Is Tibiofemoral or Patellofemoral Alignment or Trochlear Morphology Associated With Patellofemoral Osteoarthritis? A Systematic Review

Macri, Erin M; Stefanik, J.J.; Khan, Khalid; Crossley, Kay M

doi:10.1002/acr.22842

Cited by 52 publications

(69 citation statements)

References 46 publications

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“…Trochlear morphology and patellofemoral alignment are associated with patellofemoral OA 12 . In the axial plane, a shallower/wider trochlea and a patella that is more laterally displaced or tilted are associated with more severe patellofemoral OA features 12 , and trochlear morphology is associated with patellofemoral alignment 13, 14 .…”

Section: Introductionmentioning

confidence: 99%

“…In the axial plane, a shallower/wider trochlea and a patella that is more laterally displaced or tilted are associated with more severe patellofemoral OA features 12 , and trochlear morphology is associated with patellofemoral alignment 13, 14 . Theoretically, trochlear dysplasia may cause patellar instability and result in malalignment and/or aberrant movement patterns at the patellofemoral joint.…”

Section: Introductionmentioning

confidence: 99%

“…prevalence of patellofemoral OA features across the range of morphology or alignment values) 21 . A recent systematic review reported that only one of 16 studies investigating patellofemoral morphology and alignment recruited an asymptomatic comparison group 12, 18 . This is in contrast to other important medical conditions (e.g.…”

Section: Introductionmentioning

confidence: 99%

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Patellofemoral morphology and alignment: reference values and dose–response patterns for the relation to MRI features of patellofemoral osteoarthritis

Macri

Felson

Zhang

et al. 2017

Osteoarthritis and Cartilage

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Objective We aimed to (i) determine reference values for trochlear morphology and patellofemoral (PF) alignment in adults without MRI-defined PF full thickness cartilage damage or knee pain; and (ii) evaluate dose-response patterns for these measures with prevalent MRI-defined PF structural damage and/or knee pain. Design The Framingham Community Cohort is a population-based sample of ambulatory adults aged ≥50 years. We evaluated six morphology and alignment measures using MRI (n=985), and reported reference values (mean ±2SD) in a subsample without MRI-defined PF full thickness cartilage damage or knee pain (n=563). With restricted cubic spline Poisson regression, we evaluated dose-response patterns of each of the six measures with prevalent MRI-defined PF structural damage or joint pain. Our primary outcome was full thickness cartilage damage. Results For dose-response curves, prevalence ratios increased monotonically for all measures except patellar tilt, which rose with both lateral and medial tilt. Associations were generally strongest in the lateral PF compartment. Prevalence ratios (PR) for the strongest predictors of full thickness cartilage damage reached clinical relevance (PR>1.5) at sulcus angle ≥135.0°; patellar tilt angle at ≤1.0° and ≥15.0°; and bisect offset ≥57.0%. Lateral trochlear inclination achieved PR>1.5 at ≤23.0° for full thickness cartilage damage with pain. Conclusions Sulcus angle, patellar tilt, and bisect offset were most strongly associated with full thickness cartilage damage. Lateral trochlear inclination, patellar tilt and bisect offset had stronger associations with the addition of pain. These findings contribute to better identifying a subset of patients who may benefit from mechanically based interventions.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Patellofemoral morphology and alignment: reference values and dose–response patterns for the relation to MRI features of patellofemoral osteoarthritis

Macri

Felson

Zhang

et al. 2017

Osteoarthritis and Cartilage

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“…An increase in the Q angle increases the lateral force on the patella 7,14,16. It has been shown that larger Q angles are associated with femoropatellar instability and with PFOA 14,15. However, the use of the Q angle to predict PFP is controversial.…”

Section: Pfp Pathophysiology or Pathomechanicsmentioning

confidence: 99%

Patellofemoral pain in athletes

Petersen

Rembitzki

Liebau

2017

OAJSM

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Patellofemoral pain (PFP) is a frequent cause of anterior knee pain in athletes, which affects patients with and without structural patellofemoral joint (PFJ) damage. Most younger patients do not have any structural changes to the PFJ, such as an increased Q angle and a cartilage damage. This clinical entity is known as patellofemoral pain syndrome (PFPS). Older patients usually present with signs of patellofemoral osteoarthritis (PFOA). A key factor in PFPS development is dynamic valgus of the lower extremity, which leads to lateral patellar maltracking. Causes of dynamic valgus include weak hip muscles and rearfoot eversion with pes pronatus valgus. These factors can also be observed in patients with PFOA. The available evidence suggests that patients with PFP are best managed with a tailored, multimodal, nonoperative treatment program that includes short-term pain relief with nonsteroidal anti-inflammatory drugs (NSAIDs), passive correction of patellar maltracking with medially directed tape or braces, correction of the dynamic valgus with exercise programs that target the muscles of the lower extremity, hip, and trunk, and the use of foot orthoses in patients with additional foot abnormalities.

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“…In some clinical and research settings, magnetic resonance imaging (MRI) is used to evaluate knee alignment in patellofemoral osteoarthritis (OA) and related conditions (patellofemoral pain or instability) . The advantages of MRI include lack of ionizing radiation and versatility of sequence parameters.…”

mentioning

confidence: 99%

Patellofemoral and tibiofemoral alignment in a fully weight‐bearing upright MR: Implementation and repeatability

Macri

Crossley

d’Entremont

et al. 2017

Magnetic Resonance Imaging

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Is Tibiofemoral or Patellofemoral Alignment or Trochlear Morphology Associated With Patellofemoral Osteoarthritis? A Systematic Review

Cited by 52 publications

References 46 publications

Patellofemoral morphology and alignment: reference values and dose–response patterns for the relation to MRI features of patellofemoral osteoarthritis

Patellofemoral morphology and alignment: reference values and dose–response patterns for the relation to MRI features of patellofemoral osteoarthritis

Patellofemoral pain in athletes

Patellofemoral and tibiofemoral alignment in a fully weight‐bearing upright MR: Implementation and repeatability

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