The association between patellar alignment on magnetic resonance imaging and radiographic manifestations of knee osteoarthritis

Abstract

The aim of our study was to evaluate the association between patellar alignment by using magnetic resonance imaging images and radiographic manifestations of patello-femoral osteoarthritis (OA). Subjects were recruited to participate in a natural history study of symptomatic knee OA. We examined the relation of patellar alignment in the sagittal plane (patellar length ratio (PLR)) and the transverse plane (sulcus angle (SA), lateral patellar tilt angle (LPTA), and bisect offset (BO)) to radiographic features of patello-femoral OA, namely joint space narrowing and patellar osteophytes, using a proportional odds logistic regression model while adjusting for age, sex, and bone mass index (BMI). The study sample consisted of 126 males (average age 68.0 years, BMI 31.2) and 87 females (average age 64.7 years, BMI 31.6), 75% of whom had tibiofemoral OA (a Kellgren-Lawrence score of 2 or more). PLR showed a statistically significant association with joint space narrowing and osteophytosis in the lateral compartment. SA showed significant association with medial joint space narrowing and with lateral and medial patellar osteophytosis. LPTA and BO showed significant association with both radiographic indices of the lateral compartment. Clear linear trends were found in association between PLR, LPTA and BO, and with outcomes associated with lateral patello-femoral OA. SA, LPTA, and BO showed linear trends of association with medial joint space narrowing. Results of our study clearly suggest the association between indices of patellar alignment and such features of patello-femoral OA as osteophytosis and joint space narrowing. Additional studies will be required to establish the normal and abnormal ranges of patellar alignment indices and their longitudinal relation to patello-femoral OA.

Altered frontal and transverse plane tibiofemoral kinematics and patellofemoral malalignments during downhill gait in patients with mixed knee osteoarthritis

“…Regardless of the underlying mechanism, the finding of increasing lateral patella tilt in our medial and lateral OA groups is suggestive of greater lateral PF compartment compressive loading and increased probability of lateral PF joint damage (Stephen et al, 2013). This premise is supported by previous reports of the association between increased lateral patella tilt and greater risk of lateral PF compartment bone marrow lesions, osteophytosis, cartilage loss and joint space narrowing (Kalichman et al, 2007a; Kalichman et al, 2007b). …”

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

“…While several studies investigating morphology or alignment have included knee pain in their inclusion criteria 17, 18, 46, 47 , few have attempted to localize the knee pain to the patellofemoral joint to define symptomatic patellofemoral OA 18 . This may explain why a relationship between morphology or alignment and pain has not previously been demonstrated in patellofemoral OA 17, 46 .…”

Effects of patellar position and defect healing on in vitro stifle joint kinematics following removal of the central one‐third of the patellar tendon in an ovine model

“…An abnormal lateral patellar tilt angle, which is indicative of patellar mal‐tracking37 has been linked to anterior knee pain,38 patellofemoral cartilage loss, and patellofemoral osteoarthritis 39, 40. The in vitro results obtained from an ovine model under conditions of passive flexion in the current study demonstrates that the removal of the central one‐third of the PT in the ovine stifle joint causes alterations in the pattern of patellar tilt and which do not recover up to 6 months postoperatively.…”