Association Between Self-reported Measures, Physical Examination, and Early Magnetic Resonance Imaging Signs of Osteoarthritis in Patients With Patellofemoral Pain

Abstract

Background Structural abnormalities associated with osteoarthritis (OA) are found in some patients with patellofemoral pain (PFP). Objectives To investigate the association between early signs of OA on magnetic resonance imaging (MRI) and characteristics from self-reported measures and physical examination in patients with PFP. Methods This exploratory study included data from patients with PFP from a previously published cross-sectional case-control study (n = 64; 55% female; mean ± SD age, 23.4 ± 7.0 years). Structural OA features (osteophytes, bone marrow lesions, cartilage defects, Hoffa synovitis, patellar tendon abnormalities) and quantitative T2 measurements of cartilage composition were extracted from MRI. Associations between characteristics from self-reported measures (pain at rest, pain during stair walking, knee function, duration of complaints, hours of sports participation each week), physical examination (crepitus, quadriceps strength), and early MRI signs of OA were assessed. Results Symptom duration was associated with bone marrow lesions in the patella (odds ratio [OR] = 1.1; 95% confidence interval [CI]: 1.0, 1.2). Sports participation (hours per week) was inversely associated with patellar tendon abnormalities on MRI (OR = 0.8; 95% CI: 0.6, 1.0). Crepitus and bilateral nature of the complaints were associated with minor patellar cartilage defects (OR = 12.0; 95% CI: 2.3, 63.6 and OR = 7.6; 95% CI: 1.1, 53.8, respectively). There were no significant associations between clinical characteristics and cartilage T2 relaxation time. Conclusion Presence of crepitus, bilateral complaints, a long PFP symptom duration, and reduced weekly sport participation were associated with early signs of OA in a young PFP population. Level of Evidence Etiology, level 2c. J Orthop Sports Phys Ther 2019;49(9):634–639. Epub 10 Jul 2019. doi:10.2519/jospt.2019.8889

Multiparametric MRI of Knees in Collegiate Basketball Players: Associations With Morphological Abnormalities and Functional Deficits

“…Interestingly, a previous study of patients with patellofemoral pain did not identify any significant associations between T 2 and clinical characteristics of osteoarthritis such as knee pain and function. 5 While KOOS subscores other than KOOS-Symptoms were not associated significantly with T 2 , several other associations with individual characteristics were identified. Our results suggest that T 1ρ and T 2 prolongation are not necessarily indicative of degenerative changes, as these are healthy, young collegiate basketball players competing at an elite level, but rather hint of other probable and unexplored reasons such as overuse of their joints.…”

Early Osteoarthritis Questionnaire (EOAQ): a tool to assess knee osteoarthritis at initial stage

“…Clinical features should be evaluated in patients with a new onset of pain, stiffness, and other symptoms, since they might be associated with the development of OA in the future. 19 Also, it is fundamental to receive a report of the outcome directly from the patients, without the interpretation of the clinicians. Only in this way an effective questionnaire could be developed.…”

“…Only in this way an effective questionnaire could be developed. 19 For this reason, the first version of the questionnaire was discussed in October 2019 by patients and by the members of the board. During the discussion, score was assigned to each item.…”

Patellofemoral pain over time: Protocol for a prospective, longitudinal study investigating physical and non-physical features

“…Disability, reduced physical activity, and impaired social life are reported in those with PFP (3,4). Other impairments such as lower self-reported function, physical performance, and healthrelated quality of life (HRQOL) have also been reported in individuals with PFP, alongside with a possible progression to osteoarthritis (5)(6)(7)(8).…”

“…Proximal, local, and distal kinematics, kinetics, and muscle function impairments have been reported in those with PFP (1,9,(12)(13)(14)(15)(16)(17), and linked with increases in patellofemoral joint (PFJ) load during various tasks (9), a factor suggested to play a central role in PFP (9). Beyond this pathomechanical model of PFP (8), there is an increased awareness that non-physical features may be important in understanding PFP (18). Pain processing (e.g., local and central sensitization) and psychological features (e.g., kinesiophobia and pain catastrophizing) have also been reported to be altered in individuals with PFP (10,11).…”