Chondromalacia Patella among Military Recruits with Anterior Knee Pain: Prevalence and Association with Patellofemoral Malalignment

Relationship between patellofemoral joint morphology and chondromalacia patella

BACKGROUND

For the normal functioning of the patellofemoral joint (PF), the relationship between the patella and the trochlear groove must be compatible.

PURPOSE

To investigate the relationship between patellofemoral joint morphology (PFM) and patellar chondromalacia.

MATERIAL AND METHODS

Overall, 136 knees of patients aged 20-55 years examined between March 2020 and March 2021 were included in this study. In all patients, trochlear sulcus angle, trochlear sulcus depth, trochlear facet asymmetry, patella alta (Insall-Salvati [IS] index), and patellar facet asymmetry were measured. Of these cases, 66 knees with an abnormality detected in any of the measurements for PFM were included in the case group. Moreover, 70 knees with demonstrating normal PFM measurements were included in the control group.

RESULTS

The incidence and grade of chondromalacia was higher in the case group than in the control group (P < 0.001). Between the patients with and without chondromalacia trochlear sulcus angle (mean = 138.25° ± 10.02° vs. 132.58° ± 7.24°; P = 0.001), IS index (mean = 1.25 ± 0.21 vs. 1.16 ± 0.15; P = 0.014), patellar facet asymmetry (mean = 0.77 ± 0.09 vs. 0.73 ± 0.12; P = 0.039), trochlear sulcus depth (mean = 5.39 ± 1.42 mm vs. 6.27 ± 1.04 mm; P < 0.001), and trochlear facet asymmetry (mean = 0.67 ± 0.11 vs. 0.71 ± 0.09; P = 0.023) measurements, there was a significant difference.

CONCLUSION

The presence of at least one of the measures indicating pathology in PFM is associated with the presence and severity of chondromalacia.

Persistent underloading of patellofemoral joint following hamstring autograft ACL reconstruction is associated with cartilage health

OBJECTIVE

To determine the longitudinal changes of patellofemoral joint (PFJ) contact pressure following anterior cruciate ligament reconstruction (ACLR). To identify the associations between PFJ contact pressure and cartilage health.

DESIGN

Forty-nine subjects with hamstring autograft ACLR (27 males; age 28.8 [standard deviation, 8.3] years) and 19 controls (12 males; 30.7 [4.6] years) participated. A sagittal plane musculoskeletal model was used to estimate PFJ contact pressure. A combined T1ρ/T2 magnetic resonance sequence was obtained. Assessments were performed preoperatively, at 6 months, 1, 2, and 3 years postoperatively in ACLR subjects and once for controls. Repeated Analysis of Variance (ANOVA) was used to compare peak PFJ contact pressure between ACLR and contralateral knees, and t-tests to compare with control knees. Statistical parametric mapping was used to evaluate the associations between PFJ contact pressure and cartilage relaxation concurrently and longitudinally.

RESULTS

No changes in peak PFJ contact pressure were found within ACLR knees over 3 years (preoperative to 3 years, 0.36 [CI, -0.08, 0.81] MPa), but decreased over time in the contralateral knees (0.75 [0.32, 1.18] MPa). When compared to the controls, ACLR knees exhibited lower PFJ contact pressure at all time points (at baseline, -0.64 [-1.25, -0.03] MPa). Within ACLR knees, lower PFJ contact pressure at 6 months was associated with elevated T2 times (r = -0.47 to -0.49, p = 0.021-0.025).

CONCLUSIONS

Underloading of the PFJ following ACLR persists for up to 3 years and has concurrent and future consequences in cartilage health. The non-surgical knees exhibited normal contact pressure initially but decreased over time achieving limb symmetry.

Chondromalacia patella increases the risk of herpes zoster: a population-based study

BACKGROUND

The reactivation of herpes zoster (HZ) is associated with disease stress. However, the relationship between chondromalacia patella (CMP) and HZ remains poorly understood. This study investigated the relationship between CMP and the risk of developing HZ.

METHODS

Data were collected from the Taiwan's National Health Insurance Research Database. Patients with CMP diagnosed between 2000 and 2017 were assigned to the case group; patients without CMP were randomly selected from the same database and paired with controls matched by age and sex. The primary outcome was a diagnosis of HZ. All patients were followed until their diagnosis of HZ, their withdrawal from the NHI program, their death, or the end of 2017, whichever was earliest. The risk of developing HZ was compared between the case and control groups.

RESULTS

In total, 22,710 patients with CMP and 90,840 matched controls were enrolled. The overall incidence rates of HZ in the CMP and control cohorts were 7.94 and 7.35 per 1,000 person-years, respectively. After potential confounders were controlled for, the case group exhibited a higher risk of HZ than did the control group [adjusted hazard ratio (aHR) = 1.06, p < 0.05]. In a stratification analysis by age, patients over 65 years old in the CMP group exhibited a higher risk of HZ than did those in the control group (aHR = 1.22, p < 0.01). In a stratification analysis by sex, women with CMP were at greater risk of developing HZ than women without CMP (aHR = 1.18, p < 0.01).

CONCLUSION

Patients with CMP, especially elder adults and women, exhibited a higher risk of HZ. The HZ risk of patients with CMP should thus be assessed, and the necessity of HZ vaccination should be informed.

Comparison of the Superiority of Quadriceps Strengthening Isometric and Isotonic Exercises with Respect to Pain, Quality of Life, and Functional Capacity of Patients with Chondromalacia Patellae

Purpose: This study aims to investigate the superiority of different exercise modalities, including isotonic and isometric strengthening for quadriceps, over each other and their effect on pain, quality of life and functional capacity in patients diagnosed with chondromalacia patellae (CMP). Methods: This study was designed as a prospective study in 30 patients(15 patients in isometric, 15 patients in isotonic group) and 15 healthy volunteers aged 20–50 years who were diagnosed with CMP based on physical examination and magnetic resonance imaging and had pain complaints. Pain level was evaluated with Visual Analogue Scala (VAS), functional capacity with Lysholm scale, and quality of life with Short Form-36(SF-36). Q-angle, and thigh circumference were evaluated before and after exercise in all patients. Results: In patients with CMP, there were significant differences in Q-angle, pain, functional capacity, and some subcomponents of the SF-36 quality of life after performing isometric or isotonic exercises compared with the control group (p0,05). In the evaluation of the isotonic and isometric exercise groups, there were no significant difference in the assessment of Q-angle, thigh circumference, pain, functional capacity, and quality of life of patients with CMP (p>0,05). Conclusion: Isometric and isotonic quadriceps strengthening exercises are not superior to each other in terms of pain, functional capacity, and quality of life in CMP treatment.

Association of markers of patellofemoral maltracking to cartilage damage and bone marrow lesions on MRI: Data from the 2016 Olympic Games of Rio De Janeiro

Background

Patellofemoral joint (PFJ) disease is a common ailment in elite athletes. Our aim is to report the frequency of superolateral Hoffa’s fat pad (SHFP) edema, and PFJ cartilage damage and bone marrow lesions (BML), among Olympian athletes, and to study the association between measurements of trochlear morphology and vertical patellar position and a) PFJ cartilage damage or BML, and b) SHFP edema.

Methods

All knee MRI, performed in the Olympic Village and polyclinics, of participating athletes in the 2016 Olympic Games of Rio de Janeiro were included. MRI were scored for PFJ cartilage damage and BML, and SHFP edema. Trochlear morphology measurements included sulcus angle, trochlear angle, lateral trochlear inclination, and medial trochlear inclination. Insall-Salvati ratio was also assessed.

Results

One hundred twenty-one knee MRIs were included (62 female, 51.2 %). The highest frequencies of PFJ cartilage damage, combination of PFJ cartilage damage and BML, and SHFP edema were found among Beach Volleyball and Volleyball athletes. SHFP edema was more common among female compared to male Olympian athletes. We found no statistically significant associations between different measurements of trochlear morphology/vertical patellar position, and 1. SHFP edema, and 2. PFJ cartilage damage/BML.

Conclusion

SHFP edema and the combination of PFJ cartilage damage and BML are highly frequent among Olympic athletes especially those competing in Beach volleyball and Volleyball. SHFP edema is more common among female athletes. Further studies are needed to determine whether PFJ cartilage damage has a stronger association to sports disciplines rather than trochlear morphology.

Correlation between Chondromalacia Patella and Patellofemoral Factors in Middle-Age Population: A Clinical, Functional, and Radiological Analysis

Background Despite higher incidence of patellofemoral pain (PFP) and consequently morbidity, the understanding about PF factors leading to PF arthritis is way lacking.

Material and Methods A prospective study of first 80 patients who were diagnosed with chondromalacia patella (CMP) on magnetic resonance imaging (MRI) divided into early and late CMP groups were evaluated clinically, radiologically, and in terms of functional outcome.

Results : Quadriceps angle, Clark’s test, and Insall–Salvati ratio results were nonsignificant despite greater values were observed in late CMP group, whereas trochlear morphology results (sulcus angle: 153:138 degrees and sulcus depth 3.9:5.4 mm) and clinical scores were significant in late CMP group (Kujala’s score: 61:78, whereas PF pain score: 43:25). Type-C patellar morphology was found in greater number in late CMP cohort.

Conclusion Trochlear and patellar morphologies along with clinical scores play a key role in understanding of the CMP.

Patella-patellar tendon angle and lateral patella-tilt angle decrease patients with chondromalacia patella

PURPOSE

The aim of the present study was to evaluate the effect of patellofemoral joint morphology and patellar alignment (lateral patellar tilt and sagittal patellar tilt) on the presence and stage of CP, and identify the differences between sexes.

METHODS

MRI of 243 patients [146 men (60.1%)] were evaluated retrospectively. Patients were grouped as normal group without chondromalacia, group with mild chondromalacia (grades 1-2) and group with severe chondromalacia (grades 3-4). Sagittal patellofemoral alignment was assessed by the angle between the patella and patellar tendon (P-PTA), and the angle between the quadriceps tendon and patella (Q-PA). Patellar tilt was assessed by lateral patellar tilt angle (LPTA). In addition, patellofemoral joint morphology was evaluated by measuring trochlear depth (TD), trochlear sulcus angle (TSA) and patella angle (PA).

RESULTS

P-PTA, Q-PA, LPTA and TD values were significantly lower in patients with severe chondromalacia than in patients with both normal and mild chondromalacia (P < 0.001). TSA values were significantly higher in patients with severe chondromalacia than those with both normal and mild chondromalacia (P < 0.001). TSA was higher and TD was lower in women compared to men (P < 0.001). LPTA and P-PTA were lower in women compared to men, and the difference was significant. There was no difference in PA between the two sexes.

CONCLUSIONS

Patellar cartilage degeneration increases with trochlear dysplasia. There is a strong correlation between patellar malalignment (lateral patellar tilt and sagittal patellar tilt) and chondromalacia patella. Women are more prone to developing CP than men.