These results were recorded in a Microsoft Excel file (Microsoft Corporation, Seattle, WA) and were submitted for independent statistical analysis. Data are shown for compartmental distribution of osteoarthritis in 206 knees. Patellar measurements of facet asymmetry, the patella-to-patellar tendon ratio, and the amount of patellotrochlear cartilage overlap were obtained in each subject. Before x 8 There is an association between abnormal trochlear morphology and severe patellofemoral cartilage defects in patients younger than 40 years. 1 The current study uses joint space narrowing to less than 3 mm on PA and skyline radiographs as the criteria for diagnosis of osteoarthritis in any compartment. presence or absence of patellofemoral arthritis. This paper analyzes some of the radiologic measurements used in the diagnosis and management of patellofemoral disorders. One possible explanation could be the changes in articulation and contact patterns between the patella and trochlear groove during flexionextension of the knee. The lack of correlation in our study between patellar indices and cartilage defects provides evidence to conclude that patellar height and surface anatomy are not associated with patellofemoral chondral defects and to justify the importance of focusing our attention on the trochlear aspect of the joint. Epub 2019 Dec 2. The formal assessment of each of these compartments clinically and radiologically is essential if appropriate treatment is to be planned. Patients were divided into two age groups: 49 subjects (age range, 1238 years; 29 male, 20 female) were younger than 40 years and 51 subjects (range, 4087 years; 26 male, 25 female) were 40 years old or older. In: StatPearls [Internet]. The current authors are not aware of any previous series in which the patellofemoral joints of symptomatic patients were examined with a skyline radiograph. 3. Laurin CA, Dussault R, Levesque HP: The tangential xray investigation of the patellofemoral joint. 1 Each set of radiographs was reported blinded to any previous readings on two separate occasions by the lead author and on an additional occasion by the second author to allow calculation of interobserver and intraobserver variation statistics. Of all patellofemoral morphology measurements, the only lateralization of the tibial tubercle may be considered as a risk factor for lateral (not medial) tibiofemoral osteoarthritis worsening. In patients 40 years old or older, 12 knees (24%) were assessed to have normal cartilage, whereas 17 (34%) had mild and 22 (44%) had severe cartilage defects. These data are shown in Figure 5. During knee flexion the patella moves inferiorly to be completely engaged with the trochlear groove and significant medial and lateral facet contact is evident [30]. Second, in our study we modified the measurements to exclude the cartilaginous surface and measured only to the most ventral cortical points. In particular, osteoarthritis of the patellofemoral joint is becoming increasingly recognized as an important cause of knee pain and disability. The negative value indicates a trochlea with a convex anterior surface. Case Discussion Patella height, trochlear depth, and trochlear morphology are some of the measurements obtained when reporting cases of patellofemoral instability on MRI. Given the coexistence and possible interactions between patellofemoral and tibiofemoral compartments, roles of patellofemoral morphology measurements in tibiofemoral osteoarthritis (OA) have not been investigated extensively. arya.mirzaian@gmail.com. 9. MRI Findings in Transient Patellofemoral Dislocation. MRI was performed with either a 1.5-T magnet (TR range/TE range, 3,5004,000/1235; matrix size, 256 192224; field of view [FOV], 16 16 or 18 18 cm; 3-mm slice thickness) or a 3-T magnet (2,5003,000/1850; matrix size, 384 256; FOV, 16 16 cm; 3-mm slice thickness) (Signa, GE Healthcare) and an extremity coil. 2018 Nov;28(11):4669-4680. doi: 10.1007/s00330-018-5460-9. Arthritic changes occurred in the patellofemoral compartment in isolation in 13.6% of women and 15.4% . Patellofemoral morphology measurements of patella alta, trochlear dysplasia, patellar tilt . Lawrence JS, Bremner JM, Bier F: Osteoarthritis: Prevalence in the population and relationship between symptoms and xray changes. Data are shown for compartmental distribution of osteoarthritis in women older than 60 years (n=42). All measurements were made by one observer using electronic calipers. endstream Axial and sagittal MR images were reviewed to grade the severity of focal cartilage defects in the patellofemoral region on the basis of the depth of the lesion. The .gov means its official. However, we found substantial agreement in the detection of the specific grade of defects between arthroscopy and MRI. The results of statistical analysis of joint space measurements and diagnoses are shown in Table 1. The patella is a flat, inverted triangular bone, situated on the front of the knee joint. Epub 2021 Mar 8. endobj The results showed objective joint space narrowing to less than 3 mm in the patellofemoral compartment of 32.7% of men and 36.1% of women older than 60 years. Acta Radiol 38:10631070, 1997. Pitfalls and Pearls in MRI of the Knee, Review. However, most authors have failed to establish a relationship between the two. ADVERTISEMENT: Supporters see fewer/no ads. Thirty-nine patients had bilateral symptoms. Annotated images to aid in the reporting of patellofemoral instability on MRI. and transmitted securely. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. <>>>/BBox[0 0 576 756]/Length 103>>stream The fact that the patella sits atop the anterior surface of the femoral condyles, increases the angle at which the quadriceps tendon pulls on the shaft of the tibia. An official website of the United States government. w3T0WI2P0T5T R The difference in our findings and those of the other studies [14, 16, 25, 26] can be attributed to multiple factors. Zikria B, Rinaldi J, Guermazi A, Haj-Mirzaian A, Pishgar F, Roemer FW, Hakky M, Sereni C, Demehri S. Knee. The correlation of our results with previously determined values strongly suggests the association of trochlear dysplasia in cases with severe cartilage defects. Bone bruises at the anterolateral aspect of the lateral femoral condyle and at the inferomedial patella are the most constant findings in patients who have sustained a recent patellar dislocation. The patients included in the current study were a large, consecutive series of new referrals with knee pain to an orthopaedic surgeon. Clin Rheumatol. This is presented with 95% confidence intervals. A review of techniques for imaging the patellofemoral joint was published by Merchant. In conclusion, our study has important diagnostic implications because it gives valuable information regarding the cause of patellofemoral degeneration. Imaging of Anterior Cruciate Ligament Repair and Its Complications, Review. 12. Materials and Methods Institutional review board approval and written informed consent were obtained from all subjects. endstream (not medial) tibiofemoral osteoarthritis worsening. 2019 Feb;27(2):278-285. doi: 10.1016/j.joca.2018.10.013. has 2 years of experience interpreting CT images). We aimed to determine whether patellofemoral morphology is associated with the presence and longitudinal worsening of tibiofemoral OA in participants of the Osteoarthritis Initiative (OAI). Only 30 subjects were found to have undergone arthroscopy after MRI. The ventral trochlear prominence (> 8 mm), facet asymmetry (< 40%), trochlear depth (< 3 mm), lateral inclination (< 11), and sulcus angle (> 150) are some of the morphologic features used to classify the condition. your express consent. A statistical significance was defined by a p value of < 0.05. 10 The patellofemoral joint cannot be observed adequately if the knee is flexed to extreme angles because tension in the quadriceps will distort the position and orientation of the patella within the trochlea. A landmark-based 3D analysis reveals a narrower tibial plateau and patella in trochlear dysplastic knees. There were five knees with no trochlear prominence (0 mm) that had normal cartilage. On MRI, TT-PCL and PT-PCL measurements have significantly less variability compared with TT-TG and PT-TG measurements, regardless of knee position. endstream <>>>/BBox[0 0 576 756]/Length 103>>stream Eighteen (8.7%) had medial tibiofemoral plus patellofemoral changes, seven (3.4%) showed narrowing of lateral tibiofemoral and patellofemoral compartments, whereas one had narrowing in all three knee compartments. Over the years, many have investigated this theory using radiography [8, 23] and MRI [11] but without much success [24]. Patellofemoral morphology measurements of patella alta, trochlear dysplasia, patellar tilt, and lateralization of the tibial tubercle are not associated with radiographic and MRI-based medial tibiofemoral osteoarthritis worsening over 2 years. Bookshelf x 8 Patients with severe cartilage defects had a trochlear groove that was seen to be less deep (mean = 0.29 mm; range, 3 to 4 mm) than that in patients with normal cartilage (mean, 3.68 mm; range, 3 to 7 mm). endobj The authors are not aware of any previous systematic evaluation of such a cohort for patellofemoral osteoarthritis. may email you for journal alerts and information, but is committed
Four different measurements were made on the axial proton density fat-saturated sequences: the trochlear depth, trochlear facet asymmetry, sulcus angle, and lateral trochlear inclination. This may be of particular relevance as the debate about unicompartmental versus total joint replacement continues. Pishgar F, Guermazi A, Ashraf-Ganjouei A, Haj-Mirzaian A, Roemer FW, Zikria B, Sereni C, Hakky M, Demehri S. Skeletal Radiol. Results: Abstract Purpose: To test the inter-observer and inter-method reliability among the measures suggesting patellofemoral joint disorder on both CT and MRI in the same subject and find possible association with internal derangements of the patellofemoral joint on MRI. i The objective of our study was to assess patellofemoral measurements on MRI and to correlate the measurements with different grades of cartilage defect. Patellofemoral instability or maltracking is the clinical syndrome due to morphologic abnormalities in the patellofemoral joint where the patella is prone to recurrent lateral dislocation. Twenty-four patients (46.1%) had isolated medial tibiofemoral osteoarthritis. Patellofemoral morphology measurements were not associated with longitudinal joint space loss in the MTFC or MOAKS determinants. Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 N Caroline St, JHOC 4240, Baltimore, MD, 21287, USA. Similarly, trochlear measurements of the ventral trochlear prominence, trochlear depth, facet asymmetry, sulcus angle, and lateral inclination were obtained. In knees with severe cartilage defects, the ventral trochlear prominence was always greater than 5 mm, with the maximum measurement being 10 mm. !\ ^Ey9 ^Ey9 The condition is especially common in athletes and individuals who engage in activities that place inordinate stress on the knee joint. The finding of such a high prevalence of patellofemoral osteoarthritis in this group reinforces the importance of requesting an axial radiograph for all patients who present with knee pain. j 1, Patellar tendon. Joint space narrowing is not the only radiologic feature of osteoarthritis but it has been shown to be the most reproducible in the assessment of radiographs. Felson DT, Naimark A, Anderson J, et al: The prevalence of knee osteoarthritis in the elderly. Ann Rheum Dis 55:875879, 1996. For more information, please refer to our Privacy Policy. Seventeen knees (32.7%) had patellofemoral changes either alone or in combination with other compartments. In knees in which more than one cartilage defect was observed, the defect with the greatest severity was chosen. F The images were analyzed on a workstation and measured using software (eFILM Workstation version 2.1, Merge Healthcare) and electronic calipers. The femoral trochlea has been described in the literature using radiography [12, 13], CT [1], and MRI [1416]. Analysis of the Patellofemoral Region on MRI: Association of Abnormal Trochlear Morphology With Severe Cartilage Defects, Pictorial Essay. Dr. Tanaka additionally has interest in improving the understanding of treatment outcomes and injury prevention in female athletes. 2. Forty-five knees (21.8%) had patellofemoral changes either alone or in combination with other compartments. 1C). The resulting instability to the PFJ may cause an unequal distribution of forces and an unfavorable mechanical joint stress within the joint. Although further studies are warranted, the use of TT-PCL and PT-PCL measurements may offer more reliable assessment of tibial tubercle lateralization and patellofemoral alignment. The slice corresponding to the horizontal line passing through the greatest ventral trochlear prominence was determined and used to calculate the axial measurement (Fig. Therefore, the evaluation of these trochlear measurements is important when evaluating MR images of patients with patellofemoral cartilage defects. Axial and sagittal MR images of 100 patients with various pathologic knee conditions were analyzed. Additionally, no significant difference was seen between any of the axial measurements of knees with normal cartilage and knees with mild cartilage defects. 3B). These figures also are higher than previously documented. Higher TT-TG distance was associated with concurrent MRI-derived OA-related structural damages and 2-year follow-up worsening only in LTFC. government site. 1 Patellofemoral changes were seen alone or in combination in 36.1% of women and 32.7% of men older than 60 years. Tibial tuberosity to trochlear groove distance and its association with patellofemoral osteoarthritis-related structural damage worsening: data from the osteoarthritis initiative. Some studies of knee osteoarthritis have focused solely on the tibiofemoral compartments. w3T0WI2P0T5T R What is patellofemoral pain syndrome? -, Kobayashi S, Pappas E, Fransen M, Refshauge K, Simic M (2016) The prevalence of patellofemoral osteoarthritis: a systematic review and meta-analysis. The site is secure. Boegard T, Rudling O, Petersson IF, et al: Posteroanterior radiogram of the knee in weightbearing and semiflexion: Comparison with MR imaging. 12. In seven patients (16%) no compartment was narrowed to less than 3 mm. This prevalence of isolated patellofemoral arthritis in men is higher than that described previously. Ann Rheum Dis 52:655658, 1994. This is as described by Ahlback. The trochlear depth was defined as the maximum distance of the trochlear groove from the line connecting the medial and lateral trochlear facets (Fig. Also known as "runner's knee," patellofemoral pain syndrome refers to chronic pain in the patella, or kneecap. Skeletal Radiol. More recently, McAlindon et al 11 in a series of 273 symptomatic patients older than 55 years documented that 19% of men and 34% of women showed evidence of patellofemoral osteoarthritis. The reliability of the definition of osteoarthritis of the knee (< 3 mm joint space) was assessed using Cohens kappa statistic. First, this study was retrospective and only knees of symptomatic patients were analyzed. Wolfe S, Varacallo M, Thomas JD, Carroll JJ, Kahwaji CI. 2020 Dec;27(6):1971-1979. doi: 10.1016/j.knee.2020.11.002. 5. No significant difference was seen in the patellar measurements between normal knees and knees with severe cartilage defects. Last, we divided our population into two age groups to account for osteoarthritic changes in older knees [2729]. Ethical approval was granted before the start of the study. Wolters Kluwer Health
The ventral trochlear prominence was described as the distance between the line paralleling the ventral cortical surface of the distal femur and the most ventral cortical point of the femoral trochlear floor (Fig. Pfirrmann et al. 12 0 obj In this study, different trochlear and patellar morphologic parameters were measured using MRI and were correlated to different grades of cartilage defects. @!E4C@@c\C k Review of the literature and the results of the current study (Table 2) indicate that the radiologic assessment of the patellofemoral compartment using a lateral radiograph is inadequate. w3T0WI2P0T5T R Accessibility The results of the current study confirm that osteoarthritis of the knee can affect each of the three knee compartments alone or in any combination. 1A, 1B, 1C). The mean values for each of these ratios was identified and patella alta and patella baja assigned to values +/- 2 SD above and below the mean. In our study, we found no statistical correlation between patellar facet measurements and different grades of cartilage defects. Our licensed therapists work with patients on a 1-to-1 basis to create a targeted program of passive and active treatments. Axial and sagittal MR images of 100 patients with various pathologic knee conditions were analyzed. F 2). xs Therefore, having knowledge about the exact anatomy and function of the joint is required to understand, diagnose, and treat these different abnormalities appropriately. Epub 2022 Apr 2. Departments of 1 Radiology and 2 Orthopedic Surgery, University of Iowa Hospitals, Iowa City, Iowa, USA Abstract. Informed consent was obtained from each individual. Vince AS, Singhania AK, Glasgow MMS: What xrays do we need? E% We recognize some limitations in our study. Developmental or acquired alterations in the surface geometry of the PFJ are associated with multiple clinical problems such as patellar instability; chondromalacia patella; and, consequently, anterior knee pain [16]. The p value was derived using a paired Student's t test calculated using statistics software (MedCalc version 9.6, MedCalc Software Company). Sensitivity of the lateral radiograph was 66%, specificity was 83%, and positive predictive value was 52% indicating poor performance in the detection of patellofemoral osteoarthritis. Knee Diameter and Cross-Section Area Measurements in MRI as New Promising Methods of Chondromalacia Diagnosis-Pilot Study. Furthermore, the correlation between the axial measurements and severe cartilage defects was evident only in the younger population. Eleven patients (25%) had isolated medial tibiofemoral osteoarthritis. There are a paucity of data on the compartmental distribution of osteoarthritis in modern practice. In the presence of an increased trochlear prominence and decreased trochlear depth, the contact area between the patella and trochlea is reduced as it tracks along the femur. Our aim is to review the radiographic and cross-sectional imaging findings of patellofemoral malalignment, including the common measurements used to appropriately assess patellar tracking disorders, as well as frequently employed surgical treatments. In his series, a lateral radiograph was used to document 48% of 281 knees as having radiographic evidence of patellofemoral osteoarthritis either alone or in combination with other compartments. Moreover, in vivo findings suggest that a shallow trochlear groove and a trochlear facet with less angulation will allow the patella to be displaced laterally more easily [31, 32]. Arthritis Care Res (Hoboken) 68:493501 These measurements were used to determine the patellotrochlear index, which is the ratio of the trochlear cartilage overlapping with the patellar cartilage in relation to the length of the patellar cartilage (Fig. In nine patients (17%) no compartment was narrowed to less than 3 mm. Pfirrmann et al. <>>>/BBox[0 0 576 756]/Length 135>>stream Objectives: To explore the performance of a deep learning-based algorithm for automatic patellofemoral joint (PFJ) parameter measurements from the Laurin view. 1 The patient stood with weight equally distributed between the limbs and patella touching the xray film cassette. South Boston, Massachusetts, Luna PTs specialize in treating patients suffering from PFPS and chronic knee pain. Six knees (13.6%) had patellofemoral changes with normal tibiofemoral compartments. Overall, 9% of knees had patellofemoral changes in isolation however, for patients older than 60 years this figure rose to 13.6% for women and 15.4% for men. This retrospective study was performed in compliance with HIPAA regulations, with approval from our institutional review board and with a waiver of informed consent. Patellofemoral osteoarthritis was present in 17 patients. Baseline knee MRIs of 600 participants were read by two independent blinded observers in consensus to determine patellofemoral morphology measurements including tibial tuberosity to trochlear groove (TT-TG) distance, trochlear groove depth (TGD), lateral patellar tilt (LPT), and Insall-Salvati ratio (ISR). -, Iijima H, Fukutani N, Aoyama T et al (2016) Clinical impact of coexisting patellofemoral osteoarthritis in Japanese patients with medial knee osteoarthritis. Methods: xs 35 0 obj The PA radiograph was made according to the method of Ahlback. Your message has been successfully sent to your colleague. sharing sensitive information, make sure youre on a federal Unable to load your collection due to an error, Unable to load your delegates due to an error. As early as 1964, Outerbridge [9] had proposed that the motion of the medial patellar facet on the rim of the medial femoral condyle may cause wear of the cartilage in the area. Bethesda, MD 20894, Web Policies The angle formed between the medial and lateral trochlear facets was simultaneously measured and determined to be the sulcus angle (Fig. Twenty-seven (51.8%) showed changes isolated to the tibiofemoral compartments. Meta-analysis on the association between knee extensor strength and structural changes of knee osteoarthritis. Federal government websites often end in .gov or .mil. MeSH 3A). Axial slices were used to determine the patellar facet asymmetry, which is described as the ratio of the medial and lateral patellar facet lengths (Fig. All measurements were made on the sagittal slice showing the greatest patella length. The axial radiograph was made according to the method of Laurin et al 8 with the knee flexed to 25. For the 30 subjects who underwent arthroscopy, substantial agreement ( = 0.621) was found between the grade of the patellofemoral cartilage on arthroscopy and MRI [22]. Therefore, in elderly subjects, deformation of cartilage is considerably less than in the young [27]. Nineteen (43%) showed changes isolated to the tibiofemoral compartments. MRI of the Thumb: Anatomy and Spectrum of Findings in Asymptomatic Volunteers, Review. If requests for skyline radiographs had been confined to patients with abnormal patellofemoral joints as assessed on lateral films then 28 normal joints would have been imaged and 14 abnormal joints would have been missed. In patients 40 years old or older, all axial measurements of patients with normal cartilage, mild cartilage defects, and severe cartilage defects were found to be similar. The lateral radiograph had poor results for detection of patellofemoral osteoarthritis with a sensitivity of 66% and specificity of 83%. % Consequently, measurement of patellar alignment has come to be accepted as an integral part of the examination of patellofemoral pain syndrome. 4B). Lanyon P, Jones A, Doherty M: Assessing progression of patellofemoral osteoarthritis: A comparison between two radiographic methods. <>>>/BBox[0 0 576 756]/Length 103>>stream We correlated the MR findings with the reference standard arthroscopy in the 30 knees that underwent surgery.
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