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Imaging in Patellofemoral Pain

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Patellofemoral Pain and Instability

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Abstract

Anatomic function of the patellofemoral compartment requires congruency and synergy of its osseous and soft tissue components. At different degrees of flexion, various components provide the main stabilizing force protecting against lateral patellar maltracking. Knowing the anatomy allows for a better understanding of patterns of injury seen on imaging (e.g., lateral trochlear bone contusion seen with transient lateral patellar dislocations). Anatomic variants can predispose to particular pathologies and outcomes, and some of these variants can be associated with pain (e.g., trochlear dysplasia), while others are typically not (e.g., bipartite patella).

When imaging the patellofemoral joint, a radiographic series is the best initial examination to evaluate the osseous structures and their relationships and to form an impression of what soft tissue injuries may be present given secondary findings. Axial radiographic views allow for evaluation of patellar alignment, position, and joint space, while MRI offers excellent visualization of soft tissue and cartilage.

Specific causes of patellofemoral pain can be broadly split into three categories: (1) acute trauma, (2) overuse injuries ± anatomic issues, and (3) arthritis, all of which can be evaluated with imaging. Some causes of patellofemoral pain, such as fat pad impingement syndrome, patellofemoral overload syndrome, and chondral/osteochondral abnormalities, are best imaged with MRI. Others, such as patellofemoral osteoarthritis and chronic overuse injuries like Osgood-Schlatter syndrome and Sinding-Larsen-Johansson syndrome, are evaluated on radiographs. Advanced cartilage imaging techniques such as T1 rho mapping, T2 mapping, and dGEMRIC (delayed gadolinium-enhanced magnetic resonance imaging of cartilage) can evaluate cartilage ultrastructure.

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Authors and Affiliations

  1. Hospital for Special Surgery, New York, NY, USA

    Vivek Kalia & Douglas N. Mintz

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  1. Vivek Kalia
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  2. Douglas N. Mintz
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  1. Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA

    Beth E. Shubin Stein

  2. Hospital for Special Surgery, New York, NY, USA

    Sabrina M. Strickland

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Kalia, V., Mintz, D.N. (2019). Imaging in Patellofemoral Pain. In: Shubin Stein, B., Strickland, S. (eds) Patellofemoral Pain and Instability. Springer, Cham. https://doi.org/10.1007/978-3-319-97640-2_5

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  • DOI: https://doi.org/10.1007/978-3-319-97640-2_5

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