Patellofemoral alignment and geometry and early signs of osteoarthritis are associated in patellofemoral pain population

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.

Patellar instability MRI measurements are associated with knee joint degeneration after reconstruction of the medial patellofemoral ligament

“…Therefore, it may be suspected that the matrix degeneration observed in our study was at least partially preexistent before surgery. Longitudinal MR imaging assessments have previously suggested that altered patellar alignment is associated with prevalence and progression of degenerative changes in asymptomatic subjects, in patients with patellofemoral pain, and in patients with anterior cruciate ligament (ACL) reconstruction [ 36 , 60 – 62 ]. In earlier quantitative MR imaging studies, patellar malposition was associated with increased patella T1rho values [ 63 , 64 ].…”

Association of patella alignment with cartilage relaxation times and self‐reported symptoms in individuals with patellofemoral degeneration

“…Patella malalignment has been commonly reported as a mechanism for PFJ‐related pathologies, such as patellofemoral pain and chondromalacia patella 12,13 . While little is known about the relationship between patella alignment and PFJ OA, there is a suggestion that patella malalignment may be a risk factor for the development and progression of PFJ OA 14,15 . Biomechanically speaking, patella malalignment may lead to decreased PFJ contact area and elevated contact forces, 16 where excessive joint loading is related to the pathogenesis of joint pain and degeneration.…”

“…Biomechanically speaking, patella malalignment may lead to decreased PFJ contact area and elevated contact forces, 16 where excessive joint loading is related to the pathogenesis of joint pain and degeneration. Indeed, studies have demonstrated associations between patella tilt, translation, and patella alta with the presence of cartilage lesions and bone marrow edema‐like lesions (BMELs) 14,15 . While these findings are promising, it is unknown if early OA outcomes (i.e., cartilage health) and patients' self‐reported symptoms are associated with patella alignment measures.…”

“…12,13 While little is known about the relationship between patella alignment and PFJ OA, there is a suggestion that patella malalignment may be a risk factor for the development and progression of PFJ OA. 14,15 Biomechanically speaking, patella malalignment may lead to decreased PFJ contact area and elevated contact forces, 16 where excessive joint loading is related to the pathogenesis of joint pain and degeneration. Indeed, studies have demonstrated associations between patella tilt, translation, and patella alta with the presence of cartilage lesions and bone marrow edema-like lesions (BMELs).…”

“…Indeed, studies have demonstrated associations between patella tilt, translation, and patella alta with the presence of cartilage lesions and bone marrow edema-like lesions (BMELs). 14,15 While these findings are promising, it is unknown if early OA outcomes (i.e., cartilage health) and patients' self-reported symptoms are associated with patella alignment measures.…”