Relation of the chondromalatia patellae to proximal tibial anatomical parameters, assessed with MRI

Abstract

BackgroundMagnetic resonance imaging (MRI) is a non-invasive highly sensitive tool for diagnosing chondromalacia patellae in the early stages. Many studies have evaluated patellar and trochlear morphology with different radiologic indices. We aimed to assess the discriminative power of tibial, patellar, and femoral indices in MRI for chondromalacia patellae.Patients and methods100 cases of chondromalacia, as well as 100 age-matched controls among the patients who underwent knee MRI between February 2017 and March 2019, were included. The standard protocol of knee MRI was applied and the diagnosis of chondromalacia was made on MRI findings. Chondromalacia subjects were also classified as grade 1 to 4 according to the Modified Outerbridge’s MRI grading system. We measured 25 MRI parameters in the knee and adjacent structures to determine the relation between chondromalacia patellae and anatomical MRI parameters.ResultsTibial slope, trochlear depth, lateral trochlear inclination, and lateral patellar tilt angle had significant correlation with chondromalacia. Any increase in lateral trochlear inclination and lateral patellar tilt angle could increase the probability of the disease (Odds ratio [OR] 1.15, 1.13; 95% CI: 1.03–1.30; 1.02–1.26, respectively), while any increase in medial tibial slope and trochlear depth could decrease the probability of chondromalacia (OR 0.85, 0.06; 95% CI: 0.73–0.98, 0.02–0.17, respectively). We also designed a model for the severity of disease by using the patellar height index (relative odds ratio: 75.9).ConclusionsThe result of this study showed the novelty role of tibial anatomy in developing chondromalacia and its mechanism. We also concluded that patellar height might be an important factor in defining disease severity.

A study on the correlation between patellofemoral joint morphology and early patella malacia in young adults: quantitative analysis based on magnetic resonance

“…At present, the etiological study of CP is not clear. Most researchers tend relate the biomechanical function disorder of patellofemoral joint due to various factors, such as knee joint trauma, patellofemoral instability, cartilage dystrophy, and so on ( 6 , 12 , 14 ). The abnormal morphology of the patellofemoral joint can destroy the stability of the patellofemoral joint, so that the pressure distribution on the cartilage surface of the patellofemoral joint is not uniform, and the wear and softening of the patellar cartilage are aggravated.…”

“…It can display change at the early stage of cartilage degeneration, including irregular signal, fissure, and cartilage thinning. Therefore, it is often used in the early diagnosis of CP ( 6 , 7 ), with an accuracy of 69–97% ( 8 ). The need for MRI, an expensive piece of equipment, and the need for radiologists who specialize in skeletal muscle disease diagnosis contribute to the threshold for diagnosing chondromalacia patellae.…”

Patellar chondromalacia among adolescent athletes-A systematic review

“…Knee arthroscopy as well as Magnetic Resonance Imaging (MRI) can indicate the extent and degree of tissue damage and decide on further treatment. MRI with a high tissue contrast can detect chondromalacia in the lower stages: signal irregularities, fi ssures and chondral thinning thus leading to earlier diagnosis and treatment [11,13].…”

“…Patellar malalignment may be related to patellar (sub)luxation, dysplasio of the femoral trochlea as well as deformities of proximal tibia anatomical parameters such as: tibial slope, trochlear depth, lateral trochlear inclination, and lateral patellar tilt. According to some authors, articular cartilage damage (ICRS grade 1-4: cartilage softening, cartilage surface fi ssures, cartilage fragmentation, cartilage necrosis) in the region of patellofemoral joint is arthroscopically detected in 71% patients with different types of knee trauma, such as: menisci rupture (46%), anterior cruciate ligament rupture (34%) and recurrent patellar luxation (15%) Cartilage damage stimulates transition of proinfl ammatory cytokines to cartilage as well as the local metabolic changes; chondrocytes increase the secretion of proteglycans and collagen, enzymatic tissue degradation accelerates so the subchondral bone might terminally be affected with sclerosis, while cartilage becomes softer [6,7,13,14].…”

The SP-ET Index is a New Index for Assessing The Vertical Position of Patella

“…Duran S et al [10] and Tuna BK et al [5] were reported that there was an association between abnormal trochlear morphology and chondromalacia patella in women. In addition, the study of Tabary M et al showed that the patellar height might be an important factor in the severity of chondromalacia patella [11]. In the study by Deniz Özel, both patella alta and patella baja were found to be related to chondromalacia patella, and the modi ed Insall-Salvati index ratio was the best indicator to de ne patella alta [12].…”