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Erschienen in: Pediatric Radiology 8/2016

22.02.2016 | Original Article

Patellofemoral instability in children: T2 relaxation times of the patellar cartilage in patients with and without patellofemoral instability and correlation with morphological grading of cartilage damage

verfasst von: Chang Ho Kang, Hee Kyung Kim, Sahar Shiraj, Christopher Anton, Dong Hoon Kim, Paul S. Horn

Erschienen in: Pediatric Radiology | Ausgabe 8/2016

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Abstract

Background

Patellofemoral instability is one of the most common causes of cartilage damage in teenagers.

Objective

To quantitatively evaluate the patellar cartilage in patients with patellofemoral instability using T2 relaxation time maps (T2 maps), compare the values to those in patients without patellofemoral instability and correlate them with morphological grades in patients with patellofemoral instability.

Materials and methods

Fifty-three patients with patellofemoral instability (mean age: 15.9 ± 2.4 years) and 53 age- and gender-matched patients without patellofemoral instability were included. Knee MR with axial T2 map was performed. Mean T2 relaxation times were obtained at the medial, central and lateral zones of the patellar cartilage and compared between the two groups. In the patellofemoral instability group, morphological grading of the patellar cartilage (0-4) was performed and correlated with T2 relaxation times.

Results

Mean T2 relaxation times were significantly longer in the group with patellofemoral instability as compared to those of the control group across the patellar cartilage (Student’s t-test, P<0.05) with the longest time at the central area. Positive correlation was seen between mean T2 relaxation time and morphological grading (Pearson correlation coefficiency, P<0.001). T2 increased with severity of morphological grading from 0 to 3 (mixed model, P<0.001), but no statistical difference was seen between grades 3 and 4.

Conclusion

In patellofemoral instability, patellar cartilage damage occurs across the entire cartilage with the highest T2 values at the apex. T2 relaxation times directly reflect the severity in low-grade cartilage damage, which implies an important role for T2 maps in differentiating between normal and low-grade cartilage damage.
Literatur
1.
Zurück zum Zitat Heywood AWB (1961) Recurrent dislocation of the patella - a study of its pathology and treatment in 106 knees. J Bone Joint Surg (Br) 43:508–517 Heywood AWB (1961) Recurrent dislocation of the patella - a study of its pathology and treatment in 106 knees. J Bone Joint Surg (Br) 43:508–517
2.
Zurück zum Zitat Hawkins RJ, Bell RH, Anisette G (1986) Acute patellar dislocations. The natural history. Am J Sports Med 14:117–120CrossRefPubMed Hawkins RJ, Bell RH, Anisette G (1986) Acute patellar dislocations. The natural history. Am J Sports Med 14:117–120CrossRefPubMed
3.
Zurück zum Zitat Lance E, Deutsch AL, Mink JH (1993) Prior lateral patellar dislocation: MR imaging findings. Radiology 189:905–907CrossRefPubMed Lance E, Deutsch AL, Mink JH (1993) Prior lateral patellar dislocation: MR imaging findings. Radiology 189:905–907CrossRefPubMed
4.
Zurück zum Zitat Elias DA, White LM, Fithian DC (2002) Acute lateral patellar dislocation at MR imaging: injury patterns of medial patellar soft-tissue restraints and osteochondral injuries of the inferomedial patella. Radiology 225:736–743CrossRefPubMed Elias DA, White LM, Fithian DC (2002) Acute lateral patellar dislocation at MR imaging: injury patterns of medial patellar soft-tissue restraints and osteochondral injuries of the inferomedial patella. Radiology 225:736–743CrossRefPubMed
5.
Zurück zum Zitat Guerrero P, Li X, Patel K et al (2009) Medial patellofemoral ligament injury patterns and associated pathology in lateral patella dislocation: an MRI study. Sports Med Arthrosc Rehabil Ther Technol 1:17CrossRefPubMedPubMedCentral Guerrero P, Li X, Patel K et al (2009) Medial patellofemoral ligament injury patterns and associated pathology in lateral patella dislocation: an MRI study. Sports Med Arthrosc Rehabil Ther Technol 1:17CrossRefPubMedPubMedCentral
6.
Zurück zum Zitat Kirsch MD, Fitzgerald SW, Friedman H et al (1993) Transient lateral patellar dislocation: diagnosis with MR imaging. AJR Am J Roentgenol 161:109–113CrossRefPubMed Kirsch MD, Fitzgerald SW, Friedman H et al (1993) Transient lateral patellar dislocation: diagnosis with MR imaging. AJR Am J Roentgenol 161:109–113CrossRefPubMed
7.
Zurück zum Zitat Nomura E, Horiuchi Y, Inoue M (2002) Correlation of MR imaging findings and open exploration of medial patellofemoral ligament injuries in acute patellar dislocations. Knee 9:139–143CrossRefPubMed Nomura E, Horiuchi Y, Inoue M (2002) Correlation of MR imaging findings and open exploration of medial patellofemoral ligament injuries in acute patellar dislocations. Knee 9:139–143CrossRefPubMed
8.
Zurück zum Zitat Sanders TG, Paruchuri NB, Zlatkin MB (2006) MRI of osteochondral defects of the lateral femoral condyle: incidence and pattern of injury after transient lateral dislocation of the patella. AJR Am J Roentgenol 187:1332–1337CrossRefPubMed Sanders TG, Paruchuri NB, Zlatkin MB (2006) MRI of osteochondral defects of the lateral femoral condyle: incidence and pattern of injury after transient lateral dislocation of the patella. AJR Am J Roentgenol 187:1332–1337CrossRefPubMed
9.
Zurück zum Zitat Virolainen H, Visuri T, Kuusela T (1993) Acute dislocation of the patella: MR findings. Radiology 189:243–246CrossRefPubMed Virolainen H, Visuri T, Kuusela T (1993) Acute dislocation of the patella: MR findings. Radiology 189:243–246CrossRefPubMed
10.
Zurück zum Zitat McNally EG, Ostlere SJ, Pal C et al (2000) Assessment of patellar maltracking using combined static and dynamic MRI. Eur Radiol 10:1051–1055CrossRefPubMed McNally EG, Ostlere SJ, Pal C et al (2000) Assessment of patellar maltracking using combined static and dynamic MRI. Eur Radiol 10:1051–1055CrossRefPubMed
11.
Zurück zum Zitat Diederichs G, Issever AS, Scheffler S (2010) MR imaging of patellar instability: injury patterns and assessment of risk factors. Radiographics 30:961–981CrossRefPubMed Diederichs G, Issever AS, Scheffler S (2010) MR imaging of patellar instability: injury patterns and assessment of risk factors. Radiographics 30:961–981CrossRefPubMed
12.
Zurück zum Zitat Tiderius C, Hori M, Williams A et al (2006) dGEMRIC as a function of BMI. Osteoarthritis Cartilage 14:1091–1097CrossRefPubMed Tiderius C, Hori M, Williams A et al (2006) dGEMRIC as a function of BMI. Osteoarthritis Cartilage 14:1091–1097CrossRefPubMed
13.
Zurück zum Zitat Urish KL, Keffalas MG, Durkin JR et al (2013) T2 texture index of cartilage can predict early symptomatic OA progression: data from the osteoarthritis initiative. Osteoarthritis Cartilage 21:1550–1557CrossRefPubMedPubMedCentral Urish KL, Keffalas MG, Durkin JR et al (2013) T2 texture index of cartilage can predict early symptomatic OA progression: data from the osteoarthritis initiative. Osteoarthritis Cartilage 21:1550–1557CrossRefPubMedPubMedCentral
14.
Zurück zum Zitat Mosher TJ, Liu Y, Torok CM (2010) Functional cartilage MRI T2 mapping: evaluating the effect of age and training on knee cartilage response to running. Osteoarthritis Cartilage 18:358–364CrossRefPubMed Mosher TJ, Liu Y, Torok CM (2010) Functional cartilage MRI T2 mapping: evaluating the effect of age and training on knee cartilage response to running. Osteoarthritis Cartilage 18:358–364CrossRefPubMed
15.
Zurück zum Zitat Nieminen MT, Nissi MJ, Mattila L et al (2012) Evaluation of chondral repair using quantitative MRI. J Magn Reson Imaging 36:1287–1299CrossRefPubMed Nieminen MT, Nissi MJ, Mattila L et al (2012) Evaluation of chondral repair using quantitative MRI. J Magn Reson Imaging 36:1287–1299CrossRefPubMed
16.
Zurück zum Zitat Mosher TJ, Dardzinski BJ (2004) Cartilage MRI T2 relaxation time mapping: overview and applications. Semin Musculoskelet Radiol 8:355–368CrossRefPubMed Mosher TJ, Dardzinski BJ (2004) Cartilage MRI T2 relaxation time mapping: overview and applications. Semin Musculoskelet Radiol 8:355–368CrossRefPubMed
17.
Zurück zum Zitat Mosher TJ, Dardzinski BJ, Smith MB (2000) Human articular cartilage: influence of aging and early symptomatic degeneration on the spatial variation of T2--preliminary findings at 3 T. Radiology 214:259–266CrossRefPubMed Mosher TJ, Dardzinski BJ, Smith MB (2000) Human articular cartilage: influence of aging and early symptomatic degeneration on the spatial variation of T2--preliminary findings at 3 T. Radiology 214:259–266CrossRefPubMed
18.
Zurück zum Zitat Kim HK, Shiraj S, Anton CG et al (2014) Age and sex dependency of cartilage T2 relaxation time mapping in MRI of children and adolescents. AJR Am J Roentgenol 202:626–632CrossRefPubMed Kim HK, Shiraj S, Anton CG et al (2014) Age and sex dependency of cartilage T2 relaxation time mapping in MRI of children and adolescents. AJR Am J Roentgenol 202:626–632CrossRefPubMed
19.
Zurück zum Zitat Brattstroem H (1964) Shape of the intercondylar groove normally and in recurrent dislocation of patella. A clinical and X-ray-anatomical investigation. Acta Orthop Scand Suppl 68:61–148 Brattstroem H (1964) Shape of the intercondylar groove normally and in recurrent dislocation of patella. A clinical and X-ray-anatomical investigation. Acta Orthop Scand Suppl 68:61–148
20.
Zurück zum Zitat Hughston JC (1968) Subluxation of the patella. J Bone Joint Surg Am 50:1003–1026PubMed Hughston JC (1968) Subluxation of the patella. J Bone Joint Surg Am 50:1003–1026PubMed
21.
Zurück zum Zitat Shiraj S, Kim HK, Anton C et al (2014) Spatial variation of T2 relaxation times of patellar cartilage and physeal patency: an in vivo study in children and young adults. AJR Am J Roentgenol 202:W292–W297CrossRefPubMed Shiraj S, Kim HK, Anton C et al (2014) Spatial variation of T2 relaxation times of patellar cartilage and physeal patency: an in vivo study in children and young adults. AJR Am J Roentgenol 202:W292–W297CrossRefPubMed
22.
Zurück zum Zitat Shaffer JP (2007) Controlling the false discovery rate with constraints: the Newman-Keuls test revisited. Biom J 49:136–143CrossRefPubMed Shaffer JP (2007) Controlling the false discovery rate with constraints: the Newman-Keuls test revisited. Biom J 49:136–143CrossRefPubMed
23.
Zurück zum Zitat del Mar Carrion Martin M, Santiago FR, Calvo RP et al (2010) Patellofemoral morphometry in patients with idiopathic patellofemoral pain syndrome. Eur J Radiol 75:e64–e67CrossRefPubMed del Mar Carrion Martin M, Santiago FR, Calvo RP et al (2010) Patellofemoral morphometry in patients with idiopathic patellofemoral pain syndrome. Eur J Radiol 75:e64–e67CrossRefPubMed
24.
Zurück zum Zitat Davis IS, Powers CM (2010) Patellofemoral pain syndrome: proximal, distal, and local factors, an international retreat, April 30-May 2, 2009, Fells Point, Baltimore, MD. J Orthop Sports Phys Ther 40:A1–A16CrossRefPubMed Davis IS, Powers CM (2010) Patellofemoral pain syndrome: proximal, distal, and local factors, an international retreat, April 30-May 2, 2009, Fells Point, Baltimore, MD. J Orthop Sports Phys Ther 40:A1–A16CrossRefPubMed
25.
Zurück zum Zitat Franzone JM, Vitale MA, Shubin Stein BE et al (2012) Is there an association between chronicity of patellar instability and patellofemoral cartilage lesions? An arthroscopic assessment of chondral injury. J Knee Surg 25:411–416CrossRefPubMed Franzone JM, Vitale MA, Shubin Stein BE et al (2012) Is there an association between chronicity of patellar instability and patellofemoral cartilage lesions? An arthroscopic assessment of chondral injury. J Knee Surg 25:411–416CrossRefPubMed
26.
Zurück zum Zitat Vollnberg B, Koehlitz T, Jung T et al (2012) Prevalence of cartilage lesions and early osteoarthritis in patients with patellar dislocation. Eur Radiol 22:2347–2356CrossRefPubMed Vollnberg B, Koehlitz T, Jung T et al (2012) Prevalence of cartilage lesions and early osteoarthritis in patients with patellar dislocation. Eur Radiol 22:2347–2356CrossRefPubMed
27.
Zurück zum Zitat Insall J, Falvo KA, Wise DW (1976) Chondromalacia patellae. A prospective study. J Bone Joint Surg Am 58:1–8PubMed Insall J, Falvo KA, Wise DW (1976) Chondromalacia patellae. A prospective study. J Bone Joint Surg Am 58:1–8PubMed
28.
Zurück zum Zitat Fulkerson JP, Buuck DA (2004) Disorders of the patellofemoral joint. Lippincott Williams & Wilkins, Philadelphia Fulkerson JP, Buuck DA (2004) Disorders of the patellofemoral joint. Lippincott Williams & Wilkins, Philadelphia
29.
Zurück zum Zitat Outerbridge RE (1961) The etiology of chondromalacia patellae. J Bone Joint Surg (Br) 43-B:752–757 Outerbridge RE (1961) The etiology of chondromalacia patellae. J Bone Joint Surg (Br) 43-B:752–757
30.
Zurück zum Zitat Watanabe A, Obata T, Ikehira H et al (2009) Degeneration of patellar cartilage in patients with recurrent patellar dislocation following conservative treatment: evaluation with delayed gadolinium-enhanced magnetic resonance imaging of cartilage. Osteoarthritis Cartilage 17:1546–1553CrossRefPubMed Watanabe A, Obata T, Ikehira H et al (2009) Degeneration of patellar cartilage in patients with recurrent patellar dislocation following conservative treatment: evaluation with delayed gadolinium-enhanced magnetic resonance imaging of cartilage. Osteoarthritis Cartilage 17:1546–1553CrossRefPubMed
31.
Zurück zum Zitat Bengtsson Moström E, Lammentausta E, Finnbogason T et al (2015) Pre- and postcontrast T1 and T2 mapping of patellar cartilage in young adults with recurrent patellar dislocation. Magn Reson Med 74:1363–1369CrossRefPubMed Bengtsson Moström E, Lammentausta E, Finnbogason T et al (2015) Pre- and postcontrast T1 and T2 mapping of patellar cartilage in young adults with recurrent patellar dislocation. Magn Reson Med 74:1363–1369CrossRefPubMed
32.
Zurück zum Zitat Hannila I, Nieminen MT, Rauvala E et al (2007) Patellar cartilage lesions: comparison of magnetic resonance imaging and T2 relaxation-time mapping. Acta Radiol 48:444–448CrossRefPubMed Hannila I, Nieminen MT, Rauvala E et al (2007) Patellar cartilage lesions: comparison of magnetic resonance imaging and T2 relaxation-time mapping. Acta Radiol 48:444–448CrossRefPubMed
Metadaten
Titel
Patellofemoral instability in children: T2 relaxation times of the patellar cartilage in patients with and without patellofemoral instability and correlation with morphological grading of cartilage damage
verfasst von
Chang Ho Kang
Hee Kyung Kim
Sahar Shiraj
Christopher Anton
Dong Hoon Kim
Paul S. Horn
Publikationsdatum
22.02.2016
Verlag
Springer Berlin Heidelberg
Erschienen in
Pediatric Radiology / Ausgabe 8/2016
Print ISSN: 0301-0449
Elektronische ISSN: 1432-1998
DOI
https://doi.org/10.1007/s00247-016-3574-2

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