology, kinematics (medial-lateral shift/tilt), and pain. RESULTS Relative to controls, adolescents with patellofemoral pain had larger sulci (mean ± SD, 6.6 ± 0.7 vs 6.0 ± 1.1 mm; 95% CI, 0.6 mm; P = .043; d = 0.66), lateral patellar width (23.1 ± 2.4 vs 21.4 ± 2.6 mm; 95% CI, 1.6 mm; P = .033; d = 0.70), and patella-trochlear width ratio (1.2 ± 0.1 vs 1.1 ± 0.1; 95% CI, 0.1; P < .001; d = 1.26). Shape correlated with kinematics in both cohorts and in the entire population. In the patellofemoral pain group, lateral shaft length (r = 0.518; P = .019), Wiberg index (r = 0.477; P = .033), and patellar-height ratio (r = -0.582; P = .007) were correlated with medial shift. A moderate correlation existed between patellar-height ratio and lateral patellar tilt (r = 0.527; P = .017). Half of the variation in patellar shift in the patellofemoral pain cohort was explained by the patellar-height ratio and Wiberg index (R2 = 0.487; P = .003). Linear correlations with pain were not found. CONCLUSION This study provides direct evidence that patellofemoral morphology is altered and influences maltracking in adolescents with patellofemoral pain, highlighting the multifactorial etiology of this pain. Neither morphology nor kinematics (measured during active flexion-extension) correlated with pain. Both increases and decreases in these parameters likely lead to pain, negating a direct linear correlation.
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Affiliation(s)
- Cameron N Fick
- Department of Rehabilitation Medicine, NIH, Bethesda, MD, USA
| | - Camila Grant
- Department of Rehabilitation Medicine, NIH, Bethesda, MD, USA
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Li J, Sheng B, Liu X, Yu F, Lv F, Lv F, Yang H. Sharp margin of antero-inferior lateral femoral condyle as a risk factor for patellar tendon-lateral femoral condyle friction syndrome. Eur Radiol 2020; 30:2261-2269. [PMID: 31900701 DOI: 10.1007/s00330-019-06592-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 11/10/2019] [Accepted: 11/13/2019] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To determine the correlation between patellar tendon-lateral femoral condyle friction syndrome (PLFFS) and the morphological characteristics of the antero-inferior part of the lateral femoral condyle (ALFC) to explore the potential pathogenesis. METHODS A total of 170 knees of 140 patients with PLFFS (PLFFS group) were retrospectively analyzed using magnetic resonance imaging (MRI) data for a 4-year period from our database. The Insall-Salvati ratio, shape of the ALFC (SALFC, defined as two subtypes: sharp versus blunt), lateral femoral condyle angle (LFCA), lateral trochlear length (LTL), and lateral trochlear height (LTH) were measured on MRI. Two groups were enrolled as controls: pure patella alta group (n = 192) and normal group (n = 172). All the parameters of the PLFFS group were compared with those of the two control groups. RESULTS The LFCA was significantly lower (p < 0.001) in the PLFFS group than in the pure patella alta group. The SALFC was significantly different (p < 0.001) in these two groups, whereas the Insall-Salvati ratio, LTH, and LTL showed no significant difference. The LFCA, LTH, SALFC, and the Insall-Salvati ratio in the PLFFS group were also significantly different (p < 0.001) with the normal group. Receiver operating characteristic (ROC) analysis showed the efficacy of the Insall-Salvati ratio and SALFC was better than that of the other parameters. CONCLUSIONS The morphological characteristics of ALFC are correlated with PLFFS. The sharp shape of ALFC may be an important causative co-factor along with patella alta in the pathogenesis of PLFFS. KEY POINTS • A sharp margin of the antero-inferior lateral femoral condyle is an important risk factor for the development of PLFFS in patients with patella alta. • Antero-inferior femoral condyle shape can easily be assessed with high intra- and inter-reader reliability PLFFS. • PLFFS is more common in young adults.
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Affiliation(s)
- Jia Li
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong Distract, Chongqing, 400016, People's Republic of China
| | - Bo Sheng
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong Distract, Chongqing, 400016, People's Republic of China
| | - Xin Liu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong Distract, Chongqing, 400016, People's Republic of China
| | - Fan Yu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong Distract, Chongqing, 400016, People's Republic of China
| | - Fajin Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong Distract, Chongqing, 400016, People's Republic of China
| | - Furong Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong Distract, Chongqing, 400016, People's Republic of China
| | - Haitao Yang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong Distract, Chongqing, 400016, People's Republic of China.
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15
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Quantitative magnetic resonance imaging in patellar tendon-lateral femoral condyle friction syndrome: relationship with subtle patellofemoral instability. Skeletal Radiol 2019; 48:1251-1259. [PMID: 30715563 DOI: 10.1007/s00256-019-3163-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 01/07/2019] [Accepted: 01/14/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate the correlation of patellar tendon-lateral femoral condyle friction syndrome (PTLFCFS) with subtle patellofemoral instability to explore its pathogenesis. MATERIALS AND METHODS One hundred knees of 80 patients with PTLFCFS were analyzed retrospectively by retrieving magnetic resonance imaging (MRI) data over a 3-year period from our database. Seven quantitative parameters for evaluating patellofemoral stability were measured on MR images, including the Insall-Salvati ratio, tibial tuberosity-trochlear groove (TT-TG) distance, trochlear groove depth, medial trochlear/lateral trochlear length (MT/LT) ratio, medial trochlear/lateral trochlear height (MH/LH) ratio, lateral patellofemoral angle (LPA), and lateral trochlear inclination (LTI) angle. These patellofemoral parameters of the PTLFCFS group and the normal control group were compared (n = 88), and receiving-operator characteristic (ROC) curve analysis was conducted to determine the specificity and sensitivity of these parameters. RESULTS The trochlear depth, MT/LT, LPA, and LTI angle were significantly lower (p < 0.001) and the Insall-Salvati ratio was significantly higher (p < 0.001) in the PTLFCFS group. However, the TT-TG distance and MH/LH ratio showed no significant difference (p = 0.231 and 0.073 respectively). The area under the ROC curve of the Insall-Salvati ratio, trochlear depth, MT/LT, LPA, and LTI angle were 0.925, 0.784, 0.8, 0.731, and 0.675 respectively. The efficiency of the Insall-Salvati ratio was the highest among those five parameters. CONCLUSION This study verified the presence of subtle patellofemoral instability by measuring various patellofemoral parameters in patients with PTLFCFS. It confirmed that PTLFCFS is associated with subtle patellofemoral instability and could largely explain the pathogenesis of PTLFCFS.
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Clouthier AL, Smith CR, Vignos MF, Thelen DG, Deluzio KJ, Rainbow MJ. The effect of articular geometry features identified using statistical shape modelling on knee biomechanics. Med Eng Phys 2019; 66:47-55. [PMID: 30850334 DOI: 10.1016/j.medengphy.2019.02.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 02/04/2019] [Accepted: 02/11/2019] [Indexed: 01/17/2023]
Abstract
Articular geometry in the knee varies widely among people which has implications for risk of injury and pathology. The goals of this work were to develop a framework to systematically vary geometry in a multibody knee model and to use this framework to investigate the effect of morphological features on dynamic knee kinematics and contact mechanics. A statistical shape model of the tibiofemoral and patellofemoral joints was created from magnetic resonance images of 14 asymptomatic knees. The shape model was then used to generate 37 unique multibody knee models based on -3 to +3 standard deviations of the scores for the first six principal components identified. Each multibody model was then incorporated into a lower extremity musculoskeletal model and the Concurrent Optimization of Muscle Activations and Kinematics (COMAK) routine was used to simulate knee mechanics for overground walking. Changes in articular geometry affected knee function, resulting in differences up to 17° in orientation, 8 mm in translation, 0.7 BW in contact force, and 2.0 MPa in mean cartilage contact pressure. Understanding the relationship between shape and function in a joint could provide insight into the mechanisms behind injury and pathology and the variability in response to treatment.
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Affiliation(s)
- Allison L Clouthier
- Department of Mechanical and Materials Engineering, Queen's University, 130 Stuart St., McLaughlin Hall, Kingston, ON K7L 3N6, Canada.
| | - Colin R Smith
- Department of Mechanical Engineering, University of Wisconsin-Madison, 1513 University Ave, Madison, WI 53706, USA
| | - Michael F Vignos
- Department of Mechanical Engineering, University of Wisconsin-Madison, 1513 University Ave, Madison, WI 53706, USA
| | - Darryl G Thelen
- Department of Mechanical Engineering, University of Wisconsin-Madison, 1513 University Ave, Madison, WI 53706, USA
| | - Kevin J Deluzio
- Department of Mechanical and Materials Engineering, Queen's University, 130 Stuart St., McLaughlin Hall, Kingston, ON K7L 3N6, Canada
| | - Michael J Rainbow
- Department of Mechanical and Materials Engineering, Queen's University, 130 Stuart St., McLaughlin Hall, Kingston, ON K7L 3N6, Canada
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Does patellar alignment or trochlear morphology predict worsening of patellofemoral disease within the first 5 years after anterior cruciate ligament reconstruction? Eur J Radiol 2019; 113:32-38. [PMID: 30927957 DOI: 10.1016/j.ejrad.2019.01.033] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 01/23/2019] [Accepted: 01/29/2019] [Indexed: 01/29/2023]
Abstract
PURPOSE We described patellofemoral alignment and trochlear morphology at one and five years after anterior cruciate ligament reconstruction (ACLR), and evaluated the associations between alignment and trochlear morphology (at one year) and worsening patellofemoral osteoarthritis (OA) features by five years. We also evaluated the associations between alignment and morphology to self-reported pain and function (Knee injury and Osteoarthritis Outcome Score, KOOS) at five years. MATERIALS AND METHODS In this longitudinal observational study, we followed 73 participants (mean age 29[9] years, 40% women) from one- to five-years after ACLR. Using MRI, we measured alignment and morphology, and scored cartilage and bone marrow lesions at both time points. We used mixed effects and linear regression models to achieve our stated aims. RESULTS Greater lateral patella displacement increased risk of cartilage worsening (Odds Ratio [95% CI]: 1.09 [1.01, 1.16]); while less lateral tilt (0.91 [0.83, 0.99]) and greater trochlear angle (0.88 [0.77, 1.00]) were protective. Greater medial trochlear inclination increased risk of bone marrow lesion worsening (1.12 [1.04, 1.19]); while greater trochlear angle was protective (0.80 [0.67, 0.96]). Greater lateral displacement was associated with worse self-reported KOOS sport and recreation scores (β [95% CI]: -11.0 [-20.9, -1.2]) and quality of life scores (-10.5 [-20.4, -0.7]). CONCLUSIONS Lateral displacement, lateral tilt, and morphology at 1 year post-ACLR altered the risk of worsening patellofemoral OA features four years later. Lateral displacement was the only measure associated with worse self-reported symptoms at five years. These findings may lead to novel treatment strategies for secondary prevention after ACLR.
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Eijkenboom JFA, Waarsing JH, Oei EHG, Bierma-Zeinstra SMA, van Middelkoop M. Is patellofemoral pain a precursor to osteoarthritis?: Patellofemoral osteoarthritis and patellofemoral pain patients share aberrant patellar shape compared with healthy controls. Bone Joint Res 2018; 7:541-547. [PMID: 30294426 PMCID: PMC6168714 DOI: 10.1302/2046-3758.79.bjr-2018-0112.r1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objectives It has been hypothesized that patellofemoral pain, a common knee condition in adolescents and young adults, may be a precursor of degenerative joint changes and may ultimately lead to patellofemoral osteoarthritis. Since both conditions share several mechanical disease characteristics, such as altered contact area between the femur and patella and increased joint stress, we investigated whether these conditions share similar and different shape characteristics of the patella compared with normal controls. Methods This cross-sectional study compared three different study populations: 32 patellofemoral pain subjects (mean age, 32 years (22 to 45); 72% female); 56 isolated radiological patellofemoral osteoarthritis subjects (mean age, 54 years (44 to 58); 89% female); and 80 healthy control subjects (mean age, 52 years (44 to 58); 74% female). Measurements included questionnaires, and lateral and skyline radiographs of the knee. Two separate 30-point 2D statistical shape models of the patella were created from the lateral and skyline radiographs. A general linear model was used to test for differences in standardized shape modes (a specific shape variant of the patella) between patellofemoral osteoarthritis, patellofemoral pain, and controls, using Bonferroni correction and adjustment for body mass index and gender. Results Five shape modes showed statistically significant differences between groups: skyline modes 1 (p < 0.001), 8 (p = 0.004), and 10 (p < 0.001); and lateral modes 5 (p = 0.002) and 7 (p = 0.002). Skyline mode 8 and lateral mode 5 were similar for patellofemoral osteoarthritis and patellofemoral pain populations, while being statistically significant different from the control group. Conclusion Our results indicate that patellofemoral pain and patellofemoral osteoarthritis share similar shape characteristics, which are different from control subjects. These findings support the proposed continuum disease model of patellofemoral pain predisposing to the development of patellofemoral osteoarthritis. Cite this article: J. F. A. Eijkenboom, J. H. Waarsing, E. H. G. Oei, S. M. A. Bierma-Zeinstra, M. van Middelkoop. Is patellofemoral pain a precursor to osteoarthritis? Patellofemoral osteoarthritis and patellofemoral pain patients share aberrant patellar shape compared with healthy controls. Bone Joint Res 2018;7:541–547. DOI: 10.1302/2046-3758.79.BJR-2018-0112.R1.
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Affiliation(s)
- J F A Eijkenboom
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - J H Waarsing
- Department of Orthopaedics, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - E H G Oei
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - S M A Bierma-Zeinstra
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - M van Middelkoop
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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Is There a Biomechanical Link Between Patellofemoral Pain and Osteoarthritis? A Narrative Review. Sports Med 2018; 46:1797-1808. [PMID: 27142536 DOI: 10.1007/s40279-016-0545-6] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The patellofemoral (PF) joint is the knee compartment most commonly affected by osteoarthritis (OA). Even mild PF OA is associated with considerable pain and functional limitations. Despite its prevalence and impact, little is understood of the etiology or structural and functional features of PF OA. The clinical symptoms of PF OA, such as anterior knee pain during stair ambulation and squatting, share many similarities with PF pain in adolescents and young adults. PF joint OA is most commonly diagnosed in people aged >40 years, many of whom report a history of PF pain. As such, there is growing evidence that PF pain and PF OA form a continuum of disease. This review explores the possible relationship between the presence of PF pain and the development of PF OA. We review the evidence for altered neuromotor control and biomechanical factors that may be associated with altered PF loading in people with PF pain and PF OA. In doing so, we highlight similarities and differences that may evolve along the continuum. By improving our understanding of the neuromotor and biomechanical links between PF pain and PF OA, we may highlight potential targets for new rehabilitation strategies.
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Drew BT, Bowes MA, Redmond AC, Dube B, Kingsbury SR, Conaghan PG. Patellofemoral morphology is not related to pain using three-dimensional quantitative analysis in an older population: data from the Osteoarthritis Initiative. Rheumatology (Oxford) 2017; 56:2135-2144. [PMID: 28968747 PMCID: PMC5850212 DOI: 10.1093/rheumatology/kex329] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Indexed: 11/25/2022] Open
Abstract
Objectives Current structural associations of patellofemoral pain (PFP) are based on 2D imaging methodology with inherent measurement uncertainty due to positioning and rotation. This study employed novel technology to create 3D measures of commonly described patellofemoral joint imaging features and compared these features in people with and without PFP in a large cohort. Methods We compared two groups from the Osteoarthritis Initiative: one with localized PFP and pain on stairs, and a control group with no knee pain; both groups had no radiographic OA. MRI bone surfaces were automatically segmented and aligned using active appearance models. We applied t-tests, logistic regression and linear discriminant analysis to compare 13 imaging features (including patella position, trochlear morphology, facet area and tilt) converted into 3D equivalents, and a measure of overall 3D shape. Results One hundred and fifteen knees with PFP (mean age 59.7, BMI 27.5 kg/m2, female 58.2%) and 438 without PFP (mean age 63.6, BMI 26.9 kg/m2, female 52.9%) were included. After correction for multiple testing, no statistically significant differences were found between groups for any of the 3D imaging features or their combinations. A statistically significant discrimination was noted for overall 3D shape between genders, confirming the validity of the 3D measures. Conclusion Challenging current perceptions, no differences in patellofemoral morphology were found between older people with and without PFP using 3D quantitative imaging analysis. Further work is needed to see if these findings are replicated in a younger PFP population.
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Affiliation(s)
- Benjamin T Drew
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds.,NIHR Leeds Biomedical Research Centre, Leeds
| | | | - Anthony C Redmond
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds.,NIHR Leeds Biomedical Research Centre, Leeds
| | - Bright Dube
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds.,NIHR Leeds Biomedical Research Centre, Leeds
| | - Sarah R Kingsbury
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds.,NIHR Leeds Biomedical Research Centre, Leeds
| | - Philip G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds.,NIHR Leeds Biomedical Research Centre, Leeds
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Blønd L. Arthroscopic deepening trochleoplasty for chronic anterior knee pain after previous failed conservative and arthroscopic treatment. Report of two cases. Int J Surg Case Rep 2017; 40:63-68. [PMID: 28942225 PMCID: PMC5612785 DOI: 10.1016/j.ijscr.2017.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 09/04/2017] [Accepted: 09/05/2017] [Indexed: 01/29/2023] Open
Abstract
This study acknowledge that chronic anterior knee pain or patellofemoral can be caused based on trochlear dysplasia. The paper discuss the scientific background for this. By restoring the patient anatomy performing an arthroscopic trochleoplasty, the patients anterior knee pain was reduced significantly.
Purpose A proportion of patients having years of chronic anterior knee pain(AKP) that have not responded to non-operative modalities. Trochlear dysplasia have been found to be a cause for AKP. By restoring the anatomy with a trochleoplasty procedure the patellofemoral joint is unloaded. This study is a prospective 2 year follow-up study, based on two cases with chronic AKP for several years and having severe trochlear dysplasia and both were successfully treated by arthroscopic deepening trochleoplasty. Methods Case one was a 46 year old women with chronic anterior knee pain (AKP). Imaging showed lateral trochlear inclination angle of 2°, trochlear asymmetry 0.36, central height 81% and medial height 83%. Thepreoperative Kujala score was 70 and Knee injury and Osteoarthritis Outcome Score (KOOS) subscale for pain was 67. Case two was a 26 year old man troubled by AKP and knee knee joint effusion for >8 years without any instability in the history. Imaging showed lateral trochlear inclination angle of 6°, trochlear asymmetry 0.25, central height 76% and medial height 78%. The preoperative Kujala score was 49 and KOOS subscale for pain was 72. Results The postoperative Kujala score was for case one 82 and for case two 81. The postoperative KOOS subscale for pain was for case one 89 and for case two 92. Improvement in the KOOS subscale for sport and recreational activities and quality of living were also found. Conclusion This is the first case report to demonstrate that patient having had years of chronic AKP and trochlear dysplasia can be successfully treated by arthroscopic trochleoplasty.
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Affiliation(s)
- Lars Blønd
- Department of Orthopaedic Surgery, Aleris-Hamlet Parken, Copenhagen, Denmark; Department of Orthopaedic Surgery, The Zealand University Hospital, Koege, Denmark.
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Carlson VR, Boden BP, Shen A, Jackson JN, Alter KE, Sheehan FT. Patellar Maltracking Persists in Adolescent Females With Patellofemoral Pain: A Longitudinal Study. Orthop J Sports Med 2017; 5:2325967116686774. [PMID: 28210658 PMCID: PMC5302093 DOI: 10.1177/2325967116686774] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: Patellofemoral pain is one of the most common conditions seen in sports medicine practices, particularly among adolescent females. However, the natural history of the underlying pathology in patellofemoral pain during puberty remains poorly understood. Purpose: The purpose of this longitudinal study is to assess changes in patellar maltracking patterns in subjects with patellofemoral pain as they mature from mid- to late adolescence. Study Design: Cohort study; Level of evidence, 3. Methods: Three-dimensional patellofemoral kinematic data were acquired during active knee extension-flexion using dynamic magnetic resonance imaging in 6 girls (10 knees; mean age, 14.0 years) with clinically diagnosed patellofemoral pain. The subjects then returned as late adolescents (mean age, 18.5 years) for follow-up scanning. Three-dimensional patellofemoral kinematic parameters were evaluated across the range of motion, but comparison between time points was restricted to 10° of flexion. Participation in impact and nonimpact physical activities, pain score based on the visual analog scale, and the anterior knee pain score were also compared across initial and follow-up visits. Results: All subjects reported improved patellofemoral pain symptoms at follow-up, and one subject reported complete resolution. However, relative to the initial visit, no differences were found in patellar maltracking. There was a decrease in hours engaged in impact physical activities for all subjects at follow-up. Conclusion: This study provides insight into the natural history of patellofemoral pain in adolescent females. The relatively unchanged patellofemoral maltracking across subjects suggests that potential anatomic and kinematic abnormalities contributing to patellofemoral pain during mid-adolescence persist during skeletal maturation. Symptom improvement for these subjects did not result from a change in patellofemoral tracking, but rather from other causes.
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Affiliation(s)
- Victor R Carlson
- Functional and Applied Biomechanics Section, Department of Rehabilitation Medicine, National Institutes of Health, Bethesda, Maryland, USA
| | - Barry P Boden
- The Orthopaedic Center, A Division of CAO, Rockville, Maryland, USA
| | - Aricia Shen
- Functional and Applied Biomechanics Section, Department of Rehabilitation Medicine, National Institutes of Health, Bethesda, Maryland, USA
| | - Jennifer N Jackson
- Functional and Applied Biomechanics Section, Department of Rehabilitation Medicine, National Institutes of Health, Bethesda, Maryland, USA
| | - Katharine E Alter
- Functional and Applied Biomechanics Section, Department of Rehabilitation Medicine, National Institutes of Health, Bethesda, Maryland, USA
| | - Frances T Sheehan
- Functional and Applied Biomechanics Section, Department of Rehabilitation Medicine, National Institutes of Health, Bethesda, Maryland, USA
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Mwakikunga A, Katundu K, Msamati B, Adefolaju AG, Schepartz L. An anatomical and osteometric study of the femoral sulcus angle in adult Malawians. Afr Health Sci 2016; 16:1182-1187. [PMID: 28479913 PMCID: PMC5398467 DOI: 10.4314/ahs.v16i4.38] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Femoral sulcus angle is particularly important in clinical evaluation of patellofemoral joint. Individuals show considerable differences in asymmetrical dimensions of the femur. OBJECTIVES To determine the size of femoral sulcus angles in adult black Malawians using the skeletal collection in the department of Anatomy, College of Medicine and assess their gender differences; to compare femoral sulcus angles of Malawians with other ethnic groups. METHODS A cross sectional study was done in which femoral sulcus angles of dry bones were measured using a goniometer. RESULTS There is no significant difference in the mean sulcus angles between right and left femora in males (p=0.8100) and females (p=0.0742); between all males combined and females combined (p=0.8845). There is a significant difference in the mean between all left femora combined and all right femora combined (p=0.0260). CONCLUSION This study has provided the mean size of the femoral sulcus angle of adult Malawians. These findings suggest that the size of the sulcus angle cannot determine gender among adult black Malawians suggesting the interpretation that femora asymmetric dimensions are population specific, which should be considered in the patellofemoral joint evaluation.
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Affiliation(s)
- Anthony Mwakikunga
- School of Anatomical Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Anatomy, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Kondwani Katundu
- Department of Anatomy, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Boniface Msamati
- Department of Anatomy, Hubert Kairuki Memorial University, Dar Es Salaam, Tanzania
| | | | - Lynne Schepartz
- School of Anatomical Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Prakash J, Seon JK, Woo SH, Jin C, Song EK. Comparison of Radiological Parameters between Normal and Patellar Dislocation Groups in Korean Population: A Rotational Profile CT-Based Study. Knee Surg Relat Res 2016; 28:302-311. [PMID: 27894178 PMCID: PMC5134791 DOI: 10.5792/ksrr.16.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 03/31/2016] [Accepted: 04/21/2016] [Indexed: 01/26/2023] Open
Abstract
Purpose Patellofemoral instability is a common cause of anterior knee pain in adolescents and young adults. Most normal and pathological values for diagnosing patellofemoral instability are based on Western literature. We conducted this radiological study to determine normal values for different patellofemoral parameters in a Korean population and to evaluate their usefulness in diagnosis. Materials and Methods We retrospectively reviewed the rotational profile computerized tomography (CT) scans of the patellar dislocation and control groups. Trochlear, patellar, rotational profile, and trochleo-patellar alignment parameters were compared between the groups. Receiver operating characteristic curves were drawn for significant parameters, and sensitivity and specificity were calculated for the cut-off values. Results There were 48 patients in the patellar dislocation group and 87 patients in the control group. In the control group and patellar dislocation group, the mean sulcus angle was 132.5° and 143.3°, respectively, trochlear depth was 6.04 mm and 3.6 mm, bisect offset was 56.4% and 99.9%, lateral patellar tilting was 9.8° and 19.2°, patellar facet asymmetry was 63.5% and 45.16%, and the tibial tuberosity-trochlear groove (TT-TG) distance was 10.91 mm and 27.16 mm, respectively. Conclusions The trochlear depth, bisect offset, patella tilting, and TT-TG distance were parameters that significantly contributed to patellar instability. Rotational profile CT can be considered a good diagnostic tool to assess all these parameters that help to identify anatomical aberration resulting in patellofemoral instability, thereby helping in formulating the most effective treatment plan.
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Affiliation(s)
- Jatin Prakash
- Department of Orthopedic Surgery, Lady Hardinge Medical College University of Delhi, New Delhi, India
| | - Jong-Keun Seon
- Department of Orthopaedic Surgery, Chonnam National University Bitgoeul Hospital, Gwangju, Korea
| | - Seong-Hwan Woo
- Department of Orthopaedic Surgery, Chonnam National University Bitgoeul Hospital, Gwangju, Korea
| | - Cheng Jin
- Department of Orthopedic Surgery, Chinese People's Armed Police Force, Zhejiang Corps Hospital, Jiaxing, China
| | - Eun-Kyoo Song
- Department of Orthopaedic Surgery, Chonnam National University Bitgoeul Hospital, Gwangju, Korea
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25
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Selfe J, Janssen J, Callaghan M, Witvrouw E, Sutton C, Richards J, Stokes M, Martin D, Dixon J, Hogarth R, Baltzopoulos V, Ritchie E, Arden N, Dey P. Are there three main subgroups within the patellofemoral pain population? A detailed characterisation study of 127 patients to help develop targeted intervention (TIPPs). Br J Sports Med 2016; 50:873-80. [PMID: 26834185 PMCID: PMC4975826 DOI: 10.1136/bjsports-2015-094792] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2015] [Indexed: 11/04/2022]
Abstract
Background Current multimodal approaches for the management of non-specific patellofemoral pain are not optimal, however, targeted intervention for subgroups could improve patient outcomes. This study explores whether subgrouping of non-specific patellofemoral pain patients, using a series of low cost simple clinical tests, is possible. Method The exclusivity and clinical importance of potential subgroups was assessed by applying à priori test thresholds (1 SD) from seven clinical tests in a sample of adult patients with non-specific patellofemoral pain. Hierarchical clustering and latent profile analysis, were used to gain additional insights into subgroups using data from the same clinical tests. Results 130 participants were recruited, 127 had complete data: 84 (66%) female, mean age 26 years (SD 5.7) and mean body mass index 25.4 (SD 5.83), median (IQR) time between onset of pain and assessment was 24 (7–60) months. Potential subgroups defined by the à priori test thresholds were not mutually exclusive and patients frequently fell into multiple subgroups. Using hierarchical clustering and latent profile analysis three subgroups were identified using 6 of the 7 clinical tests. These subgroups were given the following nomenclature: (1) ‘strong’, (2) ‘weak and tighter’ and (3) ‘weak and pronated foot’. Conclusions We conclude that three subgroups of patellofemoral patients may exist based on the results of six clinical tests which are feasible to perform in routine clinical practice. Further research is needed to validate these findings in other data sets and, if supported by external validation, to see if targeted interventions for these subgroups improve patient outcomes.
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Affiliation(s)
- James Selfe
- University of Central Lancashire, Preston, Lancashire, UK
| | - Jessie Janssen
- University of Central Lancashire, Preston, Lancashire, UK
| | - Michael Callaghan
- Institute for Inflammation and Repair, Centre for Musculoskeletal Research, University of Manchester, Manchester, UK
| | - Erik Witvrouw
- Aspetar, Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Chris Sutton
- University of Central Lancashire, Preston, Lancashire, UK
| | - Jim Richards
- University of Central Lancashire, Preston, Lancashire, UK
| | - Maria Stokes
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | | | | | | | | | - Elizabeth Ritchie
- Department of Physiotherapy, Harrogate & District NHS Foundation Trust, Harrogate District Hospital, Harrogate, North Yorkshire, UK
| | - Nigel Arden
- University of Oxford, Nuffield Orthopaedic Centre, Oxford, UK
| | - Paola Dey
- University of Central Lancashire, Preston, Lancashire, UK
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Smoger LM, Fitzpatrick CK, Clary CW, Cyr AJ, Maletsky LP, Rullkoetter PJ, Laz PJ. Statistical modeling to characterize relationships between knee anatomy and kinematics. J Orthop Res 2015; 33:1620-30. [PMID: 25991502 PMCID: PMC4591110 DOI: 10.1002/jor.22948] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 05/13/2015] [Indexed: 02/04/2023]
Abstract
The mechanics of the knee are complex and dependent on the shape of the articular surfaces and their relative alignment. Insight into how anatomy relates to kinematics can establish biomechanical norms, support the diagnosis and treatment of various pathologies (e.g., patellar maltracking) and inform implant design. Prior studies have used correlations to identify anatomical measures related to specific motions. The objective of this study was to describe relationships between knee anatomy and tibiofemoral (TF) and patellofemoral (PF) kinematics using a statistical shape and function modeling approach. A principal component (PC) analysis was performed on a 20-specimen dataset consisting of shape of the bone and cartilage for the femur, tibia and patella derived from imaging and six-degree-of-freedom TF and PF kinematics from cadaveric testing during a simulated squat. The PC modes characterized links between anatomy and kinematics; the first mode captured scaling and shape changes in the condylar radii and their influence on TF anterior-posterior translation, internal-external rotation, and the location of the femoral lowest point. Subsequent modes described relations in patella shape and alta/baja alignment impacting PF kinematics. The complex interactions described with the data-driven statistical approach provide insight into knee mechanics that is useful clinically and in implant design.
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Affiliation(s)
- Lowell M. Smoger
- Center for Orthopaedic Biomechanics, University of Denver, Denver, CO, USA
| | | | - Chadd W. Clary
- Center for Orthopaedic Biomechanics, University of Denver, Denver, CO, USA,University of Kansas, Lawrence, KS, USA,DePuy Synthes, Warsaw, IN, USA
| | - Adam J. Cyr
- Center for Orthopaedic Biomechanics, University of Denver, Denver, CO, USA,University of Kansas, Lawrence, KS, USA
| | | | | | - Peter J. Laz
- Center for Orthopaedic Biomechanics, University of Denver, Denver, CO, USA
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Herbst KA, Barber Foss KD, Fader L, Hewett TE, Witvrouw E, Stanfield D, Myer GD. Hip Strength Is Greater in Athletes Who Subsequently Develop Patellofemoral Pain. Am J Sports Med 2015; 43:2747-52. [PMID: 26330570 PMCID: PMC4769640 DOI: 10.1177/0363546515599628] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Hip and knee strength abnormalities have been implicated in patellofemoral pain (PFP) in multiple studies. However, the relationship is unclear, as many of these studies have been retrospective. PURPOSE To compare prospective hip and knee isokinetic strength in young female athletes who subsequently went on to develop PFP relative to their uninjured, healthy peers. STUDY DESIGN Descriptive epidemiology study. METHODS Adolescent female athletes (N = 329) were tested for isokinetic strength of the knee (flexion and extension) and hip (abduction) and screened for the prevalence of PFP before their basketball seasons. After exclusion based on current PFP symptoms, 255 participants were prospectively enrolled in the study. A 1-way analysis of variance was used to determine between-group differences in incident PFP and the referent (no incident PFP) participants. RESULTS The cumulative incidence rate for the development of PFP was 0.97 per 1000 athlete-exposures. Female athletes who developed PFP demonstrated increased normalized hip abduction strength (normalized torque, 0.013 ± 0.003) relative to the referent control group (normalized torque, 0.011 ± 0.003) (P < .05). Unlike hip strength, normalized knee extension and knee flexion strength were not different between the 2 groups (P > .05). CONCLUSION The findings in this study indicate that young female athletes with greater hip abduction strength may be at an increased risk for the development of PFP. Previous studies that have looked at biomechanics indicated that those with PFP have greater hip adduction dynamic mechanics. CLINICAL RELEVANCE Combining the study data with previous literature, we theorize that greater hip abduction strength may be a resultant symptom of increased eccentric loading of the hip abductors associated with increased dynamic valgus biomechanics, demonstrated to underlie increased PFP incidence. Further research is needed to verify the proposed mechanistic link to the incidence of PFP.
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Affiliation(s)
- Kristen A Herbst
- Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA Wellington Orthopaedic and Sports Medicine, Cincinnati, Ohio, USA Mercy Hospital Anderson/University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Kim D Barber Foss
- Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA Division of Health Sciences, Department of Athletic Training, College of Mount St Joseph, Cincinnati, Ohio, USA
| | - Lauren Fader
- Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Timothy E Hewett
- Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA Departments of Pediatrics and Orthopaedic Surgery, University of Cincinnati, Cincinnati, Ohio, USA The Sports Health and Performance Institute, OSU Sports Medicine, Departments of Physiology & Cell Biology, Orthopaedic Surgery, Family Medicine, Rehabilitation Sciences, and Biomedical Engineering, Ohio State University Medical Center, Columbus, Ohio, USA
| | - Erik Witvrouw
- Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium Rehabilitation Department, Aspetar Orthopedic and Sports Medicine Hospital, Doha, Qatar
| | - Denver Stanfield
- Wellington Orthopaedic and Sports Medicine, Cincinnati, Ohio, USA
| | - Gregory D Myer
- Division of Sports Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA Wellington Orthopaedic and Sports Medicine, Cincinnati, Ohio, USA Departments of Pediatrics and Orthopaedic Surgery, University of Cincinnati, Cincinnati, Ohio, USA The Sports Health and Performance Institute, OSU Sports Medicine, Departments of Physiology & Cell Biology, Orthopaedic Surgery, Family Medicine, Rehabilitation Sciences, and Biomedical Engineering, Ohio State University Medical Center, Columbus, Ohio, USA The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA
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Freedman BR, Sheehan FT, Lerner AL. MRI-based analysis of patellofemoral cartilage contact, thickness, and alignment in extension, and during moderate and deep flexion. Knee 2015; 22. [PMID: 26213361 PMCID: PMC5536899 DOI: 10.1016/j.knee.2015.06.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Several factors are believed to contribute to patellofemoral joint function throughout knee flexion including patellofemoral (PF) kinematics, contact, and bone morphology. However, data evaluating the PF joint in this highly flexed state have been limited. Therefore, the purpose of this study was to evaluate patellofemoral contact and alignment in low (0°), moderate (60°), and deep (140°) knee flexion, and then correlate these parameters to each other, as well as to femoral morphology. METHODS Sagittal magnetic resonance images were acquired on 14 healthy female adult knees (RSRB approved) using a 1.5 T scanner with the knee in full extension, mid-flexion, and deep flexion. The patellofemoral cartilage contact area, lateral contact displacement (LCD), cartilage thickness, and lateral patellar displacement (LPD) throughout flexion were defined. Intra- and inter-rater repeatability measures were determined. Correlations between patellofemoral contact parameters, alignment, and sulcus morphology were calculated. RESULTS Measurement repeatability ICCs ranged from 0.94 to 0.99. Patellofemoral cartilage contact area and thickness, LCD, and LPD were statistically different throughout all levels of flexion (p<0.001). The cartilage contact area was correlated to LPD, cartilage thickness, sulcus angle, and epicondylar width (r=0.47-0.72, p<0.05). DISCUSSION This study provides a comprehensive analysis of the patellofemoral joint throughout its range of motion. CONCLUSIONS This study agrees with past studies that investigated patellofemoral measures at a single flexion angle, and provides new insights into the relationship between patellofemoral contact and alignment at multiple flexion angles. CLINICAL RELEVANCE The study provides a detailed analysis of the patellofemoral joint in vivo, and demonstrates the feasibility of using standard clinical magnetic resonance imaging scanners to image the knee joint in deep flexion.
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Affiliation(s)
- Benjamin R. Freedman
- Department of Biomedical Engineering, University of Rochester,Department of Bioengineering, University of Pennsylvania
| | | | - Amy L. Lerner
- Department of Biomedical Engineering, University of Rochester
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Freedman BR, Brindle TJ, Sheehan FT. Re-evaluating the functional implications of the Q-angle and its relationship to in-vivo patellofemoral kinematics. Clin Biomech (Bristol, Avon) 2014; 29:1139-45. [PMID: 25451861 PMCID: PMC4255138 DOI: 10.1016/j.clinbiomech.2014.09.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 09/25/2014] [Accepted: 09/25/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND The Q-angle is widely used clinically to evaluate individuals with anterior knee pain. Recent studies have questioned the utility of this measure and have suggested that a large Q-angle may not be associated with lateral patellofemoral translation, as often assumed. The objective of this study was to determine: 1) how accurately the Q-angle represents the line-of-action of the quadriceps and 2) if adding active quadriceps contraction or a bent knee position to the measurement of the Q-angle improves its reliability, accuracy, and association with patellofemoral kinematics. METHODS The study included individuals diagnosed with chronic idiopathic patellofemoral pain and control subjects (n=43 and n=30 knees). Three measures of the clinical Q-angle (straight- and bent-knee with relaxed quadriceps and straight-knee with maximum isometric quadriceps contraction) were obtained with a goniometer and compared to a fourth MR-based measure of Q-angle. Patellofemoral kinematics were derived from dynamic cine-phase contrast images, acquired while subjects extended/flexed their knee from approximately 0° and 45°. FINDINGS The Q-angle did not represent the line-of-action of the quadriceps. The average difference between each clinical and the MR-based Q-angle ranged from 5° to 8°. These differences varied greatly across subjects (range: -28.5° to 3.9(o)). Adding an active quadriceps contraction or a bent knee position, did not improve the reliability of the Q-angle. An increased Q-angle correlated to medial patellar displacement and tilt (r=0.38-0.54, P<0.001) in the cohort with anterior knee pain. INTERPRETATION Clinicians are cautioned against using the Q-angle to infer patellofemoral kinematics.
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Affiliation(s)
- Benjamin R. Freedman
- Functional and Applied Biomechanics, Department of Rehabilitation Medicine, NIH, Bethesda, MD, USA,Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
| | - Timothy J. Brindle
- Instructor, Physical Therapy and Rehabilitation Science, University of Maryland, College Park, MD, USA
| | - Frances T. Sheehan
- Functional and Applied Biomechanics, Department of Rehabilitation Medicine, NIH, Bethesda, MD, USA
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Regalado G, Lintula H, Eskelinen M, Kokki H, Kröger H, Svedström E, Vahlberg T, Väätäinen U. Dynamic KINE-MRI in patellofemoral instability in adolescents. Knee Surg Sports Traumatol Arthrosc 2014; 22:2795-802. [PMID: 24045916 DOI: 10.1007/s00167-013-2679-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Accepted: 09/07/2013] [Indexed: 01/16/2023]
Abstract
PURPOSE The impact of kinematic MRI (KINE-MRI) in the patellofemoral instability and anterior knee pain of the adolescents is rarely reported. Our special interest was to evaluate the patellofemoral joint biomechanics with KINE-MRI in adolescents with affected and unaffected knees in a case-control study. METHODS KINE-MRI was performed in 29 adolescents (affected knee group, n = 29 and unaffected knee group, n = 26) aged 11-16 years with unilateral patellofemoral instability. For the control group, we enrolled ten healthy age- and sex-matched volunteers (healthy knee group, n = 19). The study parameters, bisect offset, lateral patellar displacement, patellar tilt angle, sulcus angle and Insall-Salvati ratio at 0, 10, 20 and 30° of flexion-extension, were measured for the affected knee patients (n = 29), unaffected knee patients (n = 26) and the healthy knee subjects (n = 19). RESULTS The affected knee and the healthy knee subjects had a significant difference in the bisect offset ratio, lateral patellar displacement test and patellar tilt angle test. In these parameters, the difference between the affected knee patients and the healthy knee subjects progressively increased towards the full extension of the knee. In the affected knee and unaffected knee patients, bisect offset ratio at 0° ranged between 0.50 and 1.20 in both groups, whereas the bisect offset ratio in the healthy knee subjects ranged between 0.33 and 0.75 (p < 0.001). At the 0°, the lateral patellar displacement test ranged between 0 and 10 mm in the affected knee patients and between 0 and 35 mm in the unaffected knee patients, whereas the lateral displacement test ranged between 0 and 5 mm in the healthy knee subjects (p = 0.003). Patellar tilt angle test ranged between -30 and 20° in the affected knee patients and between -30 and 24° in the unaffected knee patients, and in the healthy knee subjects, the patellar tilt angle test ranged between 10 and 24° (p < 0.001). CONCLUSIONS The KINE-MRI was able to detect significant differences in patellofemoral joint kinematics between the patients and the healthy subjects. A new finding with clinical relevance in our work is that the unaffected knee is very similar to the dislocated knee in adolescents and this should be taken in account in rehabilitation of patients. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Gideon Regalado
- Department of Surgery, South Carelia Hospital, Lappeenranta, Finland
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Patellofemoral friction syndrome: magnetic resonance imaging correlation of morphologic and T2 cartilage imaging. J Comput Assist Tomogr 2014; 38:308-12. [PMID: 24448504 DOI: 10.1097/rct.0b013e3182aab187] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE This study aimed to investigate whether patellofemoral T2 cartilage changes are associated with lateral patellofemoral friction syndrome (PFS), as indicated by an edema-like signal within the superolateral infrapatellar (Hoffa) fat pad. METHODS In this institutional review board-approved retrospective study of 510 consecutive patients, 49 patients with 50 knee magnetic resonance imaging examinations demonstrating normal or low-grade patellofemoral cartilage abnormalities (whole-organ magnetic resonance imaging score [WORMS] score, ≤2) were included. Twenty-two examinations with PFS (cases) were compared with an age- and sex-matched cohort of 28 examinations without PFS (controls). A 3-T magnetic resonance imaging was performed with multi-echo, spin-echo T2 mapping. Two readers measured in consensus malalignment parameters, including patellar height index, tibial tuberosity to trochlear groove distance, and sulcus angle. Bulk T2 cartilage values in the lateral and medial patellofemoral compartment, central weight-bearing medial and lateral femoral condyles were measured independently. Interobserver agreement was quantified using concordance correlation coefficients. Demographics, anatomic measurements, whole-organ magnetic resonance imaging scores, and cartilage T2 values were compared between cases and controls using Fisher exact test, Wilcoxon rank sum test, and mixed-effects models. RESULTS Cases demonstrated higher patellar height index (P = 0.002) and tibial tuberosity to trochlear groove distance (P = 0.02). Interobserver agreement for T2 values was good overall (concordance correlation coefficient range, 0.65-0.93). Cases demonstrated higher medial facet patellar bulk T2 (38.1 [7.5] ms) versus controls (33.6 [7.3] ms) (P = 0.02); otherwise, there were no significant differences in regional T2 values. CONCLUSIONS T2 mapping in patients with PFS demonstrates increased cartilage T2 in the medial patellar facet, possibly reflecting collagen alteration from early chondromalacia (softening) or increased water content related to altered contact pressures.
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32
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The importance of the third knee compartment on outcome following total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2014; 22:475-7. [PMID: 24482214 DOI: 10.1007/s00167-014-2860-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Borotikar BS, Sheehan FT. In vivo patellofemoral contact mechanics during active extension using a novel dynamic MRI-based methodology. Osteoarthritis Cartilage 2013; 21:1886-1894. [PMID: 24012620 PMCID: PMC5548374 DOI: 10.1016/j.joca.2013.08.023] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 07/23/2013] [Accepted: 08/23/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To establish an in vivo, normative patellofemoral (PF) cartilage contact mechanics database acquired during voluntary muscle control using a novel, dynamic, magnetic resonance (MR) imaging-based, computational methodology and validate the contact mechanics sensitivity to the known sub-millimeter methodological accuracies. DESIGN Dynamic cine phase-contrast and multi-plane cine (MPC) images were acquired while female subjects (n = 20, sample of convenience) performed an open kinetic chain (knee flexion-extension) exercise inside a 3-T MR scanner. Static cartilage models were created from high resolution three-dimensional static MR data and accurately placed in their dynamic pose at each time frame based on the cine-PC (CPC) data. Cartilage contact parameters were calculated based on the surface overlap. Statistical analysis was performed using paired t-test and a one-sample repeated measures ANOVA. The sensitivity of the contact parameters to the known errors in the PF kinematics was determined. RESULTS Peak mean PF contact area was 228.7 ± 173.6 mm(2) at 40° knee angle. During extension, contact centroid and peak strain locations tracked medially on the femoral and patellar cartilage and were not significantly different from each other. At 25°, 30°, 35°, and 40° of knee extension, contact area was significantly different. Contact area and centroid locations were insensitive to rotational and translational perturbations. CONCLUSION This study is a first step towards unfolding the biomechanical pathways to anterior PF pain and osteoarthritis (OA) using dynamic, in vivo, and accurate methodologies. The database provides crucial data for future studies and for validation of, or as an input to, computational models.
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Affiliation(s)
- B S Borotikar
- Functional and Applied Biomechanics Section/Rehabilitation Medicine Department, National Institutes of Health, Bethesda, MD, USA
| | - F T Sheehan
- Functional and Applied Biomechanics Section/Rehabilitation Medicine Department, National Institutes of Health, Bethesda, MD, USA.
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Stefanik JJ, Zumwalt AC, Segal NA, Lynch JA, Powers CM. Association between measures of patella height, morphologic features of the trochlea, and patellofemoral joint alignment: the MOST study. Clin Orthop Relat Res 2013; 471:2641-8. [PMID: 23546847 PMCID: PMC3705075 DOI: 10.1007/s11999-013-2942-6] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2012] [Accepted: 03/14/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patellofemoral joint (PFJ) malalignment (lateral patella displacement and tilt) has been proposed as a cause of patellofemoral pain. Patella height and/or the morphologic features of the femoral trochlea may predispose one to patella malalignment. QUESTIONS/PURPOSES The purposes of our study were to assess the associations among patella height, morphologic features of the trochlea, and measures of PFJ alignment and to determine which measures of patella height and morphologic features of the trochlea were the best predictors of PFJ alignment. METHODS Measures of patella height (Insall-Salvati ratio and modified Insall-Salvati ratio), morphologic features of the trochlea (sulcus angle, trochlear angle, lateral trochlear inclination, medial trochlear inclination), and PFJ alignment (bisect offset and patella tilt angle) were assessed in 566 knees from the Multicenter Osteoarthritis Study. RESULTS Bisect offset was correlated with the Insall-Salvati ratio (r = 0.25) and lateral trochlear inclination (r = -0.38). Patella tilt angle correlated with the trochlear angle (-0.27) and lateral trochlear inclination (-0.32). Linear regression models including the Insall-Salvati ratio and lateral trochlear inclination explained 20% and 11% of the variance in bisect offset and patella tilt angle, respectively. CONCLUSIONS Of the variables measured in the current study, the Insall-Salvati ratio and lateral trochlear inclination were the best predictors of lateral patella displacement and lateral tilt. This knowledge will aid clinicians in the identification of anatomic risk factors for PFJ malalignment and/or PFJ dysfunction.
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Affiliation(s)
- Joshua J. Stefanik
- Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, 650 Albany Street, Suite 200, Boston, MA 02118 USA
| | - Ann C. Zumwalt
- Department of Anatomy and Neurobiology, Boston University School of Medicine, 75 East Concord St, Boston, MA 02118 USA
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Freedman BR, Sheehan FT. Predicting three-dimensional patellofemoral kinematics from static imaging-based alignment measures. J Orthop Res 2013; 31:441-7. [PMID: 23097251 PMCID: PMC4447147 DOI: 10.1002/jor.22246] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Accepted: 09/19/2012] [Indexed: 02/04/2023]
Abstract
Patellofemoral pain syndrome causes significant discomfort and disability among much of the general population. Despite recent breakthroughs in dynamic three-dimensional imaging technologies to assess pathological patellofemoral motion, such tools remain costly for clinical diagnostics applications. Thus, this study investigated whether three-dimensional patellofemoral kinematics could be predicted from routine two-dimensional static measures of patellofemoral joint alignment quantified from magnetic resonance imaging (MRI) data acquired in full knee extension. Twenty-six volunteers clinically diagnosed with patellofemoral pain (19 F/7 M, 25.9 ± 11.1 years) and 26 control subjects (19 F/7 M, 25.3 ± 7.7 years) were included in this IRB-approved study. Static three-dimensional sagittal T1-weighted gradient recall echo and dynamic MRI scans were acquired. For the dynamic image acquisition, subjects cyclically flexed and extended their knee (at 30 cycles/min) while a full cine-phase contrast MRI set (24 time frames of anatomic images and x-, y-, and z-velocity images) was acquired. From these data, static measures of patellofemoral alignment and three-dimensional patellofemoral kinematics were derived. Single and multiple regressions between static and kinematic variables were evaluated. Although shown reliable, the static MRI measures could only partially predict patellofemoral kinematics, with r(2) -values ranging from 16% to 77%. This makes it imperitave that the current precise, accurate, 3D, dynamic imaging techniques be translated into clinical tools.
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Affiliation(s)
- Benjamin R Freedman
- Functional and Applied Biomechanics, Department of Rehabilitation Medicine, NIH, CRC Room 1-1469, 10 Center Drive MSC 1604, Bethesda, Maryland 10892-1604, USA
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Parikh S, Noyes FR. Patellofemoral disorders: role of computed tomography and magnetic resonance imaging in defining abnormal rotational lower limb alignment. Sports Health 2012; 3:158-69. [PMID: 23016003 PMCID: PMC3445137 DOI: 10.1177/1941738111399372] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Background: The contribution of lower limb rotational malalignment to patellofemoral pain and instability has been well recognized. The purpose of the present study is to review the role of computed tomography (CT) and magnetic resonance imaging (MRI) in assessment of abnormal rotational alignment of lower limb. Evidence Acquisition: An analysis of all available literature in the English language through 2010 was performed to provide data on a comparison between MRI and CT—specifically, the techniques and normative values used to determine abnormal lower limb alignment. Results: CT and MRI are highly accurate in defining abnormal alignment of the lower limb. Determination of axis of femoral anteversion in proximal femur has been the subject of debate in the literature. The determination of distal femoral condylar axis, proximal tibial axis and distal tibial axis are less controversial. Conclusions: CT and MRI are both used for assessing the rotational abnormalities of the femur and tibia during evaluation for patellofemoral disorders. MRI has an advantage over CT because femoral anteversion measurements are more accurate and ionizing radiation is avoided. A standardized protocol defining the level and axes for measurement of femoral and tibial alignment indices should be used to maintain consistency in measurements.
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Affiliation(s)
- Shital Parikh
- Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio
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Jibri Z, Martin D, Mansour R, Kamath S. The association of infrapatellar fat pad oedema with patellar maltracking: a case-control study. Skeletal Radiol 2012; 41:925-31. [PMID: 22012480 DOI: 10.1007/s00256-011-1299-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2011] [Revised: 08/21/2011] [Accepted: 09/23/2011] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To look for any association between oedema in the superolateral portion of the infrapatellar fat pad and patellar maltracking. MATERIALS AND METHODS We compared two groups of knee MRI with regard to five patellar maltracking parameters. The first group included 100 knees with evidence of oedema in the superolateral aspect of the infrapatellar fat pad (the study group). The second group included another 100 knee MRI that had a normal infrapatellar fat pad (the control group). The five patellar maltracking parameters assessed were the trochlear depth, tibial tuberosity-trochlear groove distance (TTTG), patellar translation, patellofemoral angle (PFA) and the Insall-Salvati index. RESULTS There was a statistically significant difference in the Insall-Salvati index, patellar translation and PFA between the two groups (p value of <0.001, <0.001 and 0.004 respectively, Student's t test). There was a higher prevalence of patella alta, lateral patellar displacement (LPD) and lateral patellar tilt in the study group (p value of <0.001, <0.001 and 0.011 respectively, Fisher's exact test). Sixty out of 100 knees in the study group had at least one abnormal patellar maltracking parameter in comparison to 16 out of 100 knees in the control group (p < 0.001, Fisher's exact test). CONCLUSION Oedema in the superolateral portion of Hoffa's fat pad, the MRI feature of fat pad impingement, is associated with patellar maltracking.
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Affiliation(s)
- Zaid Jibri
- Department of Radiology, University Hospital of Wales, Cardiff, United Kingdom.
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Sheehan FT, Borotikar BS, Behnam AJ, Alter KE. Alterations in in vivo knee joint kinematics following a femoral nerve branch block of the vastus medialis: Implications for patellofemoral pain syndrome. Clin Biomech (Bristol, Avon) 2012; 27:525-31. [PMID: 22244738 PMCID: PMC3328589 DOI: 10.1016/j.clinbiomech.2011.12.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Revised: 12/12/2011] [Accepted: 12/13/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND A potential source of patellofemoral pain, one of the most common problems of the knee, is believed to be altered patellofemoral kinematics due to a force imbalance around the knee. Although no definitive etiology for this imbalance has been found, a weak vastus medialis is considered a primary factor. Therefore, this study's purpose was to determine how the loss of vastus medialis obliquus force alters three-dimensional in vivo knee joint kinematics during a volitional extension task. METHODS Eighteen asymptomatic female subjects with no history of knee pain or pathology participated in this IRB approved study. Patellofemoral and tibiofemoral kinematics were derived from velocity data acquired using dynamic cine-phase contrast MRI. The same kinematics were then acquired immediately after administering a motor branch block to the vastus medialis obliquus using 3-5ml of 1% lidocaine. A repeated measures analysis of variance was used to test the null hypothesis that the post- and pre-injection kinematics were no different. FINDINGS The null hypothesis was rejected for patellofemoral lateral shift (P=0.003, max change=1.8mm, standard deviation=1.7mm), tibiofemoral lateral shift (P<0.001, max change=2.1mm, standard deviation=2.9mm), and tibiofemoral external rotation (P<0.001, max change=3.7°, standard deviation=4.4°). INTERPRETATION The loss of vastus medialis obliquus function produced kinematic changes that mirrored the axial plane kinematics seen in individuals with patellofemoral pain, but could not account for the full extent of these changes. Thus, vastus medialis weakness is likely a major factor in, but not the sole source of, altered patellofemoral kinematics in such individuals.
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Affiliation(s)
- Frances T. Sheehan
- Functional and Applied Biomechanics Section/Rehabilitation Medicine Department, National Institutes of Health, Bethesda, MD
| | - Bhushan S. Borotikar
- Functional and Applied Biomechanics Section/Rehabilitation Medicine Department, National Institutes of Health, Bethesda, MD
| | - Abrahm J Behnam
- Functional and Applied Biomechanics Section/Rehabilitation Medicine Department, National Institutes of Health, Bethesda, MD
| | - Katharine E. Alter
- Functional and Applied Biomechanics Section/Rehabilitation Medicine Department, National Institutes of Health, Bethesda, MD,Mt. Washington Pediatric Hospital, Baltimore, MD, an affiliate of Johns Hopkins Health System Corp and Maryland Medical System Corp
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Borotikar BS, Sipprell WH, Wible EE, Sheehan FT. A methodology to accurately quantify patellofemoral cartilage contact kinematics by combining 3D image shape registration and cine-PC MRI velocity data. J Biomech 2012; 45:1117-22. [PMID: 22284428 PMCID: PMC3310346 DOI: 10.1016/j.jbiomech.2011.12.025] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Revised: 11/28/2011] [Accepted: 12/31/2011] [Indexed: 11/27/2022]
Abstract
Patellofemoral osteoarthritis and its potential precursor patellofemoral pain syndrome (PFPS) are common, costly, and debilitating diseases. PFPS has been shown to be associated with altered patellofemoral joint mechanics; however, an actual variation in joint contact stresses has not been established due to challenges in accurately quantifying in vivo contact kinematics (area and location). This study developed and validated a method for tracking dynamic, in vivo cartilage contact kinematics by combining three magnetic resonance imaging (MRI) techniques, cine-phase contrast (CPC), multi-plane cine (MPC), and 3D high-resolution static imaging. CPC and MPC data were acquired from 12 healthy volunteers while they actively extended/flexed their knee within the MRI scanner. Since no gold standard exists for the quantification of in vivo dynamic cartilage contact kinematics, the accuracy of tracking a single point (patellar origin relative to the femur) represented the accuracy of tracking the kinematics of an entire surface. The accuracy was determined by the average absolute error between the PF kinematics derived through registration of MPC images to a static model and those derived through integration of the CPC velocity data. The accuracy ranged from 0.47 mm to 0.77 mm for the patella and femur and from 0.68 mm to 0.86 mm for the patellofemoral joint. For purely quantifying joint kinematics, CPC remains an analytically simpler and more accurate (accuracy <0.33 mm) technique. However, for application requiring the tracking of an entire surface, such as quantifying cartilage contact kinematics, this combined imaging approach produces accurate results with minimal operator intervention.
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Affiliation(s)
- Bhushan S. Borotikar
- Functional and Applied Biomechanics, Department of Rehabilitation Medicine, NIH, Bethesda, MD, USA
| | - William H. Sipprell
- University at Buffalo, School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Emily E. Wible
- Functional and Applied Biomechanics, Department of Rehabilitation Medicine, NIH, Bethesda, MD, USA
| | - Frances T. Sheehan
- Functional and Applied Biomechanics, Department of Rehabilitation Medicine, NIH, Bethesda, MD, USA
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