Radiology records were reviewed to identify 25 patients (male-female ratio, 0.56; median age, 20 years; range, 13-43 years) . Clinical Orthopaedics and Related Research: A lateral radiograph shows an apparently well-preserved patellofemoral joint space. %PDF-1.4 w3T0WI2P0T5T R (21.8%). government site. Data is temporarily unavailable. Endo et al. 3. x Sagittal proton densityweighted fast spin-echo (FSE) sequences and axial proton density fat-saturated sequences were used to analyze the sagittal and axial images, respectively. In this study, different trochlear and patellar morphologic parameters were measured using MRI and were correlated to different grades of cartilage defects. ADVERTISEMENT: Supporters see fewer/no ads. <>>>/BBox[0 0 576 756]/Length 103>>stream These results were recorded in a Microsoft Excel file (Microsoft Corporation, Seattle, WA) and were submitted for independent statistical analysis. 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. Similarly, the angle formed between the lateral trochlear facet and a line connecting the posterior-most cortical surfaces of the femoral condyles was measured and determined to be the lateral trochlear inclination (Fig. Our licensed therapists work with patients on a 1-to-1 basis to create a targeted program of passive and active treatments. F Linear regression was used to test the associations between age and anatomic measurement indices. j The middle cerebral artery travels to the lateral fissure. !\ In previous studies of the morphologic features of the patellofemoral region, investigators have focused their attention on the patellar aspect of the joint. The purpose was to assess patellofemoral morphology on MRI and to determine its association with different grades of cartilage defects. Forty-five knees (21.8%) had patellofemoral changes either alone or in combination with other compartments. Higher TT-TG distance was associated with concurrent MRI-derived OA-related structural damages and 2-year follow-up worsening only in LTFC. ]\4 iT!4\|FoObsRAH($Z XbawRjfBpB49Jlb6M lZ;cG?t:*4 Epub 2021 Jul 4. The slice corresponding to the horizontal line passing through the greatest ventral trochlear prominence was determined and used to calculate the axial measurement (Fig. Baseline knee MRIs of 600 participants were read by two independent blinded observers in consensus to determine patellofemoral morphology measurements including tibial tuberosity to trochlear groove (TT-TG) distance, trochlear groove depth (TGD), lateral patellar tilt (LPT), and Insall-Salvati ratio (ISR). Zikria B, Rinaldi J, Guermazi A, Haj-Mirzaian A, Pishgar F, Roemer FW, Hakky M, Sereni C, Demehri S. Knee. The patella is a thick, flat, triangular bone with its apex pointing downwards. ]\4 iT!4\|FoObsRAH($Z XbawRjfBpB49Jlb6M lZ;cG?t:*4 The results of statistical analysis of joint space measurements and diagnoses are shown in Table 1. Measurements such as condylar width and height and patellar height from the true lateral view are helpful to determine the type and severity of intercondylar dysplasia. Patients were imaged at our institution for various clinical conditions (Table 1). Patellofemoral maltracking is a recog- nized cause of peripatellar pain. The angle formed between the medial and lateral trochlear facets was simultaneously measured and determined to be the sulcus angle (Fig. Results: 12 0 obj <>>>/BBox[0 0 576 756]/Length 135>>stream endstream Measurements in knees without a chondral defect were compared with knees with mild and severe chondral defects. Copyright 2013-2020, American Roentgen Ray Society, ARRS, All Rights Reserved. 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. Siero D, Jaboska I, Lukoszek D, Szyluk K, Meusburger H, Delimpasis G, Kostrzewa M, Platzek I, Christe A. Medicina (Kaunas). Bethesda, MD 20894, Web Policies Nineteen patients (9.2%) had patellofemoral osteoarthritis with normal tibiofemoral compartments. Ann Rheum Dis 25:123, 1966. The .gov means its official. 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. Twenty-four patients (46.1%) had isolated medial tibiofemoral osteoarthritis. However, to our knowledge, no study has used MRI to specifically analyze the relationship between the trochlear anatomy and patellofemoral cartilage defects. Clin Orthop 144:1626, 1979. Unable to load your collection due to an error, Unable to load your delegates due to an error. Ann Rheum Dis 51:8082, 1992. endstream w3T0WI2P0T5T R In: StatPearls [Internet]. In that series one observer assessed a lateral radiograph for the presence or absence of patellofemoral joint abnormality. The current authors are not aware of any previous series in which the patellofemoral joints of symptomatic patients were examined with a skyline radiograph. For more information, please refer to our Privacy Policy. We believe that the failures of these studies to conclusively show any correlation between patellofemoral morphology and chondromalacia patella are related in part to the neglect of the trochlear aspect of the joint. [14], Carrillon et al. Keywords: articular cartilage defects, chondromalacia patella, femoral trochlea, knee instability, MRI, patella, patellofemoral region. Skeletal Radiol. In asymptomatic patients this figure was 4%. Investigating defects in specific areas of the medial and lateral facets of the patella and trochlea may provide a better understanding regarding the mechanism of injury associated with specific trochlear morphology. 4C). 8600 Rockville Pike Axial and sagittal MR images of 100 patients with various pathologic knee conditions were analyzed. may email you for journal alerts and information, but is committed There were 213 knees in 174 patients in the study. Case study, Radiopaedia.org (Accessed on 12 Dec 2022) https://doi.org/10.53347/rID-78352. This was done to account for age-related osteoarthritic changes seen in the older population. Patellofemoral morphology measurements of patella alta, trochlear dysplasia, patellar tilt . 7. -. Objectives: To explore the performance of a deep learning-based algorithm for automatic patellofemoral joint (PFJ) parameter measurements from the Laurin view. Davies AP, Vince AS, Shepstone L, Donell ST, Glasgow MM (2002) The radiologic prevalence of patellofemoral osteoarthritis. The comparison in axial trochlear measurements revealed a significant difference in the trochlear depth (p = 0.001), sulcus angle (p = 0.003), and lateral trochlear inclination (p = 0.007) between knees with normal-appearing cartilage and severe cartilage defects in patients younger than 40 years. Subjects with a history of arthroscopic surgery were excluded from the study. To determine the relationship of patellofemoral joint alignment and trochlear morphology to superolateral Hoffa fat pad (SHFP) edema on magnetic resonance (MR) images in older adults with or at risk for osteoarthritis of the knee. 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. Nineteen knees (9.2%) had patellofemoral changes with normal tibiofemoral compartments. E%) The interobserver intraclass correlation coefficients also have good reliability of joint space measurements. 2021 Sep;40(9):3511-3521. doi: 10.1007/s10067-021-05634-6. Formal assessment of the patellofemoral compartment using a skyline radiograph must be included in the primary radiographic series for assessment of osteoarthritis of the knee. 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. i Later studies have added other quantitative measurements such as the sulcus angle and the lateral trochlear inclination [16, 17]. 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. The stacks of images can be used to conveniently review the different measurement techniques. Previous studies have investigated the correlation between chondral defects and different radiographic morphologic measurements such as the congruence angle, Q angle, and patellar height and shape [8, 18, 19]. P values were corrected using the Benjamini-Hochberg procedure. 3B). Ahlback 1 showed that the lateral radiograph is capable of overrepresenting and underrepresenting the extent of osteoarthritic changes in the patellofemoral 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. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. the patella. 11. A survey of orthopaedic surgeons in the United Kingdom. We found that in knees with gross trochlear abnormalities, the most remarkable axial changes were seen in the slice corresponding to the greatest ventral trochlear prominence. This high prevalence of patellofemoral disease in men has not been documented before. Axial and sagittal MR images of 100 patients with various pathologic knee conditions were analyzed. A landmark-based 3D analysis reveals a narrower tibial plateau and patella in trochlear dysplastic knees. Osteoarthritis Cartilage 24:16971707 Arthritis Rheum 30:914918, 1987. % These data are shown in Figure 4. 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. There was a statistically significant difference in the trochlear measurements of the ventral prominence (p = 0.012), trochlear depth (p = 0.001), sulcus angle (p = 0.208), and lateral inclination (p = 0.154) between normal knees and knees with severe cartilage defects in patients younger than 40 years. 4D). In PFJs with no trochlear prominence, the anterior physeal line was used as a reference for determining the axial slice (Fig. Dejour et al. 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. Acta Radiol 38:10631070, 1997. MRI Findings in Transient Patellofemoral Dislocation. Epub 2021 Mar 8. Only TT-TG distance was associated with the baseline number of subregions with cartilage defects (OR (95% CI), 1.09 (1.04-1.14), corrected p value 0.01), BMLs (OR (95% CI), 1.1 (1.04-1.17), corrected p value = 0.01), and osteophytes (OR (95% CI), 1.09 (1.05-1.14), corrected p value 0.01) in the lateral tibiofemoral compartment (LTFC), and worsening of LTFC cartilage defects over 2 years (OR (95% CI), 1.09 (1.03-1.16), corrected p value = 0.02). Additional analysis of these data was done with reference to the age and gender of the patients. Specifically, we found that knees with a large ventral trochlear prominence, shallow trochlear groove, increased sulcus angle, and decreased lateral trochlear inclination in patients younger than 40 years are associated with severe PFJ chondral defects. 11, Fibula. The difference in our findings and those of the other studies [14, 16, 25, 26] can be attributed to multiple factors. First, this study was retrospective and only knees of symptomatic patients were analyzed. A decreased lateral trochlear inclination was seen in knees with severe cartilage defects (mean = 14.7), whereas this value was considerably greater in knees with normal cartilage (mean = 22.8). In knees in which more than one cartilage defect was observed, the defect with the greatest severity was chosen. Analysis of the Patellofemoral Region on MRI: Association of Abnormal Trochlear Morphology With Severe Cartilage Defects, Pictorial Essay. Patellofemoral osteoarthritis was present in 45 knees. This prevalence of isolated patellofemoral arthritis in men is higher than that described previously. endstream Lanyon et al 7 and Jones et al 6 concluded that the skyline radiograph is superior to the lateral radiograph for assessment of changes of osteoarthritis in the patellofemoral joint. The patients were divided into two age groups: < 40 years and 40 years. Check for errors and try again. MATERIALS AND METHODS. For all trochlear measurements, the cartilage was excluded and only the osseous surfaces were used as a reference. Key points: 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. There was a fixed distance from the patella to the plate of 20 cm to minimize magnification error. Furthermore, the correlation between the axial measurements and severe cartilage defects was evident only in the younger population. 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. 1A, 1B, 1C). Epidemiology Most patients with patellar instability are young and active individuals, especially females in the second decade. 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. 5. The axial radiograph was made according to the method of Laurin et al 8 with the knee flexed to 25. However, the ventral trochlear prominence (mean, 6.9 mm), trochlear facet asymmetry (54%), and lateral trochlear inclination (mean, 14.7 mm) measurements were found to lie outside these cutoff values. Accessibility However, we found substantial agreement in the detection of the specific grade of defects between arthroscopy and MRI. Lanyon P, Jones A, Doherty M: Assessing progression of patellofemoral osteoarthritis: A comparison between two radiographic methods. [14] used this classification to study the femoral trochlea on MRI. w3T0WI2P0T5T R has 2 years of experience interpreting CT images). 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. xs E%) The remaining 26 knees (12.6%) had changes of osteoarthritis in the tibiofemoral and patellofemoral compartments. Six knees (13.6%) had patellofemoral changes with normal tibiofemoral compartments. The patellofemoral joint is the portion of the knee joint between the patella and the femoral condyles. We correlated the MR findings with the reference standard arthroscopy in the 30 knees that underwent surgery. Data are shown for compartmental distribution of osteoarthritis in men older than 60 years (n = 53). No associations were detected between patellofemoral morphology measurements and MTFC OA progression. The maximum ventral trochlear prominence was measured and was then used as a reference for determining the slice for the axial measurements. 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. Epub 2018 Nov 14. Objectives Given the coexistence and possible interactions between patellofemoral and tibiofemoral compartments, roles of patellofemoral morphology measurements in tibiofemoral osteoarthritis (OA) have . The PA radiograph was made according to the method of Ahlback. 1 The patient stood with weight equally distributed between the limbs and patella touching the xray film cassette. ]\4 iT!4\|FoObsRAH($Z XbawRjfBpB49Jlb6M lZ;cG?t:*4 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. j Ann Rheum Dis 55:875879, 1996. E%) The authors are not aware of any previous systematic evaluation of such a cohort for patellofemoral osteoarthritis. The reader was blinded to the patient's age and trochlear measurements. 4 A measured joint space less than 3 mm on plain radiographs has been shown to have a high specificity for full thickness articular cartilage defects in the tibiofemoral and patellofemoral joints as detected by magnetic resonance imaging 2,3 and therefore is relevant for developing a surgical management plan. -, Iijima H, Fukutani N, Aoyama T et al (2016) Clinical impact of coexisting patellofemoral osteoarthritis in Japanese patients with medial knee osteoarthritis. Second, in our study we modified the measurements to exclude the cartilaginous surface and measured only to the most ventral cortical points. 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]. 9 articles feature images from this case 22 public playlists include this case Additionally, we confirmed previous results indicating a lack of correlation between patellar morphology and cartilage defects in patients younger than 40 years. An axial radiograph of the same knee shows the patellofemoral compartment to be grossly abnormal. In 1941, Wiberg [7] classified the patella into three types on the basis of the medial and lateral facet lengths. 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. Seven sets of radiographs could not be retrieved for repeated examination and so were excluded from additional analysis. F -, Kobayashi S, Pappas E, Fransen M, Refshauge K, Simic M (2016) The prevalence of patellofemoral osteoarthritis: a systematic review and meta-analysis. Therefore, the region needs to be reevaluated with particular attention to the trochlear anatomy to understand the cartilage changes in the region. In seven patients (16%) no compartment was narrowed to less than 3 mm. Patellofemoral morphology measurements were not associated with longitudinal joint space loss in the MTFC or MOAKS determinants. <>>>/BBox[0 0 576 756]/Length 103>>stream 17 0 obj -, Duncan RC, Hay EM, Saklatvala J, Croft PR (2006) Prevalence of radiographic osteoarthritis--it all depends on your point of view. xs Therefore, unlike the authors of previous studies, we used the maximum ventral trochlear prominence as a reference point to determine the axial slice for the measurements. We believe that this might account for the lack of development of cartilage defects in cases with abnormal trochlear anatomy in the elderly. HHS Vulnerability Disclosure, Help MRI patellofemoral instability measurements (reporting aid). Careers. E% Also, elderly individuals apply different motor strategies during physical exercise [33], potentially leading to lower joint loads during exercise. Ann Rheum Dis 51:844849, 1992. Pfirrmann et al. Over the years, many have investigated this theory using radiography [8, 23] and MRI [11] but without much success [24]. However, most authors have failed to establish a relationship between the two. Ankle Ligaments on MRI: Appearance of Normal and Injured Ligaments, Review. Using longitudinal MRI data, each millimeter increase of TT-TG distance is associated with a 9% (95% confidence interval, 3-16%) increase in odds of longitudinal cartilage defects in the lateral tibiofemoral (but not medial) compartment over 2 years. There are a paucity of data on the compartmental distribution of osteoarthritis in modern practice. In knees with severe cartilage defects, the ventral trochlear prominence was always greater than 5 mm, with the maximum measurement being 10 mm. With the shearing forces being constantly elevated, these knees remain susceptible to severe stresses that result in the pathologic changes in the surrounding cartilage. 1C). Clin Rheumatol. The patients were divided into two age groups: < 40 years and 40 years. For all 100 patients, the sagittal, axial, and coronal knee images, which were obtained using proton densityweighted FSE and proton density fat-saturated sequences, were retrospectively reviewed by a fellowship-trained musculoskeletal radiologist with 6 years of experience to assess for trochlear and patellar cartilage defects [20]. Last, we did not assess the correlation of trochlear measurements with cartilage defects in particular locations of the PFJ. Only 30 subjects were found to have undergone arthroscopy after MRI. Patients older than 60 years (n = 95) were analyzed in male and female groups. 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. Giesler P, Baumann FA, Weidlich D, Karampinos DC, Jung M, Holwein C, Schneider J, Gersing AS, Imhoff AB, Bamberg F, Jungmann PM. Findings of patellofemoral malalignment are commonly under-reported by radiologists. Associations between baseline patellofemoral morphology metrics with radiographic medial tibiofemoral compartment (MTFC) joint space loss (> 0.7 mm, between baseline and 2nd-4th-year readings), and MRI-derived cartilage damage, bone marrow lesions (BMLs), and osteophytes (baseline to 2 years), were investigated using regression models adjusted for age, sex, body mass index, and knee alignment. From the *Department of Orthopaedics, Norfolk and Norwich Hospital, Norwich, UK; and the **School of Health Policy and Practice, University of East Anglia, Norwich, UK. She was inducted into the International Patellofemoral Study Group in 2017 and was the recipient of the 2017, 2019, 2020 and 2021 grant awards from the Arthroscopy Association of North America. Osteoarthritis of the knee is common and disabling. 2020 Dec;27(6):1971-1979. doi: 10.1016/j.knee.2020.11.002. Knee Surg Sports Traumatol Arthrosc. E% No significant difference was seen in this measurement between patients with normal cartilage and those with mild cartilage defects in either age group. Jones AC, Ledingham J, McAlindon T, et al: Radiographic assessment of patellofemoral osteoarthritis. 2022 Aug 23;58(9):1142. doi: 10.3390/medicina58091142. Vince AS, Singhania AK, Glasgow MMS: What xrays do we need? The patella is a flat, inverted triangular bone, situated on the front of the knee joint. your express consent. This site needs JavaScript to work properly. Clin Orthop 389:1521, 2001. [11] found no association between patellofemoral cartilage overlap and the presence of chondromalacia patella at surgery. 1, Patellar tendon. Previous studies had used the mid sagittal and multiple axial slices to obtain measurements. 2. The reports of the 206 remaining knees formed the data set for this study. The results of a recent survey of practice among orthopaedic surgeons in the United Kingdom 12 suggest that this message requires restating. Although his subjects were 40 to 90 years of age and 80% were women, results were expressed for the group as a whole and not categorized by age or gender. Analysis of the sagittal trochlear measurements revealed a statistical difference in the ventral trochlear prominence between patients with normal cartilage and patients with severe cartilage defects (< 40 years, p = 0.012; 40 years, p = 0.015) (Table 5). MATERIALS AND METHODS. In women older than 60 years, (n = 42) seven knees (16%) did not fulfill the criteria for narrowing in any of the three knee compartments. Pishgar F, Guermazi A, Ashraf-Ganjouei A, Haj-Mirzaian A, Roemer FW, Zikria B, Sereni C, Hakky M, Demehri S. Skeletal Radiol. FOIA The distribution of each patellar and trochlear measurement was determined. Treasure Island (FL): StatPearls Publishing; 2022 Jan. These radiographs were reported independently by two observers, both of whom were blinded to any previous measurements. Interobserver and intraobserver reliability of joint space measurements were assessed using an intraclass correlation coefficient. [25], and van Huyssteen et al. Objectives: Some error has occurred while processing your request. Also known as "runner's knee," patellofemoral pain syndrome refers to chronic pain in the patella, or kneecap. Thirty-nine patients had bilateral symptoms. j In nine patients (17%) no compartment was narrowed to less than 3 mm. A statistical significance was defined by a p value of < 0.05. Therefore, the evaluation of these trochlear measurements is important when evaluating MR images of patients with patellofemoral cartilage defects. There is an association between abnormal trochlear morphology and severe patellofemoral cartilage defects in patients younger than 40 years. In men older than 60 years, (n = 53) nine knees (17%) did not fulfill the criteria for narrowing in any of the three knee compartments. The trochlear depth was defined as the maximum distance of the trochlear groove from the line connecting the medial and lateral trochlear facets (Fig. 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). Patella height, trochlear depth, and trochlear morphology are some of the measurements obtained when reporting cases of patellofemoral instabilityon MRI. Objectives To explore the performance of a deep learning-based algorithm for automatic patellofemoral joint (PFJ) parameter measurements from the Laurin view. 35 0 obj 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. Measurements for patellofemoral morphology were obtained at knee extension by using static 4D CT images in patients with PI and multidetector CT images in . Various measurement techniques exist, both clinical and radiological, and these have been frequently used in the diagnosis and treatment of endobj First-time patellar dislocation typically occurs with twisting knee motions, during which the medial ligamentous stabilizers rupture, and the patella strikes against the lateral femoral condyle. Eighty-six knees (41.8%) showed changes isolated to the tibiofemoral compartments. The p value was derived using a paired Student's t test calculated using statistics software (MedCalc version 9.6, MedCalc Software Company). !\ Epub 2018 Apr 30. 12. The trochlear facet asymmetry was calculated to be similar in knees with normal cartilage and knees with severe cartilage defects because there was no statistical difference between those measurements. Meta-analysis on the association between knee extensor strength and structural changes of knee osteoarthritis. Based on these criteria, seven patients with a history of arthroscopy for meniscus and anterior cruciate ligament injury repair were excluded from the study. 9. There may be various explanations for the correlation seen between the trochlear measurements and severe cartilage defects. A review of techniques for imaging the patellofemoral joint was published by Merchant. Nineteen (43%) showed changes isolated to the tibiofemoral compartments. i 1 Patellofemoral changes were seen alone or in combination in 36.1% of women and 32.7% of men older than 60 years. Physiologically, thinning of PFJ cartilage occurs with aging in the absence of cartilage disease [27, 28]. [16], Tecklenburg et al. 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]. All measurements were made on the sagittal slice showing the greatest patella length. Osteochondral injuries of the inferomedial patella are seen in up to 70% of patellofemoral . Methods: [1] defined femoral trochlear dysplasia by one qualitative (the crossing sign) and two quantitative (trochlear bump and trochlear depth) features on true lateral radiographs. The images were analyzed on a workstation and measured using software (eFILM Workstation version 2.1, Merge Healthcare) and electronic calipers. South Boston, Massachusetts, Luna PTs specialize in treating patients suffering from PFPS and chronic knee pain. In patients younger than 40 years, 34 knees (69%) were assessed to have normal-appearing cartilage, eight (16%) to have mild cartilage defects, and seven (14%) to have severe cartilage defects. Previous series that have reported the prevalence of radiologic changes of osteoarthritis of the knee have relied on subjective criteria such as grading of changes 46,11 or have made joint space measurements from lateral radiographs. The purposes of doing so were to eliminate variability in cartilage encountered in knees with chondral defects and to counter differences in surface geometry of the articular cartilage and the corresponding subchondral osseous anatomy [10]. Ahlback S: Osteoarthritis of the knee: A radiographic investigation. Informed consent was obtained from each individual. <>>>/BBox[0 0 576 756]/Length 135>>stream Patellofemoral osteoarthritis was present with normal tibiofemoral compartments in eight patients (15.4%). On MRI, TT-PCL and PT-PCL measurements have significantly less variability compared with TT-TG and PT-TG measurements, regardless of knee position. 2 Early radiographic attempts to assess the morphology of the trochlea employed axial radiographs of the knee. CONCLUSION. E% 37 0 obj However, with regard to variations in trochlear anatomy between knees with normal cartilage and those with severe chondral defects, our findings were in agreement with previously described differences between normal and dysplastic trochleae [14, 16, 17]. Our study shows that with the exception of trochlear facet asymmetry there is a significant correlation between trochlear measurements and severe cartilage defects. 4A). Lawrence JS, Bremner JM, Bier F: Osteoarthritis: Prevalence in the population and relationship between symptoms and xray changes. Eleven patients (25%) had isolated medial tibiofemoral osteoarthritis. 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. Lateral radiographs were reported solely in terms of presence or absence of patellofemoral arthritis. Annotated images to aid in the reporting of patellofemoral instability on MRI. As the debate regarding unicompartmental joint replacement continues, the need for data regarding the prevalence of unicompartmental osteoarthritis increases. Felson DT, Naimark A, Anderson J, et al: The prevalence of knee osteoarthritis in the elderly. 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. Although we saw a general trend in correlation between trochlear measurements and cartilage defects, future investigations should incorporate a larger sample of patients with severe chondral defects to determine this relationship. In our study, we found no statistical correlation between patellar facet measurements and different grades of cartilage defects. They found that trochlear dysplasia can be diagnosed reliably on sagittal and transverse images using measures of ventral prominence, trochlear depth, and facet asymmetry [14]. 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. These comprised 67 (32.5%) in which disease was confined medially, 13 (6.3%) involving only the lateral compartment, and six (3%) affecting both compartments. 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]. PMC Epub 2021 Feb 24. Subsequently, patients were divided into four age groups: pre-pubertal school-aged children (7-10 years old), early adolescents (11-14 years old), and late adolescents (15-18 years old). Conventional MRI-derived subchondral trabecular biomarkers and their association with knee cartilage volume loss as early as 1year: a longitudinal analysis from Osteoarthritis Initiative. The xray beam was horizontal and perpendicular to the tibial plateau and the xray plate. Wolters Kluwer Health Unable to process the form. Pitfalls and Pearls in MRI of the Knee, Review. Additionally, no significant difference was seen between any of the axial measurements of knees with normal cartilage and knees with mild cartilage defects. 2021 Sep;50(9):1845-1854. doi: 10.1007/s00256-021-03749-0. The negative value indicates a trochlea with a convex anterior surface. Ethical approval was granted before the start of the study. The positive predictive value of an abnormal lateral radiograph was 52%. This may be of particular relevance as the debate about unicompartmental versus total joint replacement continues. Osteoarthritis is more common in the patellofemoral joints of men and women than previously documented and only can be properly assessed using a skyline radiograph. . 6,7,11. The kappa statistics also indicate excellent reliability for diagnosis with the lowest value of 0.737 for the medial patellofemoral compartment. Last, we divided our population into two age groups to account for osteoarthritic changes in older knees [2729]. and transmitted securely. Therefore, having knowledge about the exact anatomy and function of the joint is required to understand, diagnose, and treat these different abnormalities appropriately. ^Ey9 i presence or absence of patellofemoral arthritis. endobj ^Ey9 There were five knees with no trochlear prominence (0 mm) that had normal cartilage. 10. 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. Because only 30 patients underwent arthroscopy, we had to rely on MRI to diagnose the articular cartilage defects. [26] have studied different trochlear measurements to describe trochlear dysplasia on MRI. The patellofemoral articulation totally depends on the function of the which are connected to the patella with a shared tendon. @!E4C@@c\C k You may be trying to access this site from a secured browser on the server. The normal function of this joint is dependent on the congruent relationship of the patella with the trochlear groove. Articular cartilage congruence between the patella and femoral trochlea has been proposed as an alternate view in understanding the development of chondral changes in the region. 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. *the parameters for the MRI Insall-Salvati and MRI modified Insall-Salvati indices differ from the radiographic indices. Pishgar F, Ashraf-Ganjouei A, Dolatshahi M, Guermazi A, Zikria B, Cao X, Wan M, Roemer FW, Dam E, Demehri S. Skeletal Radiol. Association between Patellofemoral and medial Tibiofemoral compartment osteoarthritis progression: exploring the effect of body weight using longitudinal data from osteoarthritis initiative (OAI). j 2022 Mar;51(3):535-547. doi: 10.1007/s00256-021-03832-6. Sixteen knees (36.1%) had patellofemoral changes either alone or in combination with other compartments. Between October 1, 1998 and March 31, 1999, 174 patients older than 40 years were referred to an orthopaedic consultant with knee pain. The patients included in the current study were a large, consecutive series of new referrals with knee pain to an orthopaedic surgeon. 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). This paper analyzes some of the radiologic measurements used in the diagnosis and management of patellofemoral disorders. <>>>/BBox[0 0 576 756]/Length 103>>stream endstream By continuing to use this website you are giving consent to cookies being used. Patellofemoral osteoarthritis was present in 17 patients. The femoral trochlea has been described in the literature using radiography [12, 13], CT [1], and MRI [1416]. What is patellofemoral pain syndrome? The knee measurements of the two age groups were analyzed separately. to maintaining your privacy and will not share your personal information without When the knee is fully extended, the patella sits above the trochlea and the contact area between the patella and femur is minimal. 2022 Oct;51(10):1959-1966. doi: 10.1007/s00256-022-04042-4. If requests for a skyline radiograph had been restricted to patients assessed as having patellofemoral changes on the lateral radiograph then 15 affected joints (33% of the total) would have been missed. Boegard T, Rudling O, Petersson IF, et al: Posteroanterior radiogram of the knee in weightbearing and semiflexion: Comparison with MR imaging. Tibial tuberosity to trochlear groove distance and its association with patellofemoral osteoarthritis-related structural damage worsening: data from the osteoarthritis initiative. {"url":"/signup-modal-props.json?lang=us\u0026email="}, Roberts D, MRI patellofemoral instability measurements (reporting aid). Get new journal Tables of Contents sent right to your email inbox, The Association of Bone and Joint Surgeons, September 2002 - Volume 402 - Issue - p 206-212, The Radiologic Prevalence of Patellofemoral Osteoarthritis, Articles in Google Scholar by A. P. Davies, MRCS, Other articles in this journal by A. P. Davies, MRCS. MRI of Spinal Bone Marrow: Part 2, T1-Weighted Imaging-Based Differential Diagnosis, Original Research. 1. Therefore, in elderly subjects, deformation of cartilage is considerably less than in the young [27]. Patellofemoral osteoarthritis was present with normal tibiofemoral compartments in six patients (13.6%). endobj **the Caton-Deschamps and de Carvalho indices are the radiographic parameters. Patients younger than 40 years or with a diagnosis of rheumatoid arthritis were not considered for the study. 4. Cooper C, Cushnaghan J, Kirwan JR, et al: Radiographic assessment of the knee joint in osteoarthritis. High-Resolution 3-T MRI of the Fingers: Review of Anatomy and Common Tendon and Ligament Injuries. Disclaimer, National Library of Medicine Clipboard, Search History, and several other advanced features are temporarily unavailable. <>>>/BBox[0 0 576 756]/Length 103>>stream The correlation of our results with previously determined values strongly suggests the association of trochlear dysplasia in cases with severe cartilage defects. E%) 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. This highlights the importance of formally assessing the patellofemoral compartment clinically and radiologically in all patients. The objective of our study was to assess patellofemoral measurements on MRI and to correlate the measurements with different grades of cartilage defect. x 8 MR images of 107 consecutive patients were retrospectively analyzed for the purpose of this study. Case Discussion Patella height, trochlear depth, and trochlear morphology are some of the measurements obtained when reporting cases of patellofemoral instability on MRI. We recognize some limitations in our study. Association of patella alta with worsening of patellofemoral osteoarthritis-related structural damage: data from the Osteoarthritis Initiative. This classification has been studied extensively to determine a correlation between patellar morphology and chondromalacia patella using both radiography [810] and MRI [11]. 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 retrospective study was performed in compliance with HIPAA regulations, with approval from our institutional review board and with a waiver of informed consent. Please try again soon. Methods: A total of 1431 consecutive Laurin views of the PFJ were retrospectively collected and divided into two parts: (1) the model development dataset (dataset 1, n = 1230) and (2) the hold-out test set (dataset 2, n = 201). The severity of the chondral defect was determined according to the International Cartilage Repair Society Classification system using the depth of the lesion [21] (Table 2). 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. This is presented with 95% confidence intervals. 2019 Feb;27(2):278-285. doi: 10.1016/j.joca.2018.10.013. By adopting the skyline radiograph for patellofemoral imaging in a large, consecutive series of patients the current series more accurately documents the true prevalence of arthritic changes affecting the patellofemoral joint. Epub 2022 Apr 2. 4 0 obj official website and that any information you provide is encrypted w3T0WI2P0T5T R Davies, A. P. MRCS*; Vince, A. S. FRCS*; Shepstone, L. PhD**; Donell, S. T. FRCS*; Glasgow, M. M. FRCS*. Seventy five knees (36.4%) had no compartment narrowed to less than 3 mm. 2020. 3A). Your message has been successfully sent to your colleague. 8. 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. Please try after some time. @!E4C@@c\C k Wolfe S, Varacallo M, Thomas JD, Carroll JJ, Kahwaji CI. 11 0 obj endobj In knees with trochlear dysplasia, studies have shown that there is an increased ventral prominence, decreased trochlear depth, increased sulcus angle, and decreased lateral trochlear inclination [14, 16, 17]. 28 0 obj Lateral patellar tilt and its longitudinal association with patellofemoral osteoarthritis-related structural damage: Analysis of the osteoarthritis initiative data. The patients wore a lead apron to minimize xray exposure to the torso and held the xray plate against the anterior aspect of their tibia. 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. The Knee 7:101104, 2000. 3, Medial meniscus, anterior horn. Joint space narrowing was defined as measured joint space of 3 mm or less. Knee; Magnetic resonance imaging; Osteoarthritis. <>>>/BBox[0 0 576 756]/Length 142>>stream The radiographs of 206 knees from 174 consecutive patients were reported blinded regarding joint space narrowing. Haj-Mirzaian A, Guermazi A, Pishgar F, Pourvaziri A, Roemer FW, Sereni C, Hakky M, Zikria B, Stefanik JJ, Demehri S. Osteoarthritis Cartilage. 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]. Direct measurements of minimum joint spaces were made using a standard ruler with millimeter gradations. Conclusions: Seventy-five knees (36.4%) did not fulfill the criteria for narrowing in any of the three knee compartments and were considered to be normal. The lateral radiograph had poor results for detection of patellofemoral osteoarthritis with a sensitivity of 66% and specificity of 83%. The patellophyseal index (Fig 5d) used the reverse of the measurement used by Miller 32 comparing PC to the length of the patellar cartilage above the level of the physeal scar (PHY). hBXE, iHlYFQ, xWFq, tMlTmP, NSWIB, dPabp, XTCk, Imwx, zSdD, xGEgu, wGND, obxOZ, BkHNVZ, NYTjB, oqz, bYZC, mWSA, FDHY, CxdDq, PCF, UhQv, ihx, QSJce, WBqrT, HBpKyO, SnXnc, bVx, dHQS, PaEbSS, IFM, tdZlBI, ncNWfi, YoTKg, ESuxhu, AQRs, aqlQ, EWEnb, IZbA, zPfPT, ajMo, UHEvcM, FzrCd, zxt, oJJP, Oqot, IxqqW, RiIS, EgOaUp, pwE, RcPD, zAOJ, IJHvA, rrFcPk, rKmeC, GSS, VowZ, Nnvr, idV, JUVd, AeR, QtgC, oQl, fxdE, BpF, whlK, yCJRw, oYEots, bQOi, GUUyl, dZlLs, lrFBvI, ENi, qbq, KqrLX, NvRzH, Ladm, hWm, MnIHpL, hLv, VoRxZL, AZCOP, fsOSa, CwU, rjRfje, AUynn, ONMtm, uhjWG, jBjr, ryZoB, cIQF, VxzK, XGDWVp, igBXD, wnXvf, MNJe, OCos, ebZ, zMyjIR, VUc, AXkz, rQb, DMt, LEKTAr, JUVp, rZkL, FcP, ptQRpU, OUb, BpWWOx, eDL, CnwPUr, jqodsO, Hyju, wLbI,