Structural Abnormalities on Magnetic Resonance Imaging in Patients With Patellofemoral Pain

Heijden, Rianne A. van der; Kanter, Janneke L M de; Bierma-Zeinstra, Sita M A; Verhaar, Jan A N; Veldhoven, Peter L J van; Krestin, Gabriël P.; Oei, Edwin H.G.; Middelkoop, Marienke van

doi:10.1177/0363546516646107

Cited by 56 publications

(38 citation statements)

References 34 publications

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“…Osteophytes were also prevalent in this cohort (62%). BMLs were less prevalent in this study (39%) yet are common even in young asymptomatic knees 48 and can fluctuate over relatively short time periods 49 and thus may not represent a stable indicator of disease state. While we did not report reference values using these other structural features, we did evaluate them as secondary outcomes, and found similar dose-response patterns with thresholds suggesting a similar but somewhat weaker association than full thickness cartilage damage (Table 3, Supplementary tables 2 and 3).…”

Section: Discussioncontrasting

confidence: 59%

Patellofemoral morphology and alignment: reference values and dose–response patterns for the relation to MRI features of patellofemoral osteoarthritis

Macri

Felson

Zhang

et al. 2017

Osteoarthritis and Cartilage

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Objective We aimed to (i) determine reference values for trochlear morphology and patellofemoral (PF) alignment in adults without MRI-defined PF full thickness cartilage damage or knee pain; and (ii) evaluate dose-response patterns for these measures with prevalent MRI-defined PF structural damage and/or knee pain. Design The Framingham Community Cohort is a population-based sample of ambulatory adults aged ≥50 years. We evaluated six morphology and alignment measures using MRI (n=985), and reported reference values (mean ±2SD) in a subsample without MRI-defined PF full thickness cartilage damage or knee pain (n=563). With restricted cubic spline Poisson regression, we evaluated dose-response patterns of each of the six measures with prevalent MRI-defined PF structural damage or joint pain. Our primary outcome was full thickness cartilage damage. Results For dose-response curves, prevalence ratios increased monotonically for all measures except patellar tilt, which rose with both lateral and medial tilt. Associations were generally strongest in the lateral PF compartment. Prevalence ratios (PR) for the strongest predictors of full thickness cartilage damage reached clinical relevance (PR>1.5) at sulcus angle ≥135.0°; patellar tilt angle at ≤1.0° and ≥15.0°; and bisect offset ≥57.0%. Lateral trochlear inclination achieved PR>1.5 at ≤23.0° for full thickness cartilage damage with pain. Conclusions Sulcus angle, patellar tilt, and bisect offset were most strongly associated with full thickness cartilage damage. Lateral trochlear inclination, patellar tilt and bisect offset had stronger associations with the addition of pain. These findings contribute to better identifying a subset of patients who may benefit from mechanically based interventions.

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Section: Discussioncontrasting

confidence: 59%

Patellofemoral morphology and alignment: reference values and dose–response patterns for the relation to MRI features of patellofemoral osteoarthritis

Macri

Felson

Zhang

et al. 2017

Osteoarthritis and Cartilage

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“…7 In a recent study, several novel magnetic resonance imaging (MRI) techniques were applied to gain more insight in the etiology of PFP. 8 Although it was long believed that PFP was caused by chondromalacia, 9 van der Heijden et al showed that structural abnormalities (eg, cartilage loss and osteophytes) seen on MRI are not associated with the presence of PFP. 8,10 Additionally, no differences in cartilage composition were seen between groups.…”

Section: Introductionmentioning

confidence: 99%

“…8 Although it was long believed that PFP was caused by chondromalacia, 9 van der Heijden et al showed that structural abnormalities (eg, cartilage loss and osteophytes) seen on MRI are not associated with the presence of PFP. 8,10 Additionally, no differences in cartilage composition were seen between groups. 11 However, in another study, significantly higher T1ρ relaxation times in lateral patellar cartilage were found in a group of maltracking (eg, patellar tilt present) PFP patients compared with healthy controls, indicating an impaired biochemical composition.…”

Section: Introductionmentioning

confidence: 99%

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

Eijkenboom

Heijden

Kanter

et al. 2020

Scandinavian Med Sci Sports

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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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“…A recent study using 3 T magnetic resonance imaging (MRI) demonstrated that structural abnormalities of the patellofemoral cartilage are not associated with PFP 9. In this study, minor patellar cartilage defects or patellar bone marrow lesions were frequently seen in both PFP patients and subjects without PFP.…”

Section: Pfp Pathophysiology or Pathomechanicsmentioning

confidence: 52%

“…These observations show that PFP can affect patients with and without any structural damage to the patellofemoral joint (PFJ) 7. Structural damage that is sometimes associated with PFP includes chondral and osteochondral damage, osteoarthritis (OA), overuse injuries of the extensor apparatus (tendonitis and insertional tendinosis), and patellar instability 9. It has been recommended that patients with a history of dislocations or subluxations should be considered separately from other patients with PFP because this subgroup of patients frequently have biomechanical risk factors that require different treatment approaches 1.…”

Section: Introductionmentioning

confidence: 97%

Patellofemoral pain in athletes

Petersen

Rembitzki

Liebau

2017

OAJSM

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Patellofemoral pain (PFP) is a frequent cause of anterior knee pain in athletes, which affects patients with and without structural patellofemoral joint (PFJ) damage. Most younger patients do not have any structural changes to the PFJ, such as an increased Q angle and a cartilage damage. This clinical entity is known as patellofemoral pain syndrome (PFPS). Older patients usually present with signs of patellofemoral osteoarthritis (PFOA). A key factor in PFPS development is dynamic valgus of the lower extremity, which leads to lateral patellar maltracking. Causes of dynamic valgus include weak hip muscles and rearfoot eversion with pes pronatus valgus. These factors can also be observed in patients with PFOA. The available evidence suggests that patients with PFP are best managed with a tailored, multimodal, nonoperative treatment program that includes short-term pain relief with nonsteroidal anti-inflammatory drugs (NSAIDs), passive correction of patellar maltracking with medially directed tape or braces, correction of the dynamic valgus with exercise programs that target the muscles of the lower extremity, hip, and trunk, and the use of foot orthoses in patients with additional foot abnormalities.

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Structural Abnormalities on Magnetic Resonance Imaging in Patients With Patellofemoral Pain

Abstract: Structural abnormalities of the patellofemoral joint have been hypothesized as a factor in the pathogenesis of PFP, but the study findings suggest that structural abnormalities of the patellofemoral joint on MRI are not associated with PFP.

Cited by 56 publications

References 34 publications

Patellofemoral morphology and alignment: reference values and dose–response patterns for the relation to MRI features of patellofemoral osteoarthritis

Patellofemoral morphology and alignment: reference values and dose–response patterns for the relation to MRI features of patellofemoral osteoarthritis

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

Patellofemoral pain in athletes

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