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



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).


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.


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).


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.


Magnetic resonance imaging Osteoarthritis Knee 

Abbreviations and acronyms


Body mass index


Bone marrow lesions


Foundation for the National Institutes of Health


Insall–Salvati ratio




Joint space loss




Lateral patellar tilt


Lateral tibiofemoral compartment


MRI osteoarthritis knee scoring


Medial tibiofemoral compartment




Osteoarthritis Initiative






Trochlear groove depth


Turbo spin-echo


Tibial tuberosity to trochlear groove



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.


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

Compliance with ethical standards


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.


• Prospective

• Observational/case–control

• Multicenter study

Supplementary material

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


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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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