Comparison of MRI and <sup>18</sup>F‐NaF PET/CT in patients with patellofemoral pain

Draper, Christine E.; Quon, Andrew; Fredericson, Michael; Besier, Thor F.; Delp, Scott L.; Beaupré, Gary S.; Gold, Garry E.

doi:10.1002/jmri.23682

Cited by 41 publications

(35 citation statements)

References 18 publications

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“…Although cartilage is aneural, the subchondral bone is richly innervated, and elevated cartilage/bone mechanical stress has long been proposed to be a possible cause of pain (28). Immunohistochemistry and confocal microscopy studies confirm the sensory and sympathetic innervation of bone and its potential role in skeletal pain (26) and our recent study using F-NaF positron emission tomography showed that chronic patellofemoral pain patients display elevated bone metabolic activity (15). However, testing a hypothesis that relates joint pain to mechanical stress remains difficult due to an inability to measure stress in vivo and the subjective assessment of pain.…”

Section: Introductionmentioning

confidence: 55%

The Role of Cartilage Stress in Patellofemoral Pain

Besier

Pal

Draper

et al. 2015

Medicine &Amp; Science in Sports &Amp; Exercise

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Purpose Elevated cartilage stress has been identified as a potential mechanism for retropatellar pain; however, there are limited data in the literature to support this mechanism. Females are more likely to develop patellofemoral pain than males, yet the causes of this dimorphism are unclear. We used experimental data and computational modeling to determine whether patients with patellofemoral pain had elevated cartilage stress compared to pain-free controls and test the hypothesis that females exhibit greater cartilage stress than males. Methods We created finite element models of 24 patients with patellofemoral pain (11 males; 13 females) and 16 pain-free controls (8 males; 8 females) to estimate peak patellar cartilage stress (strain energy density) during a stair climb activity. Simulations took into account cartilage morphology from MRI, joint posture from weight-bearing MRI, and muscle forces from an EMG-driven model. Results We found no difference in peak patellar strain energy density between patellofemoral pain (1.9 ± 1.23 J/m3) and control subjects (1.66 ± 0.75 J/m3, p=0.52). Females exhibited greater cartilage stress compared to males (2.2 vs 1.3 J/m3, respectively, p=0.0075), with large quadriceps muscle forces (3.7BW females vs 3.3BW males) and 23% smaller joint contact area (females: 467 ± 59 mm2 vs males: 608 ± 95mm2). Conclusion Patellofemoral pain patients did not display significantly greater patellar cartilage stress compared to pain-free controls; however, there was a great deal of subject variation. Females exhibited greater peak cartilage stress compared to males, which might explain the greater prevalence of patellofemoral pain in females compared to males but other mechanical and biological factors are clearly involved in this complex pathway to pain.

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Section: Introductionmentioning

confidence: 55%

The Role of Cartilage Stress in Patellofemoral Pain

Besier

Pal

Draper

et al. 2015

Medicine &Amp; Science in Sports &Amp; Exercise

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“…Recently, imaging data from patients with PFP have been published using newer imaging modalities and technologies in hope that these modalities are more sensitive to detect any possible pathology related to the cartilage under the patella and in the patellar groove. Positron emission tomography-computed tomography (PET-CT) imaging shows that 44-85 % of older adults (mean age [29][30][31][32][33][34] with PFP show increased tracer uptake in the patellofemoral joint that tends to coincide with bone marrow oedema, subchondral bone cysts, and cartilage damage [45][46][47]. Furthermore, there appears to be an association between the tracer uptake and pain intensity, and an association between pain location and location of tracer uptake that suggests an aetiological link [46].…”

Section: Patellofemoral Pain and Pathology?mentioning

confidence: 99%

Patellofemoral Pain in Adolescence and Adulthood: Same Same, but Different?

et al. 2015

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The mainstay of patellofemoral pain (PFP) treatment is exercise therapy, often in combination with adjunct treatments such as patient education, orthoses, patella taping and stretching, making the intervention multimodal in nature. The vast majority of randomised controlled trials among patients with PFP have investigated the effect of treatment among adults (>18 years of age). So, while systematic reviews and meta-analyses provide evidence-based recommendations for treating PFP, these recommendations are largely based upon the trials in adults. In the present article, we have summarised the findings on the efficacy of multimodal treatment (predominantly exercise) from the three largest trials concerning patients with PFP, focusing on the long-term success-rate 1 year after receiving multimodal treatment, and with a particular focus on the success rate across the different age groups, including both adolescents, young adults and adults. The results of this paper show that there appears to be a difference in the success rate between adolescents and adults, despite providing similar exercise treatment and having similar exercise compliance. While PFP may present in a similar fashion in adolescence and adults, it may not be the same underlying condition or stage, and different treatments may be required. Collectively, this highlights the importance of increasing our understanding of the underlying pathology, pain mechanisms and why treatment may-or may not-work in adolescents and adults with PFP.

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“…According to recent studies, 18 F-FDG PET sensitively detects active inflammation in rheumatic diseases, including synovitis in RA [12][13][14][15][16][17][18]. In contrast, 18 F-NaF PET is an increasingly used molecular imaging modality in human skeletal disorders [19][20][21][22][23]. 18 F-NaF incorporates into the bone at the site of bone formation or remodeling; there, osteoblasts and osteoclasts are activated, and 18 F ions exchange the hydroxyl ions in bone crystal to form fluorapatite.…”

Section: Introductionmentioning

confidence: 95%