Can radiographic patellofemoral osteoarthritis be diagnosed using clinical assessments?

Abstract

Introduction: The aim of this study was to determine whether participant characteristics and clinical assessments could identify radiographic osteoarthritis (OA) in individuals with clinically diagnosed, symptomatic patellofemoral osteoarthritis (PFOA). Methods: Participant characteristics and clinical assessments were obtained from 179 individuals aged 50 years and over with clinically diagnosed symptomatic PFOA, who were enrolled in a randomised trial. Anteroposterior, lateral, and skyline X-rays were taken of the symptomatic knee. The presence of radiographic PFOA was defined as "no or early PFOA" (Kellgren and Lawrence [KL] grade ≤1 in the PF compartment) or "definite PFOA" (KL grade ≥2). Diagnostic test statistics were applied to ascertain which participant characteristics and clinical assessments could identify the presence of definite radiographic PFOA. Results: A total of 118 participants (66%) had definite radiographic PFOA. Univariate analysis identified that older age (>61 years), female sex, higher body mass index (BMI) (>29 kg/m 2), longer pain duration (>2.75 years), higher maximum knee pain during stair ambulation (>47/100 mm), and fewer repeated single step-ups to pain onset (<21) were associated with the presence of definite radiographic PFOA. Multivariate logistic regression indicated that BMI, pain duration, and repeated single stepups to pain onset were independently associated with radiographic PFOA and identified the presence of definite radiographic PFOA with an overall accuracy of 73%. Conclusion: In individuals over 50 years of age with a clinical diagnosis of PFOA, higher BMI, longer pain duration, and fewer repeated single step-ups to pain onset increased the likelihood of radiographic PFOA. However, overall diagnostic accuracy was modest, suggesting that radiographic PFOA cannot be confidently identified using these tests.

Machine Learning Based Texture Analysis of Patella from X-Rays for Detecting Patellofemoral Osteoarthritis

“…Moreover, in clinical setting, radiographic TF joint is often evaluated with a posterior-anterior (PA) view radiograph from which the PF joint can not be evaluated at all. In addition, clinical assessments and participant characteristics alone cannot be used to diagnose patellofemoral OA [9,10,11]. Since it has been reported that, at least in some phenotypes of knee OA, PF joint changes even precede TF joint changes ([12, 13, 14]), there is a strong need to consider also PF joint when developing new imaging biomarkers to diagnose and monitor knee OA .…”