Association between radiological findings and symptoms at the patellofemoral joint in advanced knee osteoarthritis

Chang, Chong Bum; Han, Ilkyu; Kim, S. J.; Seong, Sang Cheol; Kim, T. K.

doi:10.1302/0301-620x.89b10.19120

Cited by 18 publications

(11 citation statements)

References 21 publications

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“…In our study, 7 patients had lateral subluxation of the patella on the preoperative skyline radiographs, and this was a highly significant predictor of poor outcome. Chang et al (2007) found that lateral patellar translation of the patella and difficulty in rising from a chair was predictive of increased anterior knee pain in osteoarthritic knees after total knee replacement. They suggested that patellofemoral malaligment and abnormal tracking may be an important cause of postoperative pain.…”

Section: Discussionmentioning

confidence: 95%

Preoperative lateral subluxation of the patella is a predictor of poor early outcome of Oxford phase-III medial unicompartmental knee arthroplasty

Munk¹,

Odgaard²,

Madsen³

et al. 2011

Acta Orthopaedica

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Background and purposeThere is disagreement in the literature about the importance of patellofemoral joint degeneration and knee pain for the outcome of unicompartmental knee arthroplasty (UKA). We therefore investigated the importance of selected predictors including patellofemoral joint degeneration and the location of preoperative knee pain for the early outcome of UKA.Patients and methodsThe study group comprised 260 consecutive patients from 5 hospitals who underwent Oxford UKA for anteromedial osteoarthritis. Data were collected at baseline and included pain location, radiologically observed degeneration of the patellofemoral joint including subluxation of the patella, intraoperative cartilage status of the patellofemoral joint, disease-specific knee status, and Oxford knee score (OKS). Outcomes were evaluated after 1 year using the OKS, global patient satisfaction, and global patient result.ResultsThe average OKS score at baseline was 24 (SD 7), and it was 40 (SD 8) at the 1-year follow-up. 94% of the patients claimed improvement after the operation and 90% were satisfied with the UKA. Lateral subluxation of the patella was a predictor of poor outcome, and the preoperative OKS score was also a predictor of outcome. Full-thickness cartilage loss at any location gave a similar outcome to that with a normal or near-normal joint surface, and likewise, preoperative anterior knee pain was not a predictor of outcome.InterpretationWe conclude that the good early outcome after UKA in this study is in line with the best reported results. Patellofemoral degeneration should not be considered a contraindication to Oxford UKA. Patients with lateral subluxation of the patella have an increased risk of a poor result after UKA and should preferably be offered a total knee replacement.

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Section: Discussionmentioning

confidence: 95%

Preoperative lateral subluxation of the patella is a predictor of poor early outcome of Oxford phase-III medial unicompartmental knee arthroplasty

Munk¹,

Odgaard²,

Madsen³

et al. 2011

Acta Orthopaedica

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“…Although patellar malalignment is considered to be a feature of patellofemoral joint pain in younger populations (14, 15), no studies have investigated whether people with patellofemoral joint OA have malaligned patellae. However, recent research has identified that patellar malalignment is associated with indices of patellofemoral joint OA (JSN and loss of cartilage thickness) (16–18), increased risk of progression of OA (greater JSN) (19), and greater symptom severity (20, 21). Furthermore, patellar malalignment is typically observed in a lateral direction (displacement or tilt), which likely reflects the OA disease process predominantly affecting the lateral patellofemoral joint compartment (22).…”

Section: Introductionmentioning

confidence: 99%

Can patellar tape reduce the patellar malalignment and pain associated with patellofemoral osteoarthritis?

Crossley

Marino

Macilquham³

et al. 2009

Arthritis & Rheumatism

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Objective. Patellar taping is a conservative treatment that may reduce patellar malalignment and pain in people with patellofemoral joint osteoarthritis (OA). This study aimed to compare patellar alignment in people with and without patellofemoral joint OA and to evaluate immediate effects of patellar taping on patellar alignment and pain in people with patellofemoral joint OA. Methods. Patellar malalignment was measured from magnetic resonance imaging (MRI; 15°knee flexion) in 28 individuals (14 with patellofemoral joint OA and 14 asymptomatic, age-matched controls). In the patellofemoral joint OA group, MRI data were collected in 2 randomly allocated conditions (tape and no tape). Patellar alignment indices were measured from deidentified axial scans by 1 examiner. Pain during squatting was recorded in the 2 conditions (tape and no tape). Results. People with patellofemoral joint OA exhibited greater lateral displacement and bisect offset compared with controls (P < 0.001). Lateral patellar tilt angle did not differ between groups. In the patellofemoral joint OA group, patellar tape resulted in a significant lessening of lateral alignment, with reduced lateral displacement (P ‫؍‬ 0.028) and increased lateral patellar tilt angle (P < 0.001). Mean pain during squatting decreased with patellar tape by 15 mm on a 100-mm scale (P ‫؍‬ 0.045). Conclusion. Patellar tape may reduce malalignment and pain associated with patellofemoral joint OA.

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“… 24 Patellofemoral malalignment has been linked to symptom severity among older people with knee OA, although results are inconsistent. 2 , 19 Thus, while there is literature suggesting that patellofemoral malalignment may be related to magnetic resonance imaging (MRI)–defined structural features of patellofemoral OA (eg, osteophytes and cartilage defects) among people with PFP, this relationship and the potential relationship with symptoms (ie, pain and function) are currently unknown. Therefore, the aim of this study was to determine whether patellofemoral joint alignment and bony shape are associated with (1) cartilage, bone, and soft tissue morphological abnormalities defined on MRI and (2) patient characteristics and reported symptoms among people with PFP.…”

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confidence: 99%

Are Patellofemoral Joint Alignment and Shape Associated With Structural Magnetic Resonance Imaging Abnormalities and Symptoms Among People With Patellofemoral Pain?

et al. 2018

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Background:Patellofemoral malalignment has been observed among people with patellofemoral pain (PFP) and may be associated with the presence of imaging features of osteoarthritis, symptoms, and function.Purpose:To determine whether patellofemoral joint alignment and bony shape are associated with (1) cartilage, bone, and soft tissue morphological abnormalities defined on magnetic resonance imaging (MRI) and (2) reported symptoms and function among people with PFP.Study Design:Cross-sectional study; Level of evidence, 3.Methods:Participants (mean ± SD age, 30.2 ± 9.5 years; range, 14-50 years; 78 females, 58.6%) completed questionnaires regarding demographics, pain, symptoms, and function and underwent a 3-T MRI scan of their more symptomatic eligible knee. Structural MRI abnormalities were scored with the MOAKS (Magnetic Resonance Imaging Osteoarthritis Knee Score), and MRI alignment and shape were measured with standardized methods. Associations among MOAKS features, PFP symptoms, and alignment and shape measures were evaluated with regression analyses (α = .05).Results:Minor cartilage defects were present in 22 (16.5%) participants, patellar osteophytes in 83 (62.4%), anterior femur osteophytes in 29 (21.8%), Hoffa synovitis in 81 (60.9%), and prefemoral fat pad synovitis in 49 (36.8%). A larger Insall-Salvati ratio was significantly associated with the presence of patellar osteophytes (odds ratio [OR], 51.82; 95% CI, 4.20-640.01), Hoffa synovitis (OR, 60.37; 95% CI, 4.66-782.61), and prefemoral fat pad synovitis (OR, 43.31; 95% CI, 4.28-438.72) in the patellofemoral joint. A larger patellar tilt angle was significantly associated with the presence of minor cartilage defects (OR, 1.10; 95% CI, 1.00-1.20), the presence of patellar osteophytes (OR 1.12; 95%CI 1.02-1.22), and prefemoral fat pad synovitis (OR, 1.11; 95% CI, 1.03-1.20) in the patellofemoral joint. Finally, a larger bisect offset was significantly associated with the presence of minor cartilage defects (OR, 1.05; 95% CI, 1.00-1.11) and patellar osteophytes (OR, 1.07; 95% CI, 1.01-1.14) in the patellofemoral joint. The majority of patellofemoral alignment measures were not associated with symptoms or function.Conclusion:For people with PFP, the presence of morphological abnormalities defined on MRI appears to be related to particular patellofemoral alignment measures, including higher Insall-Salvati ratio (indicating patella alta), larger patellar tilt angle (indicating greater lateral tilt), and larger bisect offset (indicating greater lateral displacement). Hardly any associations were found with symptoms or function. So there might be a distinct subgroup of PFP that is more prone to developing patellofemoral osteoarthritis later in life, as particular alignment measures seem to be associated with the presence of patellar osteophytes. Prospective studies are required to investigate the longitudinal relationship between alignment or bony shape and morphological abnormalities defined on MRI in this patient population.

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Association between radiological findings and symptoms at the patellofemoral joint in advanced knee osteoarthritis

Cited by 18 publications

References 21 publications

Preoperative lateral subluxation of the patella is a predictor of poor early outcome of Oxford phase-III medial unicompartmental knee arthroplasty

Preoperative lateral subluxation of the patella is a predictor of poor early outcome of Oxford phase-III medial unicompartmental knee arthroplasty

Can patellar tape reduce the patellar malalignment and pain associated with patellofemoral osteoarthritis?

Are Patellofemoral Joint Alignment and Shape Associated With Structural Magnetic Resonance Imaging Abnormalities and Symptoms Among People With Patellofemoral Pain?

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