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Knee joint anterior malalignment and patellofemoral osteoarthritis: an MRI study

  • Musculoskeletal
  • Published:
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Abstract

Objectives

To evaluate patellofemoral congruency measurements on MRI and correlate the findings with severity of ipsilateral osteoarthritis.

Methods

We retrospectively reviewed 650 consecutive knee MRI examinations from 622 patients divided into two age groups: ≤50 and >50 year-old. The femoral sulcus angle (SA) and depth (SD), lateral patellar displacement (LPD), lateral patellofemoral angle (LPFA), tibial tubercle-trochlear groove (TT-TG) distance and Insall-Salvati index as well as the grade of focal cartilage defects (ranging from I to IV) in the patellofemoral region were assessed in each subject on axial and sagittal fat-saturated intermediate-w MR images.

Results

A significant difference exists between normal and knees with patellofemoral joint osteoarthritis regarding SA (p = 0.0002 and <0.0001), SD (p = 0.0004 and <0.0001), LPD (p = 0.0014 and 0.0009) and LPFA (p = 0.0002 and 0.0003) in both age groups (≤50 and >50 respectively). Significant correlation was found between grading of cartilage defects and SA (rho = 0.21, p = 0.0001 and 0.443, <0.0001), SD (rho = −0.198, p = 0.0003 and −0.418, <0.0001), LPD (rho = 0.176, p = 0.0013 and 0.251, 0.0002) and LPFA (rho = −0.204, p = 0.0002 and −0.239, 0.0005) in both age groups.

Conclusions

Knee joint anterior malalignment is multivariably associated with patellofemoral osteoarthritis.

Key Points

• MRI is an excellent method to evaluate knee alignment and articular cartilage damage.

• Significant associations exist between alignment parameters and osteoarthritis of the patellofemoral joint.

• The “sulcus angle” and “sulcus depth” were the most valuable osteoarthritic markers.

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References

  1. Woolf AD, Pfleger B (2003) Burden of major musculoskeletal conditions. Bull World Health Organ 81:646–656

    PubMed  Google Scholar 

  2. Felson DT, McAlindon TE, Anderson JJ, Naimark A, Weissman BW, Aliabadi P, Evans S, Levy D, LaValley MP (1997) Defining radiographic osteoarthritis for the whole knee. Osteoarthr Cartil 5:241–250

    Article  PubMed  CAS  Google Scholar 

  3. Guermazi A, Zaim S, Taouli B, Miaux Y, Peterfy CG, Genant HG (2003) MR findings in knee osteoarthritis. Eur Radiol 13:1370–1386

    Article  PubMed  Google Scholar 

  4. Arendt E (2005) Anatomy and malalignment of the patellofemoral joint: its relation to patellofemoral arthrosis. Clin Orthop 436:71–75

    PubMed  Google Scholar 

  5. Duncan R, Hay E, Saklatvala J, Croft P (2006) Prevalence of radiographic osteoarthritis: it all depends on your point of view. Rheumatology 45:757–760

    Article  PubMed  CAS  Google Scholar 

  6. Davies AP, Vince AS, Shepstone L, Donell ST, Glasgow MM (2002) The radiologic prevalence of patellofemoral osteoarthritis. Clin Orthop 402:206–212

    Article  PubMed  Google Scholar 

  7. Hinman RS, Crossley KM (2007) Patellofemoral osteoarthritis: an important subgroup of knee osteoarthritis. Rheumatology 46:1057–1062

    Article  PubMed  CAS  Google Scholar 

  8. Grelsamer RP, Dejour D, Gould J (2008) The pathophysiology of patellofemoral arthritis. Orthop Clin North Am 39:269–274

    Article  PubMed  Google Scholar 

  9. Mäenpää H, Lehto MU (1997) Patellofemoral osteoarthritis after patellar dislocation. Clin Orthop 339:156–162

    Article  PubMed  Google Scholar 

  10. Kalichman L, Zhang Y, Niu J, Goggins J, Gale D, Felson D, Hunter DJ (2007) The association between patellar alignment and patellofemoral joint osteoarthritis features—an MRI study. Rheumatology 46:1303–1308

    Article  PubMed  CAS  Google Scholar 

  11. Yang B, Tan H, Yang L, Dai G, Guo B (2009) Correlating anatomy and congruence of the patellofemoral joint with cartilage lesions. Orthopedics 32:20

    Article  PubMed  CAS  Google Scholar 

  12. Ali SA, Helmer R, Terk MR (2010) Analysis of the patellofemoral region on MRI: association of abnormal trochlear morphology with severe cartilage defects. AJR Am J Roentgenol 194:721–727

    Article  PubMed  Google Scholar 

  13. Wittstein JR, Bartlett EC, Easterbrook J, Byrd JC (2006) Magnetic resonance imaging evaluation of patellofemoral malalignment. Arthroscopy 22:643–649

    Article  PubMed  Google Scholar 

  14. Sanders TG, Loredo R, Grayson D (2001) Computed tomography and magnetic resonance imaging evaluation of patellofemoral instability. Oper Tech Sports Med 9:152–163

    Article  Google Scholar 

  15. Beaconsfield T, Pintore E, Maffulli N, Petri GJ (1994) Radiologic measurements in patellofemoral disorders. A review. Clin Orthop 308:18–28

    PubMed  Google Scholar 

  16. Walker C, Cassar-Pullicino VN, Vaisha R, McCall IW (1993) The patello-femoral joint—a critical appraisal of its geometric assessment utilizing conventional axial radiography and computed arthro-tomography. Br J Radiol 66:755–761

    Article  PubMed  CAS  Google Scholar 

  17. Koëter S, Horstmann WG, Wagenaar FC, Huysse W, Wymenga AB, Anderson PG (2007) A new CT scan method for measuring the tibial tubercle trochlear groove distance in patellar instability. Knee 14:128–132

    Article  PubMed  Google Scholar 

  18. Brittberg M, Winalski CS (2003) Evaluation of cartilage injuries and repair. J Bone Joint Surg Am 85:58–69

    PubMed  Google Scholar 

  19. DeLong ER, DeLong DM, Clarke-Pearson DL (1988) Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics 44:837–845

    Article  PubMed  CAS  Google Scholar 

  20. Insall J, Falvo KA, Wise DW (1976) Chondromalacia patellae: a prospective study. J Bone Joint Surg Am 58:1–8

    PubMed  CAS  Google Scholar 

  21. Outerbridge RE (1964) Further studies on the etiology of chondromalacia patellae. J Bone Joint Surg Br 46:179–190

    PubMed  CAS  Google Scholar 

  22. Endo Y, Schweitzer ME, Bordalo-Rodrigues M, Rokito AS, Babb JS (2007) MRI quantitative morphologic analysis of patellofemoral region: lack of correlation with chondromalacia patellae at surgery. AJR Am J Roentgenol 189:1165–1168

    Article  PubMed  Google Scholar 

  23. Goodfellow J, Hungerford DS, Zindel M (1976) Patellofemoral joint mechanics and pathology: functional anatomy of the patello-femoral joint. J Bone Joint Surg Br 58:287–290

    PubMed  CAS  Google Scholar 

  24. McNally EG (2001) Imaging assessment of anterior knee pain and patellar maltracking. Skelet Radiol 30:484–495

    Article  CAS  Google Scholar 

  25. Pfirrmann CW, Zanetti M, Romero J, Hodler J (2000) Femoral trochlear dysplasia: MR findings. Radiology 216:858–864

    PubMed  CAS  Google Scholar 

  26. Carrillon Y, Abidi H, Dejour D, Fantino O, Moyen B, Tran-Minh VA (2000) Patellar instability: assessment on MR images by measuring the lateral trochlear inclination-initial experience. Radiology 216:582–585

    PubMed  CAS  Google Scholar 

  27. Davies AP, Costa ML, Shepstone L, Glasgow MM, Donell S (2000) The sulcus angle and malalignment of the extensor mechanism of the knee. J Bone Joint Surg Br 82:1162–1166

    Article  PubMed  CAS  Google Scholar 

  28. Link TM (2010) MR imaging in osteoarthritis: hardware, coils, and sequences. Magn Reson Imaging Clin N Am 18:95–110

    Article  PubMed  Google Scholar 

  29. Post WR, Fulkerson JP (1992) Distal realignment of the patellofemoral joint. Indications, effects, results, and recommendations. Orthop Clin North Am 23:631–643

    PubMed  CAS  Google Scholar 

  30. Lee TQ, Morris G, Csintalan RP (2003) The influence of tibial and femoral rotation on patellofemoral contact area and pressure. J Orthop Sports Phys Ther 33:686–693

    PubMed  Google Scholar 

  31. Dejour H, Walch G, Nove-Josserand L, Guier C (1994) Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc 2:19–26

    Article  PubMed  CAS  Google Scholar 

  32. Grelsamer RP (2000) Current concepts review—patellar malalignment. J Bone Joint Surg Am 82A:1639–1650

    Google Scholar 

  33. Donell S (2006) Patellofemoral dysfunction-extensor mechanism malalignment. Curr Orthopaed 20:103–111

    Article  Google Scholar 

  34. Wagenaar FC, Koëter S, Anderson PG, Wymenga AB (2007) Conventional radiography cannot replace CT scanning in detecting tibial tubercle lateralisation. Knee 14:51–54

    Article  PubMed  Google Scholar 

  35. Diks MJ, Wymenga AB, Anderson PG (2003) Patients with lateral tracking patella have better pain relief following CT-guided tuberosity transfer than patients with unstable patella. Knee Surg Sports Traumatol Arthrosc 11:384–388

    Article  PubMed  CAS  Google Scholar 

  36. Koëter S, Diks MJ, Anderson PG, Wymenga AB (2007) A modified tibial tubercle osteotomy for patellar maltracking: results at two years. J Bone Joint Surg Br 89:180–185

    Article  PubMed  Google Scholar 

  37. Insall J, Salvati E (1971) Patella position in the normal knee. Radiology 101:101–104

    PubMed  CAS  Google Scholar 

  38. Al-Sayyad MJ, Cameron JC (2002) Functional outcome after tibial tubercle transfer for the painful patella alta. Clin Orthop 396:152–162

    Article  PubMed  Google Scholar 

  39. Bentley G, Dowd G (1984) Current concepts of etiology and treatment of chondromalacia patellae. Clin Orthop 189:209–228

    PubMed  Google Scholar 

  40. Geenen E, Molenaers G, Martens M (1989) Patella alta in patellofemoral instability. Acta Orthop Belg 55:387–393

    PubMed  CAS  Google Scholar 

  41. Simmons E Jr, Cameron JC (1992) Patella alta and recurrent dislocation of the patella. Clin Orthop 274:265–269

    PubMed  Google Scholar 

  42. Singerman R, Davy DT, Goldberg VM (1994) Effects of patella alta and patella infera on patellofemoral contact forces. J Biomech 27:1059–1065

    Article  PubMed  CAS  Google Scholar 

  43. Chrisman OD (1986) The role of articular cartilage in patellofemoral pain. Orthop Clin North Am 17:231–234

    PubMed  CAS  Google Scholar 

  44. Stefanik JJ, Zhu Y, Zumwalt AC, Gross KD, Clancy M, Lynch JA, Frey Law LA, Lewis CE, Roemer FW, Powers CM, Guermazi A, Felson DT (2010) Association between patella alta and the prevalence and worsening of structural features of patellofemoral joint osteoarthritis: the multicenter osteoarthritis study. Arthritis Care Res 62:1258–1265

    Article  CAS  Google Scholar 

  45. Hart DJ, Spector TD (1993) The relationship of obesity, fat distribution and osteoarthritis in women in the general population: the Chingford Study. J Rheumatol 20:331–335

    PubMed  CAS  Google Scholar 

  46. Felson DT, Zhang Y, Anthony JM, Naimark A, Anderson JJ (1992) Weight loss reduces the risk for symptomatic knee osteoarthritis in women. The Framingham Study. Ann Intern Med 116:535–539

    PubMed  CAS  Google Scholar 

  47. Sandmark H, Hogstedt C, Lewold S, Vingard E (1999) Osteoarthrosis of the knee in men and women in association with overweight, smoking, and hormone therapy. Ann Rheum Dis 58:151–155

    Article  PubMed  CAS  Google Scholar 

  48. Cicuttini FM, Spector T, Baker J (1997) Risk factors for osteoarthritis in the tibiofemoral and patellofemoral joints of the knee. J Rheumatol 24:1164–1167

    PubMed  CAS  Google Scholar 

  49. Roubenoff R (1996) Applications of bioelectrical impedance analysis for body composition to epidemiologic studies. Am J Clin Nutr 64:459S–462S

    PubMed  CAS  Google Scholar 

  50. Teichtahl AJ, Wang Y, Wluka AE, Szramka M, English DR, Giles GG, O’Sullivan R, Cicuttini FM (2008) The longitudinal relationship between body composition and patella cartilage in healthy adults. Obesity (Silver Spring) 16:421–427

    Article  Google Scholar 

  51. Smith TO, Davies L, Toms AP, Hing CB, Donell ST (2011) The reliability and validity of radiological assessment for patellar instability. A systematic review and meta-analysis. Skelet Radiol 40:399–414

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Medical Imaging, University Hospital, University of Crete, Heraklion, 711 10, Crete, Greece

    Nikolaos Tsavalas & Apostolos H. Karantanas

  2. Department of Orthopaedic Surgery, University Hospital, University of Crete, Heraklion, Crete, Greece

    Pavlos Katonis

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  1. Nikolaos Tsavalas
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  2. Pavlos Katonis
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  3. Apostolos H. Karantanas
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Correspondence to Apostolos H. Karantanas.

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Tsavalas, N., Katonis, P. & Karantanas, A.H. Knee joint anterior malalignment and patellofemoral osteoarthritis: an MRI study. Eur Radiol 22, 418–428 (2012). https://doi.org/10.1007/s00330-011-2275-3

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  • DOI: https://doi.org/10.1007/s00330-011-2275-3

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