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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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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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Takashima Y, Nakano N, Ishida K, Kamenaga T, Tsubosaka M, Kuroda Y, Hayashi S, Kuroda R, Matsumoto T. Effects of Femoral Component Design on the Deepest Point Position of the Trochlear Grove in Kinematically Aligned Total Knee Arthroplasty: A Comparison of Four Prothesis Designs. J Knee Surg 2023; 36:1316-1322. [PMID: 36150661 DOI: 10.1055/s-0042-1756502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The aim of the study is to explore and compare the differences in trochlear shape and knee anatomy between four types of prostheses and preoperative native knee matched with preoperative computed tomography (CT). Thirty patients were scheduled for primary kinematically aligned total knee arthroplasty (TKA) for varus knee osteoarthritis at our hospital and the region between their pelvis to ankle joint was simulated using a CT-based three-dimensional planning software. The axial plane containing the transepicondylar axis was set as Slice A, and the 10-mm distal plane from Slice A was set as Slice B. The distances to the deepest trochlear groove between the native knee and each prosthesis and the medial and lateral facet heights were compared among the four groups. The deepest femoral trochlear groove of the prostheses was located 1.6 to 3.0 mm more medial than that of the native knee, and in the Persona group, it was significantly more medial than in the e-motion or Triathlon groups on both Slices A and B. The native knee and the medial and lateral facet heights of the four prostheses on both Slices A and B were significantly lower than those of preoperative native knees when femoral prostheses were set in the kinematically aligned (KA)-TKA position. The deepest point of the trochlear groove of the Persona group was the most medial among the four prostheses studied, and the deepest points differed depending on the prosthesis design in KA-TKA. Thus, surgeons should carefully select the type of prostheses used in KA-TKA.
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Affiliation(s)
- Yoshinori Takashima
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Naoki Nakano
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kazunari Ishida
- Department of Orthopedic Surgery, Kobe Kaisei Hospital, Kobe, Japan
| | - Tomoyuki Kamenaga
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masanori Tsubosaka
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yuichi Kuroda
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shinya Hayashi
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ryosuke Kuroda
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Matsumoto T, Nakano N, Ishida K, Takashima Y, Maeda T, Kuroda Y, Hayashi S, Matsushita T, Niikura T, Muratsu H, Kuroda R. The Effect of Prosthesis Type on Intraoperative Soft-Tissue Balance and Clinical Outcomes in Modified Kinematically Aligned Cruciate-Retaining Total Knee Arthroplasty. J Knee Surg 2022. [PMID: 35817057 DOI: 10.1055/s-0042-1748895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Kinematically aligned total knee arthroplasty (KA-TKA) has gained interest for achieving more favorable clinical outcomes than mechanically aligned TKA. One of the advantages of KA-TKA is reported to be an easy acquisition of intraoperative soft-tissue balance without excessive medial release for varus osteoarthritis. However, we hypothesized that the prosthesis type affects intraoperative soft-tissue balance even in the KA-TKA. The present study aimed to compare intraoperative soft-tissue balance and clinical outcomes of KA-TKAs using single-radius (SR) or multiradius (MR) prostheses. MATERIALS AND METHODS: Consecutive 70 cruciate-retaining modified KA-TKAs (31 SR and 39 MR) were performed in patients with varus-type osteoarthritis using a navigation system. Intraoperative soft-tissue balance including joint component gap and varus/valgus balance was measured with femoral component placement and patellofemoral joint reduction throughout the range of motion using offset-type tensor and compared between the two groups. Two years postoperatively, the range of motion and 2011 Knee Society Scores were compared between the two groups. RESULTS AND CONCLUSION Joint component gaps showed no significant differences between the two groups from 0 to 30 degrees of flexion. However, during 60 to 120 degrees of flexion, joint component gaps of SR group showed significantly larger values than those of MR group (p < 0.05). There were no significant differences in varus/valgus balance throughout the range of motion between the two groups. The postoperative clinical outcomes showed no significant differences between the two groups. INTERPRETATION Despite no difference in clinical outcomes, joint component gap showed different patterns due to the prosthesis type in modified KA-TKAs.
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Affiliation(s)
- Tomoyuki Matsumoto
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Chuo-ku, Kobe, Japan
| | - Naoki Nakano
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Chuo-ku, Kobe, Japan
| | - Kazunari Ishida
- Department of Orthopedic Surgery, Kobe Kaisei Hospital, Kobe, Japan
| | - Yoshinori Takashima
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Chuo-ku, Kobe, Japan
| | - Toshihisa Maeda
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Chuo-ku, Kobe, Japan
| | - Yuichi Kuroda
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Chuo-ku, Kobe, Japan
| | - Shinya Hayashi
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Chuo-ku, Kobe, Japan
| | - Tekehiko Matsushita
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Chuo-ku, Kobe, Japan
| | - Takahiro Niikura
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Chuo-ku, Kobe, Japan
| | - Hirotsugu Muratsu
- Department of Orthopedic Surgery, Steel Memorial Hirohata Hospital, Himeji, Japan
| | - Ryosuke Kuroda
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Chuo-ku, Kobe, Japan
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Matsumoto T, Takashima Y, Takayama K, Ishida K, Nakano N, Kuroda Y, Tsubosaka M, Kamenaga T, Matsushita T, Niikura T, Hayashi S, Kuroda R. Comparison between Single- and Multi-Radius Prostheses Used in Modified Kinematically Aligned Cruciate-Retaining Total Knee Arthroplasty. J Knee Surg 2022; 35:1004-1009. [PMID: 33368061 DOI: 10.1055/s-0040-1721413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Kinematically aligned total knee arthroplasty (TKA) has gained interest for achieving more favorable clinical outcomes than mechanically aligned TKA. The present study aimed to compare the clinical outcomes of kinematically aligned TKAs using single-radius (SR) or multi-radius (MR) prostheses. Sixty modified kinematically aligned cruciate-retaining TKAs (30 SR and 30 MR type prostheses) were performed in patients with varus-type osteoarthritis using a navigation system. Intraoperative and postoperative patellar tracking were compared between the two groups. Trochlea shape was also compared between the prostheses and preoperative native anatomy using three-dimensional simulation software. Total 2 years postoperatively, the range of motion and 2011 Knee Society Scores (KSS) were compared between the two groups. There were no differences in patellar maltracking including patellar lateral shift and tilt between the two groups; however, the ratio of intraoperative lateral retinacular release for adjusting patellar tracking was significantly higher in the MR group than in the SR group. Lateral and medial facet heights in both prostheses were understuffed compared with native knee anatomy, while the deepest point of the trochlear groove was significantly more medial in the MR group. The postoperative clinical outcomes showed no significant differences between the two groups. In conclusion, modified kinematically aligned TKAs using a SR or MR prosthesis showed no significant differences in clinical outcomes or patellar tracking when appropriate lateral retinacular release was performed.
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Affiliation(s)
- Tomoyuki Matsumoto
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Chuo-ku, Kobe, Japan
| | - Yoshinori Takashima
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Chuo-ku, Kobe, Japan
| | - Koji Takayama
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Chuo-ku, Kobe, Japan
| | - Kazunari Ishida
- Department of Orthopedic Surgery, Kobe Kaisei Hospital, Kobe, Japan
| | - Naoki Nakano
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Chuo-ku, Kobe, Japan
| | - Yuichi Kuroda
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Chuo-ku, Kobe, Japan
| | - Masanori Tsubosaka
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Chuo-ku, Kobe, Japan
| | - Tomoyuki Kamenaga
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Chuo-ku, Kobe, Japan
| | - Takehiko Matsushita
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Chuo-ku, Kobe, Japan
| | - Takahiro Niikura
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Chuo-ku, Kobe, Japan
| | - Shinya Hayashi
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Chuo-ku, Kobe, Japan
| | - Ryosuke Kuroda
- Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Chuo-ku, Kobe, Japan
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Hart HF, Patterson BE, Crossley KM, Culvenor AG, Khan MCM, King MG, Sritharan P. May the force be with you: understanding how patellofemoral joint reaction force compares across different activities and physical interventions-a systematic review and meta-analysis. Br J Sports Med 2022; 56:521-530. [PMID: 35115309 DOI: 10.1136/bjsports-2021-104686] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To systematically review and synthesise patellofemoral joint reaction force (PFJRF) in healthy individuals and those with patellofemoral pain and osteoarthritis (OA), during everyday activities, therapeutic exercises and with physical interventions (eg, foot orthotics, footwear, taping, bracing). DESIGN A systematic review with meta-analysis. DATA SOURCES Medline, Embase, Scopus, CINAHL, SportDiscus and Cochrane Library databases were searched. ELIGIBILITY CRITERIA Observational and interventional studies reporting PFJRF during everyday activities, therapeutic exercises, and physical interventions. RESULTS In healthy individuals, the weighted average of mean (±SD) peak PFJRF for everyday activities were: walking 0.9±0.4 body weight (BW), stair ascent 3.2±0.7 BW, stair descent 2.8±0.5 BW and running 5.2±1.2 BW. In those with patellofemoral pain, peak PFJRF were: walking 0.8±0.2 BW, stair ascent 2.5±0.5 BW, stair descent 2.6±0.5 BW, running 4.1±0.9 BW. Only single studies reported peak PFJRF during everyday activities in individuals with patellofemoral OA/articular cartilage defects (walking 1.3±0.5 BW, stair ascent 1.6±0.4 BW, stair descent 1.0±0.5 BW). The PFJRF was reported for many different exercises and physical interventions; however, considerable variability precluded any pooled estimates. SUMMARY Everyday activities and exercises involving larger knee flexion (eg, squatting) expose the patellofemoral joint to higher PFJRF than those involving smaller knee flexion (eg, walking). There were no discernable differences in peak PFJRF during everyday activities between healthy individuals and those with patellofemoral pain/OA. The information on PFJRF may be used to select appropriate variations of exercises and physical interventions.
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Affiliation(s)
- Harvi F Hart
- La Trobe Sports and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia .,Department of Physical Therapy, Western University, London, Ontario, Canada
| | - Brooke E Patterson
- La Trobe Sports and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Kay M Crossley
- La Trobe Sports and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Adam G Culvenor
- La Trobe Sports and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Michaela C M Khan
- Motion Analysis and Biofeedback Laboratory, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Matthew G King
- La Trobe Sports and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Prasanna Sritharan
- La Trobe Sports and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia
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Immonen J, Stevens K, Albin A, Chaus D, Gilmer L, Zdilla M. Assessment of the Degree of Osteoarthritis in Aging Male and Female Femoral Condyles: A Cadaveric Study. Cartilage 2021; 13:1684S-1695S. [PMID: 32396386 PMCID: PMC8808813 DOI: 10.1177/1947603520916530] [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] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Determine if femoral chondral cartilage degeneration on cadaveric knee joints exacerbate differently with aging between the sexes. METHODS A total of 85 cadaveric femurs were assessed for macroscopic femoral condyle pathology using a scale for gross signs of osteoarthritis. Raters scored specimens and raters' scores were averaged to provide each specimen a Disease Severity Score (DSS). RESULTS The DSS for the 80+-year-old population was greater than the DSS of the 70- to 79-year-old population (*P < 0.05) and the <70-year-old population (**P < 0.01). Specimens that scored a DSS of 2 and higher were assessed for their specific site of most severe degeneration. The most severe degeneration on the articular cartilage was most regularly on the patellar fossa. The second most degenerated region varied by age and biomechanical alterations. There were no significant changes in DSS between the sexes within the age groups. CONCLUSIONS No difference was shown between the sexes in the severity or location of degeneration indicating that men and women are likely affected by the same biomechanical changes that spur on osteoarthritis in their eighth decade of life (70s) and later. Lateral femoral degeneration predominates in younger populations. When patients approach their 70s, medial degeneration begins to predominate likely based on an increase in shearing at the knee joint.
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Affiliation(s)
- Jessica Immonen
- Department of Physical Therapy, Rocky
Mountain University of Health Professions, Provo, UT, USA
| | - Kelsey Stevens
- Department of Physical Therapy, Rocky
Mountain University of Health Professions, Provo, UT, USA
| | - Alexa Albin
- Department of Anatomy and Neurobiology,
University of Utah, Salt Lake City, UT, USA
| | - David Chaus
- Department of Anatomy and Neurobiology,
University of Utah, Salt Lake City, UT, USA
| | - Lesley Gilmer
- Department of Physical Therapy, Rocky
Mountain University of Health Professions, Provo, UT, USA
| | - Matthew Zdilla
- Departments of Natural Sciences &
Mathematics and Graduate Health Sciences, West Liberty University, West Liberty, WV,
USA
- Department of Pathology, Anatomy, and
Laboratory Medicine, West Virginia University School of Medicine, Morgantown, WV,
USA
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8
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Macri EM, Crossley KM, Hart HF, d'Entremont AG, Forster BB, Ratzlaff CR, Wilson DR, Khan KM. Clinical findings in patellofemoral osteoarthritis compared to individually-matched controls: a pilot study. BMJ Open Sport Exerc Med 2021; 6:e000877. [PMID: 34422286 PMCID: PMC8323464 DOI: 10.1136/bmjsem-2020-000877] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 09/28/2020] [Accepted: 11/12/2020] [Indexed: 12/02/2022] Open
Abstract
Objective To explore clinical characteristics in individuals with patellofemoral osteoarthritis (PFOA) compared to individually-matched asymptomatic controls. We also explored associations between functional performance and patient-reported symptoms with patellofemoral alignment. Methods We assessed 15 individuals with PFOA and 15 individually-matched asymptomatic controls. In addition to physical examination and patient-reported questionnaires, we evaluated functional performance, lower extremity strength and range of motion, and patellar alignment (using MRI). We analysed group differences with Wilcoxon’s matched-pairs signed rank tests, and within-group associations with Spearman’s rank correlations. Results We included 24 (80%) women with median (IQR) age of 56 (9) years and BMI of 22.8 (5.9) kg/m2. Individuals with PFOA reported lower quality of life (8/100 points lower EQ-5D-5L, p=0.02), and performed worse on two functional tests: repeated one-leg rises (median 16 fewer rises, p=0.04) and timed stair climb (1.2 s slower, p=0.03). There were no differences in strength tests performed or range of motion. Patellar proximal translation correlated with worse functional performance and worse patient-reported pain, function and self-efficacy, while lateral translation and lateral tilt correlated with worse knee-related quality of life (Spearman’s r ranging from 0.5 to 0.7). Conclusion Functional performance was worse in individuals with PFOA, despite those individuals having no significant differences on lower extremity strength testing. Patellofemoral alignment was associated with worse functional performance as well as worse patient-reported outcomes, and it may represent one mechanism underpinning PFOA-related symptoms.
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Affiliation(s)
- Erin M Macri
- Department of Family Practice, The University of British Columbia, Vancouver, Canada.,Department of General Practice; Department of Orthopaedics and Sport Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Kay M Crossley
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia
| | - Harvi F Hart
- Department of Physical Therapy, Western University, London, Canada
| | - Agnes G d'Entremont
- Department of Mechanical Engineering, The University of British Columbia, Vancouver, Canada
| | - Bruce B Forster
- Department of Radiology, The University of British Columbia Faculty of Medicine, Vancouver, Canada
| | - Charles R Ratzlaff
- Department of Physical Therapy, The University of British Columbia, Vancouver, Canada
| | - David R Wilson
- Department of Orthopaedics, The University of British Columbia, Vancouver, Canada
| | - Karim M Khan
- Department of Family Practice, The University of British Columbia, Vancouver, Canada
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9
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Ashraf Y, Iqbal HJ, Senevirathana S, Ashraf T. Has the modern design of Attune total knee replacement improved outcome in patients with isolated patellofemoral arthritis? J Orthop Surg (Hong Kong) 2021; 28:2309499020975553. [PMID: 33272080 DOI: 10.1177/2309499020975553] [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] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION AND AIM Modern knee replacements aim to improve patient function in arthritis affecting different compartments of the knee. This study evaluates the Patient Reported Outcome Measure (PROM) and functional outcome of a modern total knee replacement (Attune, DePuy) in patients with isolated patellofemoral arthritis. METHODS A total of 50 consecutive patients with isolated unilateral patellofemoral arthritis having had Attune total knee replacements at a single institution between 2010 and 2016 were prospectively studied. Five patients who developed symptoms on the opposite side during the study and two patients lost to follow-up were excluded. One patient needed early revision for loosening, leaving a total of 42 patients to be followed up over a period of 4 years. The Oxford Knee score (OKS) and Knee Injury and Osteoarthritis Outcome Score (KOOS) recorded pre-operatively and at follow-up was compared. A Functional assessment at around 8 months after operation was undertaken. RESULTS At average follow-up of 24 months the mean OKS score improved by 15 points and the KOOS score improved by 20 points. Final KOOS sub-score for Pain was 80, Symptom 80, and ADL 82, Sports & Recreation 32 and QOL 60. Functional assessment at mean 8 months showed that a significant number of patients were able to Kneel (50%); Sit cross legged (23%); sit on their heel (23%) and were able do a single leg dip test (86%). CONCLUSION This unique study of a modern design total knee replacement (Attune) in patients with isolated unilateral patellofemoral arthritis shows good PROM scores at 2 years and good functional assessment results at 8 months. The PROM scores are marginally better than the published results with Attune's predecessor, in a similar cohort of patients, but falls short of the published results of patellofemoral replacement implants. Large randomised comparative studies between traditional and the modern implant design is recommended to answer the question if design modification has influenced clinical outcome in patients with patellofemoral arthritis.
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Zimmermann F, Milinkovic DD, Balcarek P. Outcomes After Deepening Trochleoplasty and Concomitant Realignment in Patients With Severe Trochlear Dysplasia With Chronic Patellofemoral Pain: Results at 2-Year Follow-up. Orthop J Sports Med 2021; 9:23259671211010404. [PMID: 34164556 PMCID: PMC8191084 DOI: 10.1177/23259671211010404] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 01/05/2021] [Indexed: 01/26/2023] Open
Abstract
Background Abnormal patellofemoral joint stress appears to have major relevance in a subgroup of patients with patellofemoral pain (PFP). Purpose To evaluate whether patients with chronic PFP and trochlear dysplasia-induced patellofemoral joint malalignment benefit from a deepening trochleoplasty procedure with the aim of improving patellotrochlear congruence. Study Design Case series; Level of evidence, 4. Methods Included were 15 patients (male/female, 1/14; mean age, 30.3 years [range, 19-51 years]) with 8.8 years (range, 1-20 years) of chronic PFP and severe trochlear dysplasia. All patients underwent correction of patellotrochlear malalignment with deepening trochleoplasty and concomitant realignment procedures. The Kujala score and a numerical analog scale (0-10) for intensity of pain were used to assess symptoms preoperatively and at 12 and 24 months postoperatively. Pre- and postoperative magnetic resonance imaging (MRI) scans from the patients were compared with the MRI scans of age- and sex-matched controls regarding the patellotrochlear contact area and contact ratio, patellar tilt, patellotrochlear index, and lateral trochlear inclination (LTI) angle. Results The Kujala score increased from a mean of 55 (range, 15-81) preoperatively to 82.5 (range, 53-98) after 12 months (95% CI, -42.56 to -12.37; P < .001) and to 84.2 (range, 59-99) after 24 months (95% CI, -44.29 to -14.11; P < .001). The intensity of PFP decreased from 5.7 (range, 3-10) preoperatively to 1.4 (range, 0-4) after 12 months (95% CI, 2.57 to 5.96; P < .001) and had a mean of 1.6 (range, 0-6) after 24 months (95% CI, 2.44 to 5.75; P < .001). Preoperatively, parameters in the study group indicated significant patellotrochlear malalignment, which improved and normalized (except for the LTI angle) postoperatively compared with the values of the control group (P > .05). Conclusion In a subgroup of patients with chronic PFP due to severe trochlear dysplasia, deepening trochleoplasty and concomitant realignment procedures significantly reduced pain and improved knee joint function while normalizing patellotrochlear congruence.
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Affiliation(s)
| | | | - Peter Balcarek
- Arcus Sportklinik, Pforzheim, Germany.,Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University of Göttingen, Göttingen, Germany
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Aarvold A, Lohre R, Chhina H, Mulpuri K, Cooper A. Dynamic deformation of the femoral head occurs on weightbearing in Legg-Calves-Perthes disease: a translational pilot study. Bone Jt Open 2020; 1:364-369. [PMID: 33215126 PMCID: PMC7659704 DOI: 10.1302/2633-1462.17.bjo-2020-0030.r1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Aims Though the pathogenesis of Legg-Calve-Perthes disease (LCPD) is unknown, repetitive microtrauma resulting in deformity has been postulated. The purpose of this study is to trial a novel upright MRI scanner, to determine whether any deformation occurs in femoral heads affected by LCPD with weightbearing. Methods Children affected by LCPD were recruited for analysis. Children received both standing weightbearing and supine scans in the MROpen upright MRI scanner, for coronal T1 GFE sequences, both hips in field of view. Parameters of femoral head height, width, and lateral extrusion of affected and unaffected hips were assessed by two independent raters, repeated at a one month interval. Inter- and intraclass correlation coefficients were determined. Standing and supine measurements were compared for each femoral head. Results Following rigorous protocol development in healthy age-matched volunteers, successful scanning was performed in 11 LCPD-affected hips in nine children, with seven unaffected hips therefore available for comparison. Five hips were in early stage (1 and 2) and six were in late stage (3 and 4). The mean age was 5.3 years. All hips in early-stage LCPD demonstrated dynamic deformity on weightbearing. Femoral head height decreased (mean 1.2 mm, 12.4% decrease), width increased (mean 2.5 mm, 7.2% increase), and lateral extrusion increased (median 2.5 mm, 23% increase) on standing weightbearing MRI compared to supine scans. Negligible deformation was observed in contra-lateral unaffected hips, with less deformation observed in late-stage hips. Inter- and intraclass reliability for all measured parameters was good to excellent. Conclusion This pilot study has described an effective novel research investigation for children with LCPD. Femoral heads in early-stage LCPD demonstrated dynamic deformity on weightbearing not previously seen, while unaffected hips did not. Expansion of this protocol will allow further translational study into the effects of loading hips with LCPD. Cite this article: Bone Joint Open 2020;1-7:364–369.
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Affiliation(s)
- Alexander Aarvold
- Southampton Children's Hospital, Southampton, UK.,Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ryan Lohre
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Harpreet Chhina
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kishore Mulpuri
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anthony Cooper
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
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