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Patellofemoral morphology measurements and their associations with tibiofemoral osteoarthritis-related structural damage: exploratory analysis on the osteoarthritis initiative

  • Arya Haj-MirzaianEmail author
  • Ali Guermazi
  • Farhad Pishgar
  • Frank W. Roemer
  • Christopher Sereni
  • Michael Hakky
  • Bashir Zikria
  • Shadpour Demehri
Musculoskeletal
  • 17 Downloads

Abstract

Objectives

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. 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).

Methods

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). Radiographic and MRI OA knee scoring (MOAKS) measurements were extracted from baseline and 2-year follow-up readings. 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. P values were corrected using the Benjamini–Hochberg procedure.

Results

Patellofemoral morphology measurements were not associated with longitudinal joint space loss in the MTFC or MOAKS determinants. 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).

Conclusions

Higher TT–TG distance was associated with concurrent MRI-derived OA-related structural damages and 2-year follow-up worsening only in LTFC. No associations were detected between patellofemoral morphology measurements and MTFC OA progression.

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.

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.

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.

Keywords

Magnetic resonance imaging Osteoarthritis Knee 

Abbreviations and acronyms

BMI

Body mass index

BMLs

Bone marrow lesions

FNIH

Foundation for the National Institutes of Health

ISR

Insall–Salvati ratio

IW

Intermediate-weighted

JSL

Joint space loss

KL

Kellgren–Lawrence

LPT

Lateral patellar tilt

LTFC

Lateral tibiofemoral compartment

MOAKS

MRI osteoarthritis knee scoring

MTFC

Medial tibiofemoral compartment

OA

Osteoarthritis

OAI

Osteoarthritis Initiative

PF

Patellofemoral

TF

Tibiofemoral

TGD

Trochlear groove depth

TSE

Turbo spin-echo

TT–TG

Tibial tuberosity to trochlear groove

Notes

Acknowledgments

The OAI project is a partnership between public and private sectors, including five contracts (N01-AR-2-2258, N01-AR-2-2259, N01-AR-2-2260, N01-AR-2-2261, and N01-AR-2-2262), which is conducted by investigators of the OAI study and is financially supported by the National Institutes of Health (NIH). Private funding partners are Merck Research Laboratories, Novartis Pharmaceuticals Corporation, GlaxoSmithKline, and Pfizer, Inc. The FNIH is the manager of financial support of the private sectors. In preparing this manuscript, OAI publicly available datasets were used, and the results of this work do not necessarily reflect the opinions of the OAI investigators, the NIH, or the private funding partners.

Several grants and direct or in-kind contributions provide the publically available data from the FNIH OA Biomarkers Consortium Project, including AbbVie, Amgen, Arthritis Foundation, Artialis; Bioiberica, BioVendor, DePuy, Flexion Therapeutics, GSK, IBEX, IDS, Merck Serono, Quidel, Rottapharm | Madaus, Sanofi, Stryker, the Pivotal OAI MRI Analyses (POMA) study, NIH HHSN2682010000 21C, and the Osteoarthritis Research Society International.

Funding

The authors state that this work has not received any funding.

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Dr. Shadpour Demehri.

Conflict of interest

AG received funding for consultation from MerckSerono, AstraZeneca, Genzyme, OrthoTrophix, and TissueGene, and as a shareholder and the president and from Boston Imaging Core Lab (BICL). FWR received funding from BICL as a shareholder and chief executive officer (CEO). SD received funding from Toshiba Medical Systems for consultation, and grants for a cone-beam computed tomographic clinical trial from GERRAF, and Carestream Health. The other authors declare that they did not have any competing interests. None of the authors had any competing interests that could influence the results of this work.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was not required for this study because we used open-access OAI database. All enrolled subjects in the OAI study gave informed consent.

Ethical approval

Institutional Review Board approval was not required because we used an open-access OAI database. The OAI study has received ethics board approval by the institutional review board at the University of California, San Francisco (OAI Coordinating Center; Approval Number: 10-00532).

Study subjects or cohorts overlap

Some study subjects or cohorts have been previously reported in the OAI database and OAI-related articles.

Methodology

• Prospective

• Observational/case–control

• Multicenter study

Supplementary material

330_2019_6324_MOESM1_ESM.docx (47 kb)
ESM 1 (DOCX 47 kb)

References

  1. 1.
    Davies AP, Vince AS, Shepstone L, Donell ST, Glasgow MM (2002) The radiologic prevalence of patellofemoral osteoarthritis. Clin Orthop Relat Res 402:206–212CrossRefGoogle Scholar
  2. 2.
    Duncan RC, Hay EM, Saklatvala J, Croft PR (2006) Prevalence of radiographic osteoarthritis--it all depends on your point of view. Rheumatology (Oxford) 45:757–760CrossRefGoogle Scholar
  3. 3.
    Iijima H, Fukutani N, Aoyama T et al (2016) Clinical impact of coexisting patellofemoral osteoarthritis in Japanese patients with medial knee osteoarthritis. Arthritis Care Res (Hoboken) 68:493–501CrossRefGoogle Scholar
  4. 4.
    Kobayashi S, Pappas E, Fransen M, Refshauge K, Simic M (2016) The prevalence of patellofemoral osteoarthritis: a systematic review and meta-analysis. Osteoarthritis Cartilage 24:1697–1707CrossRefGoogle Scholar
  5. 5.
    Kornaat PR, Watt I, Riyazi N, Kloppenburg M, Bloem JL (2005) The relationship between the MRI features of mild osteoarthritis in the patellofemoral and tibiofemoral compartments of the knee. Eur Radiol 15:1538–1543CrossRefGoogle Scholar
  6. 6.
    Coskun Benlidayi I, Cuzdan Coskun N, Sarpel T (2016) SAT0451 the association of patella alta with the severity of radiological tibiofemoral knee osteoarthritis. Ann Rheum Dis 75:835Google Scholar
  7. 7.
    Stefanik JJ, Zhu Y, Zumwalt AC et al (2010) Association between patella alta and the prevalence and worsening of structural features of patellofemoral joint osteoarthritis: the multicenter osteoarthritis study. Arthritis Care Res (Hoboken) 62:1258–1265CrossRefGoogle Scholar
  8. 8.
    Jungmann PM, Tham SC, Liebl H et al (2013) Association of trochlear dysplasia with degenerative abnormalities in the knee: data from the Osteoarthritis Initiative. Skeletal Radiol 42:1383–1392CrossRefGoogle Scholar
  9. 9.
    Kalichman L, Zhang Y, Niu J et al (2007) The association between patellar alignment and patellofemoral joint osteoarthritis features--an MRI study. Rheumatology (Oxford) 46:1303–1308CrossRefGoogle Scholar
  10. 10.
    Tsavalas N, Katonis P, Karantanas AH (2012) Knee joint anterior malalignment and patellofemoral osteoarthritis: an MRI study. Eur Radiol 22:418–428CrossRefGoogle Scholar
  11. 11.
    Roemer FW, Guermazi A, Collins JE et al (2016) Semi-quantitative MRI biomarkers of knee osteoarthritis progression in the FNIH biomarkers consortium cohort - methodologic aspects and definition of change. BMC Musculoskelet Disord 17:466CrossRefGoogle Scholar
  12. 12.
    Hunter DJ, Guermazi A, Lo GH et al (2011) Evolution of semi-quantitative whole joint assessment of knee OA: MOAKS (MRI Osteoarthritis Knee Score). Osteoarthritis Cartilage 19:990–1002CrossRefGoogle Scholar
  13. 13.
    Haj-Mirzaian A, Thawait GK, Tanaka MJ, Demehri S (2017) Diagnosis and characterization of patellofemoral instability: review of available imaging modalities. Sports Med Arthrosc Rev 25:64–71CrossRefGoogle Scholar
  14. 14.
    Thakkar RS, Del Grande F, Wadhwa V et al (2016) Patellar instability: CT and MRI measurements and their correlation with internal derangement findings. Knee Surg Sports Traumatol Arthrosc 24:3021–3028CrossRefGoogle Scholar
  15. 15.
    Pandit S, Frampton C, Stoddart J, Lynskey T (2011) Magnetic resonance imaging assessment of tibial tuberosity-trochlear groove distance: normal values for males and females. Int Orthop 35:1799–1803CrossRefGoogle Scholar
  16. 16.
    Guermazi A, Roemer FW, Haugen IK, Crema MD, Hayashi D (2013) MRI-based semiquantitative scoring of joint pathology in osteoarthritis. Nat Rev Rheumatol 9:236–251CrossRefGoogle Scholar
  17. 17.
    Runhaar J, Schiphof D, van Meer B, Reijman M, Bierma-Zeinstra SM, Oei EH (2014) How to define subregional osteoarthritis progression using semi-quantitative MRI osteoarthritis knee score (MOAKS). Osteoarthritis Cartilage 22:1533–1536CrossRefGoogle Scholar
  18. 18.
    Cohen J (1988) Statistical power analysis for the behavioral sciences. Erlbaum Associates, HillsdaleGoogle Scholar
  19. 19.
    Macri EM, Culvenor AG, Morris HG et al (2017) Lateral displacement, sulcus angle and trochlear angle are associated with early patellofemoral osteoarthritis following anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc.  https://doi.org/10.1007/s00167-017-4571-1
  20. 20.
    Özgül A, Günendi Z, Kesikburun S, Omaç ÖK, Taşkaynatan MA (2013) The association between patellar alignments features and tibiofemoral joint osteoarthritis. Clin Rheumatol 32:1017–1020Google Scholar
  21. 21.
    Macri EM, Stefanik JJ, Khan KK, Crossley KM (2016) Is tibiofemoral or patellofemoral alignment or trochlear morphology associated with patellofemoral osteoarthritis? A systematic review. Arthritis Care Res (Hoboken) 68:1453–1470CrossRefGoogle Scholar
  22. 22.
    Williams AA, Elias JJ, Tanaka MJ et al (2016) The relationship between tibial tuberosity-trochlear groove distance and abnormal patellar tracking in patients with unilateral patellar instability. Arthroscopy 32:55–61CrossRefGoogle Scholar
  23. 23.
    Sanders TG, Paruchuri NB, Zlatkin MB (2006) MRI of osteochondral defects of the lateral femoral condyle: incidence and pattern of injury after transient lateral dislocation of the patella. AJR Am J Roentgenol 187:1332–1337CrossRefGoogle Scholar
  24. 24.
    Mizuno Y, Kumagai M, Mattessich SM et al (2001) Q-angle influences tibiofemoral and patellofemoral kinematics. J Orthop Res 19:834–840CrossRefGoogle Scholar
  25. 25.
    Mani S, Kirkpatrick MS, Saranathan A, Smith LG, Cosgarea AJ, Elias JJ (2011) Tibial tuberosity osteotomy for patellofemoral realignment alters tibiofemoral kinematics. Am J Sports Med 39:1024–1031CrossRefGoogle Scholar
  26. 26.
    Gigante A, Enea D, Greco F et al (2009) Distal realignment and patellar autologous chondrocyte implantation: mid-term results in a selected population. Knee Surg Sports Traumatol Arthrosc 17:2–10CrossRefGoogle Scholar
  27. 27.
    Becher C, Schumacher T, Fleischer B, Ettinger M, Smith T, Ostermeier S (2015) The effects of a dynamic patellar realignment brace on disease determinants for patellofemoral instability in the upright weight-bearing condition. J Orthop Surg Res 10:126CrossRefGoogle Scholar
  28. 28.
    Dejour H, Walch G, Nove-Josserand L, Guier C (1994) Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc 2:19–26CrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  • Arya Haj-Mirzaian
    • 1
    Email author
  • Ali Guermazi
    • 2
  • Farhad Pishgar
    • 3
  • Frank W. Roemer
    • 2
    • 4
  • Christopher Sereni
    • 5
  • Michael Hakky
    • 6
  • Bashir Zikria
    • 7
  • Shadpour Demehri
    • 1
  1. 1.Russell H. Morgan Department of Radiology and Radiological ScienceJohns Hopkins University School of MedicineBaltimoreUSA
  2. 2.Department of RadiologyBoston University School of MedicineBostonUSA
  3. 3.Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Science InstituteTehran University of Medical SciencesTehranIran
  4. 4.Department of RadiologyUniversity of Erlangen-NurembergErlangenGermany
  5. 5.Department of RadiologyUniversity of Massachusetts Medical SchoolBostonUSA
  6. 6.Department of RadiologyFlorida HospitalMaitlandUSA
  7. 7.Department of Orthopaedic SurgeryJohns Hopkins University School of MedicineBaltimoreUSA

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