Abstract
PurposeThe quadriceps muscle has a positive effect on anterior knee pain. However, its effect on the patellofemoral (PF) cartilage in patients with end-stage knee osteoarthritis is unknown. The present study aimed to evaluate whether the quadriceps muscle area had a positive effect on the PF cartilage and whether this muscle had a positive effect on the clinical scores.Materials and methodsPatients with confirmed cartilage status and clinical scores who underwent total knee arthroplasty (TKA) were included. The PF cartilage status was evaluated during TKA. The thickness and the area of the quadriceps muscle were measured using a knee computed tomography scan obtained before the surgery. The Q-angle, hip–knee–ankle angle, alignment, and Insall–Salvati ratio were measured by radiography.ResultsAltogether, 204 patients were included in the study. Logistic regression was performed including factors associated with PF cartilage lesions. The regression model was found to be statistically significant (Hosmer–Lemeshow test, χ2 = 0.493). A smaller hip–knee–ankle (HKA) angle was associated with a higher incidence of PF cartilage lesions (p = 0.033) and only the alignment had an effect on the PF cartilage lesions. PF cartilage lesions did not correlate with the clinical scores. A thicker medial portion of the quadriceps muscle was associated with a significantly higher Knee Society Knee Score (KSKS) (p = 0.028).ConclusionsQuadriceps muscle thickness and area, Q-angle, and patellar height were not associated with PF cartilage lesions, while a smaller HKA angle was associated with PF cartilage lesions. The presence of PF cartilage lesions did not affect the clinical symptoms. However, a thicker medial portion of the quadriceps muscle was associated with a higher KSKS.
Highlights
Anterior knee pain is one of the main types of knee pain in elderly individuals, and patellofemoral (PF) cartilage lesions are the representative causes [1, 2]
A smaller hip–knee–ankle (HKA) angle was associated with a higher incidence of PF cartilage lesions (p = 0.033) and only the alignment had an effect on the PF cartilage lesions
Quadriceps muscle thickness and area, Q-angle, and patellar height were not associated with PF car‐ tilage lesions, while a smaller HKA angle was associated with PF cartilage lesions
Summary
Anterior knee pain is one of the main types of knee pain in elderly individuals, and patellofemoral (PF) cartilage lesions are the representative causes [1, 2]. Yoon et al Knee Surgery & Related Research (2022) 34:6 the quadriceps muscle power and the PF joint. Most of the studies reported that lower quadriceps muscle power was associated with greater damage to the PF cartilage or higher PF joint pressure [4, 5]. Some studies have reported contrasting observations [6, 7]. Several factors such as the Q-angle, alignment, and patellar height can affect PF cartilage lesions. Another study suggested that a high Q-angle was unlikely to be associated with changes in the thickness of the knee articular cartilage [9]. The patellar height did not correlate with PF articular cartilage congruence [10]. A further study reported that abnormal patellar height was significantly correlated with chondral lesions [11]
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