Does isolated patellofemoral osteoarthritis matter?

Duncan, Rachel; Peat, George; Thomas, Elaine; Wood, Laurence; Hay, Elaine M; Croft, Peter

doi:10.1016/j.joca.2009.03.016

Cited by 122 publications

(122 citation statements)

References 18 publications

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“…Contrary to common belief, the PF joint may be a more common site of OA (1,2) and source of symptoms (3,4) than the TF joint. PF joint OA also predicts the incidence of TF joint OA (5,6).…”

Section: Introductionmentioning

confidence: 66%

Diagnostic Performance of Clinical Examination Measures and Pain Presentation to Identify Patellofemoral Joint Osteoarthritis

Stefanik

Duncan

Felson

et al. 2017

Arthritis Care & Research

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ObjectiveTo assess the diagnostic performance of a comprehensive set of tests and measures to discriminate patellofemoral (PF) from tibiofemoral (TF) osteoarthritis (OA).MethodsThe Clinical Assessment of the Knee Study is a study of knee pain in the general population. The presence of PF crepitus and pain with PF compression were assessed. Anterior knee pain was determined using a knee pain map. Pain with climbing/descending stairs and walking on level ground were assessed with the Western Ontario and McMaster Universities Osteoarthritis Index. Radiographs were used to define the compartment(s) of the knee affected by OA (no OA, isolated/predominant PF joint OA, and isolated/predominant TF joint OA). In knees with mixed OA, knees with more severe PF joint OA were included in the isolated/predominant PF group (the same was done for TF joint OA). We determined the sensitivity, specificity, positive predictive value (PPV), negative predictive value, and positive likelihood ratio (LR+) for each test and measure individually, and the combination of these measures, in distinguishing knees with PF joint OA from knees with TF joint OA or no OA.ResultsThere were 745 knees included in the study. No measure had high sensitivity and specificity. Pain with climbing/descending stairs had the greatest sensitivity (90%) but poor specificity (15%). The combination of definite crepitus with no pain on walking had the greatest specificity (96%), PPV (53%), and LR+ (1.8), but poor sensitivity (7%).ConclusionTypical clinical examination findings and knee pain patterns commonly thought to represent underlying PF joint pathology do not discriminate knees with PF joint OA from knees without OA or TF joint OA.

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“…Contrary to common belief, the PF joint may be a more common site of OA (1,2) and source of symptoms (3,4) than the TF joint. PF joint OA also predicts the incidence of TF joint OA (5,6).…”

Section: Introductionmentioning

confidence: 66%

Diagnostic Performance of Clinical Examination Measures and Pain Presentation to Identify Patellofemoral Joint Osteoarthritis

Stefanik

Duncan

Felson

et al. 2017

Arthritis Care & Research

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“…However, the brace increased kneeling or squatting. It is associated with pain, stiffness and functional limitation 3,5 .…”

Section: Mmentioning

confidence: 99%

A knee brace alters patella position in patellofemoral osteoarthritis: a study using weight bearing magnetic resonance imaging

Callaghan¹,

Guney²,

Reeves³

et al. 2016

Osteoarthritis and Cartilage

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Results: Thirty participants were recruited (mean age 57 SD 27.8; BMI 27.8 SD 4.2); 17 were females. Four patients had non-usable data. Main analysis used paired t tests comparing within subject patellar position with and without brace.For bisect offset index, patellar tilt and patellar height ratio there were no significant differences between the brace and no brace conditions. However, the brace increased lateral facet contact area (p =.04) and decreased lateral patellofemoral separation (p = .03). For bisect offset index, patellar tilt and patellar height ratio there were no significant 22 differences between the brace and no brace conditions. However, the brace increased 23 lateral facet contact area (p =.04) and decreased lateral patellofemoral separation (p = 24 .03).

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“…Cross-sectional community-based research studies suggest that structural changes consistent with OA may be more common in the PFJ than in the tibiofemoral joint (Lanyon et al, 1998;Duncan et al, 2006;Szebenyi et al, 2006), and are likely to be an important source of symptoms in knee OA (Hunter et al, 2003;Englund and Lohmander, 2005;Kornaat et al, 2006;Duncan et al, 2009). Indeed, one of these showed that approximately a quarter of .50-year-olds who had experienced some knee pain in the past year had isolated patellofemoral OA in at least one of their knees (Duncan et al, 2006).…”

Section: Discussionmentioning

confidence: 99%

The epidemiology of patellofemoral disorders in adulthood: a review of routine general practice morbidity recording

Wood

Müller

Peat

2011

Prim Health Care Res Dev

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Aim: To describe the annual consultation prevalence of different patellofemoral disorders across the adult life span. Background: The knee is the second most common site for musculoskeletal pain. Evidence from sports injury and orthopaedic settings suggests that patellofemoral disorders constitute a significant proportion of knee pain cases, but we have no evidence from general practice -the setting where most patellofemoral problems will present and be dealt with -of the prevalence of consultations for these problems in the different age groups. Methods: Age-and gender-stratified annual person consulting prevalence rates (APCPRs) for patellofemoral disorders were calculated using 2006 data from the 'Consultations in Primary Care Archive' (CiPCA) -a fully audited database of continuous morbidity recording used by the general practitioners (GPs) in eight general practices in North Staffordshire. Findings: A total of 57 555 .15-year-olds were registered with the eight general practices in 2006; 1782 made a kneerelated consultation, of which 303 (one-in-six) were coded as patellofemoral disorders (APCPR, 53 per 10 000 persons), suggesting that GPs consider a significant proportion of adult knee pain consulters to have patellofemoral disorders. Twelve patellofemoral disorders diagnosed by the GPs were identified. The non-specific diagnosis of 'anterior knee pain' (AKP) was by far the most common (APCPR, 37.2/10 000). Other more specific diagnoses were rare by contrast, suggesting that specific patellofemoral disorders are rarely diagnosed in general practice (consultation prevalences, in order of most prevalent first: bursitis (7.8/10 000), patellofemoral osteoarthritis (2.3/10 000); APCPRs for the remaining nine diagnoses ranged between 0 and 1.6/10 000). However, the use of alternative less anatomically specific diagnostic codes, such as for 'knee pain', may mean that our estimate of one-in-six is an underestimate of GPs' true attribution rates to patellofemoral joint disorders of people consulting them with knee pain. AKP was seen equally commonly by GPs across all age strata, contradicting the received wisdom that AKP problems are most common among younger adults.

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Does isolated patellofemoral osteoarthritis matter?

Abstract: Mild isolated PF OA is significantly associated with symptoms of pain, stiffness and functional limitation. Further research on its recognition in clinical practice and the development of targeted treatments to prevent or slow progression are warranted.

Cited by 122 publications

References 18 publications

Diagnostic Performance of Clinical Examination Measures and Pain Presentation to Identify Patellofemoral Joint Osteoarthritis

Diagnostic Performance of Clinical Examination Measures and Pain Presentation to Identify Patellofemoral Joint Osteoarthritis

A knee brace alters patella position in patellofemoral osteoarthritis: a study using weight bearing magnetic resonance imaging

The epidemiology of patellofemoral disorders in adulthood: a review of routine general practice morbidity recording

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