Tibiofemoral Joint Osteoarthritis Research Articles

Quantitative morphometric analysis in tibiofemoral joint osteoarthritis imaging: A literature review

ObjectiveTo highlight published quantitative morphometric analysis (QMA) methods for assessing tibiofemoral joint osteoarthritis in magnetic resonance imaging and computed tomography and underline the need for open and interoperable protocols for quantitative image analysis. DesignA literature search on PubMed/MEDLINE and Web of Science of keywords relating to QMA in magnetic resonance imaging and computed tomography in the context of tibiofemoral osteoarthritis in the past 23 years (2000–2022). The search was based on, but not limited to: “quantitative morphometric analysis” or “quantitative image analysis” in combination with “osteoarthritis”, “articular cartilage”, “subchondral bone”, “tibiofemoral joint”, “joint”, “CT”, and “MRI”. The search found 73 relevant publications that were manually screened and sorted for QMA methods. A further search to extract key functions of the underlying algorithms was performed. ResultMRI is generally used for QMA of articular cartilage and joint contact area, while CT is generally used for QMA of subchondral bone and joint space width. Studies have shown that QMA algorithms can be adapted to new tissues and modalities. However, many methods are not easily accessible, and there is fragmentation of computational tools and platforms in the research field. ConclusionQMA is an active research area, and many techniques from one modality can be readily extended to another. Adoption of open-source practices can allow algorithms developed for other imaging modalities to be shared, making it possible to bridge the knowledge gap for structures and pathological features for which QMA has not yet been investigated and to increase research output overall.

Effect of motion control versus neutral walking footwear on pain associated with lateral tibiofemoral joint osteoarthritis: a comparative effectiveness randomised clinical trial

ObjectivesTo determine if motion control walking shoes are superior to neutral walking shoes in reducing knee pain on walking in people with lateral knee osteoarthritis (OA).DesignParticipant-blinded and assessor-blinded, comparative effectiveness,...

Magnetic Resonance Imaging-Defined Osteoarthritis Features and Anterior Knee Pain in Individuals With, or at Risk for, Knee Osteoarthritis: A Multicenter Study on Osteoarthritis.

ObjectiveThe lack of strong association between knee osteoarthritis (OA) structural features and pain continues to perplex researchers and clinicians. Evaluating the patellofemoral joint in addition to the tibiofemoral joint alone has contributed to explaining this structure–pain discordance, hence justifying a more comprehensive evaluation of whole‐knee OA and pain. The present study, therefore, was undertaken to evaluate the association between patellofemoral and tibiofemoral OA features with localized anterior knee pain (AKP) using 2 study designs.MethodsUsing cross‐sectional data from the Multicenter Osteoarthritis Study, our first approach was a within‐person, knee‐matched design in which we identified participants with unilateral AKP. We then assessed magnetic resonance imaging (MRI)–derived OA features (cartilage damage, bone marrow lesions [BMLs], osteophytes, and inflammation) in both knees and evaluated the association of patellofemoral and tibiofemoral OA features to unilateral AKP. In our second approach, MRIs from 1 knee per person were scored, and we evaluated the association of OA features to AKP in participants with AKP and participants with no frequent knee pain.ResultsUsing the first approach (n = 71, 66% women, mean ± SD age 69 ± 8 years), lateral patellofemoral osteophytes (odds ratio [OR] 5.0 [95% confidence interval (95% CI) 1.7–14.6]), whole‐knee joint effusion‐synovitis (OR 4.7 [95% CI 1.3–16.2]), and infrapatellar synovitis (OR 2.8 [95% CI 1.0–7.8]) were associated with AKP. Using the second approach (n = 882, 59% women, mean ± SD age 69 ± 7 years), lateral and medial patellofemoral cartilage damage (prevalence ratio [PR] 2.3 [95% CI 1.3–4.0] and PR 1.9 [95% CI 1.1–3.3], respectively) and lateral patellofemoral BMLs (PR 2.6 [95% CI 1.5–4.7]) were associated with AKP.ConclusionPatellofemoral but not tibiofemoral joint OA features and inflammation were associated with AKP.

Effect of biomechanical correction of tibia on medial joint space loading, varus deformity and functional tasks in patients with medial tibiofemoral joint osteoarthritis: a two-group pre-test, post-test randomized clinical trial study protocol

BACKGROUND/OBJECTIVES: Knee osteoarthritis (KOA) is the most prevalent chronic disease of joints. There are various biomechanical factors which affect the alignment of the knee joints resulting in the varus or valgus deformities, which leads to unequal loading on the joints structures. The primary aim of the study is to determine the biomechanical corrections on tibia and varus deformity in Medial Tibiofemoral Knee Joint Osteoarthritis (MTKJOA). Secondary aim is to see the improvement in physical functions of the patients. METHODOLOGY/DESIGN: A Two Group Pretest-Posttest Equivalent Randomized Clinical Trial. Total ‘52’ patients will be included between the age of 35 to 80 years with medial tibiofemoral joint osteoarthritis. Subjects will be divided in the biomechanical correction group (Mobilization with movement in addition with conventional physiotherapy treatment). Conventional physiotherapy group which include electrotherapy and exercise therapy. For measuring the pain, the Numeric Pain Rating Scale (NPRS) will be taken, for range of motion goniometer will be taken, Western Ontario McMaster Universities Arthritis Index (WOMAC) will be taken for assessing the physical performance and TraumaCaD Software will be used to determine the alignment of the affected limb. In both the groups, conventional physiotherapy treatment will be given for 9 days. Total 9 sessions will be in given in three weeks and in each week 3 sessions will be given on alternative days. The outcome will be measured at baseline. TRIAL REGISTRATION: Clinical Trials Registry – India. (NCT04324931). UNIVERSAL TRIAL NUMBER: U1111-1249-3661. DISCUSSION: To our knowledge this study will be the first to correct the biomechanical axis of knee joints. After Biomechanical Correction, the weight bearing distribution will be adjusted and progression of deformity can be reduced which will help to improve the functional tasks and prevent to undergo early Total Knee Arthroplasty (TKA).

Is step rate associated with worsening of patellofemoral and tibiofemoral joint osteoarthritis in women and men? The Multicenter Osteoarthritis Study.

© 2019, American College of Rheumatology This is the peer reviewed version of the following article: Step Rate and Worsening of Patellofemoral and Tibiofemoral Joint Osteoarthritis in Women and Men: The Multicenter Osteoarthritis Study, which has been published in final form at https://onlinelibrary.wiley.com/doi/full/10.1002/acr.23864. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.Objective: To determine the association of self-selected walking step rate with worsening of cartilage damage in the patellofemoral (PF) joint and tibiofemoral (TF) joint compartments at a 2-year follow-up visit. Methods: The Multicenter Osteoarthritis Study (MOST) is a prospective cohort of men and women with or at risk of knee osteoarthritis. Self-selected step rate was measured using an instrumented GAITRite walkway (CIR Systems) at the 60-month visit. Cartilage damage was semiquantitatively graded on magnetic resonance images at the 60- and 84-month visits in the medial and lateral PF and TF compartments. Step rate was divided into quartiles, and logistic regression was used to determine the association of step rate with the risk of worsening cartilage damage in men and women separately. Analyses were adjusted for age, body mass index, and knee injury/surgery. Results: A total of 1,089 participants were included. Mean ± SD age was 66.9 ± 7.5 years, mean ± SD body mass index was 29.6 ± 4.7 kg/m2, and 62.3% of the participants were women. Women with the lowest step rate had increased risk of lateral PF (risk ratio [RR] 2.1 [95% confidence interval (95% CI) 1.1–3.8]) and TF (RR 1.8 [95% CI 1.1–2.9]) cartilage damage worsening 2 years later compared to those with the highest step rate. Men with the lowest step rate had increased risk of medial TF cartilage damage worsening 2 years later (RR 2.1 [95% CI 1.1–3.9]). Conclusion: Lower step rate was associated with increased risk of cartilage damage worsening in the lateral PF and TF compartments in women and worsening medial TF joint damage in men. Future research is necessary to understand the influence of step rate manipulation on joint biomechanics in women and men.

Stress response envelopes of intact tibiofemoral joint and knee osteoarthritis.

The purpose of this study was to determine stress envelopes for an intact tibiofemoral joint and to study how they vary with knee loading, external-internal rotation, varus-valgus rotation and cartilage degradation (osteoarthritis) using the finite element method. The envelopes were presented in terms of knee flexion angle. The maximum von Mises stress for all tibiofemoral joint components increased with increasing the axial compressive force magnitude. Menisci exhibited the highest magnitude of maximum von Mises stress as compared to the femoral and tibial cartilages. In a range of flexion angles between 0° and 100°, the medial meniscus exhibited the highest maximum von Mises stress than the lateral meniscus and the stress in medial meniscus tended to increase with increasing the flexion angle. External-internal and varus-valgus rotations changed the stress distribution: higher stress on lateral compartment but lower stress on medial compartment, and conversely. The internal rotation provided more extreme effect than the external rotation. For the knee osteoarthritis, cartilage degradation (early stage) caused maximum von Mises stress to increase on the intact menisci revealing that knee osteoarthritis could also cause meniscal tear. The late osteoarthritis caused the maximum von Mises stress to increase on the calcified cartilage and subchondral bone.

Footwear for osteoarthritis of the lateral knee: protocol for the FOLK randomised controlled trial

BackgroundStructural features of lateral tibiofemoral (TF) joint osteoarthritis (OA) occur in up to half of all people with knee OA, and co-existing lateral TF OA is associated with worse knee pain in people with mixed compartmental knee OA. Clinical guidelines for management of knee OA advocate advice about appropriate footwear, yet there is no research evaluating which types of footwear are best for managing pain associated with lateral TF OA. Biomechanical evidence suggests that “motion-control” footwear, which possess midsoles that are stiffer medially compared to laterally, may shift load away from the lateral compartment of the knee and thus may reduce knee pain associated with lateral TF OA. The primary aim of this study is to compare the effects of motion-control shoes to neutral shoes on knee pain in people with predominantly lateral TF OA.MethodsThis will be an assessor- and participant-blinded, two-arm, comparative effectiveness randomized controlled trial (RCT) conducted in Melbourne, Australia. We will recruit a minimum of 92 people with painful lateral TF OA from the community. Participants will be randomly allocated to receive either motion-control shoes or neutral shoes and will be instructed to wear their allocated shoes for a minimum of 6 h per day for 6 months. The primary outcome is change in self-reported knee pain on walking, measured using a numerical rating scale, assessed at baseline and 6 months. Secondary outcomes include other measures of knee pain, physical function, quality of life, participant-perceived change in pain and function, and physical activity levels.DiscussionThis study will compare the efficacy of motion-control shoes to neutral shoes for people with painful lateral TF OA. Findings will be the first to provide evidence of the effects of footwear on knee pain in this important subgroup of people with knee OA and allow clinicians to provide accurate advice about the most appropriate footwear for managing pain associated with lateral TF OA.Trial registrationThis trial has been prospectively registered by the Australian New Zealand Clinical Trials Registry on 15/11/2018 (reference: ACTRN12618001864213).

Prognostic factors for radiographic and symptomatic tibiofemoral and patellofemoral osteoarthritis 32-37 years after anterior cruciate ligament injury

Purpose: Anterior cruciate ligament (ACL) injury is associated with an increased risk of tibiofemoral joint (TFJ) and patellofemoral joint (PFJ) osteoarthritis (OA). OA following ACL injury occurs at a younger age, progresses at a faster rate, with fewer treatment options than idiopathic OA in older adults. Identifying prognostic factors for OA after ACL injury is needed to inform prevention strategies. The purpose was to identify prognostic factors for TFJ and PFJ radiographic OA (ROA) and symptomatic OA (SOA) following acute ACL injury.

Step Rate and Worsening of Patellofemoral and Tibiofemoral Joint Osteoarthritis in Women and Men: The Multicenter Osteoarthritis Study.

To determine the association of self-selected walking step rate with worsening of cartilage damage in the patellofemoral (PF) joint and tibiofemoral (TF) joint compartments at a 2-year follow-up visit. The Multicenter Osteoarthritis Study (MOST) is a prospective cohort of men and women with or at risk of knee osteoarthritis. Self-selected step rate was measured using an instrumented GAITRite walkway (CIR Systems) at the 60-month visit. Cartilage damage was semiquantitatively graded on magnetic resonance images at the 60- and 84-month visits in the medial and lateral PF and TF compartments. Step rate was divided into quartiles, and logistic regression was used to determine the association of step rate with the risk of worsening cartilage damage in men and women separately. Analyses were adjusted for age, body mass index, and knee injury/surgery. A total of 1,089 participants were included. Mean ± SD age was 66.9 ± 7.5 years, mean ± SD body mass index was 29.6 ± 4.7 kg/m2 , and 62.3% of the participants were women. Women with the lowest step rate had increased risk of lateral PF (risk ratio [RR] 2.1 [95% confidence interval (95% CI) 1.1-3.8]) and TF (RR 1.8 [95% CI 1.1-2.9]) cartilage damage worsening 2 years later compared to those with the highest step rate. Men with the lowest step rate had increased risk of medial TF cartilage damage worsening 2 years later (RR 2.1 [95% CI 1.1-3.9]). Lower step rate was associated with increased risk of cartilage damage worsening in the lateral PF and TF compartments in women and worsening medial TF joint damage in men. Future research is necessary to understand the influence of step rate manipulation on joint biomechanics in women and men.

The effects of knee meniscectomy on the development of osteoarthritis in the patellofemoral joint 40\xa0years following meniscectomy

Most knee osteoarthritis and meniscectomy studies focus on osteoarthritis in the tibiofemoral joint and ignore the patellofemoral joint. This study aims to assess the long-term effects of total meniscectomy on the patellofemoral joint. To our knowledge, this is the only study of osteoarthritis in the patellofemoral joint following meniscectomy that extends to a 40-year follow-up period. Twenty-two patients with osteoarthritis were evaluated at a mean of 40 years post-meniscectomy using standardised weight-bearing radiographs of the operated and non-operated knees. Patellofemoral joint osteoarthritis was diagnosed by the presence of osteophytes and joint space narrowing to less than 5 mm. Kellgren and Lawrence scores were calculated from the radiographs. Patellofemoral joint osteoarthritis and tibiofemoral joint osteoarthritis were correlated with International Knee Documentation Committee scores and range of movement measurements. A significant difference was observed between the operated and non-operated knees in terms of patellofemoral joint osteophyte formation. There was a significant difference in tibiofemoral joint Kellgren and Lawrence scores, International Knee Documentation Committee scores and range of movement measurements between knees with lateral facet patellofemoral joint space of < 5 mm and > 5 mm. This study shows an association between open total meniscectomy and patellofemoral joint osteoarthritis at 40 years following surgery. There was also an association between patellofemoral joint space narrowing in the lateral facet and tibiofemoral joint osteoarthritis. Possible causes include altered biomechanical loading patterns following meniscectomy as well as global processes within the knee.

Tibiofemoral joint structural change from 2.5 to 4.5\u2009years following ACL reconstruction with and without combined meniscal pathology

BackgroundPeople who have had anterior cruciate ligament reconstruction (ACLR) are at a high risk of developing tibiofemoral joint (TFJ) osteoarthritis (OA), with concomitant meniscal injury elevating this risk. This study aimed to investigate OA-related morphological change over 2 years in the TFJ among individuals who have undergone ACLR with or without concomitant meniscal pathology and in healthy controls. A secondary aim was to examine associations of baseline TFJ cartilage defects and bone marrow lesions (BML) scores with tibial cartilage volume change in ACLR groups.MethodsFifty seven ACLR participants aged 18–40 years (32 isolated ACLR, 25 combined meniscal pathology) underwent knee magnetic resonance imaging (MRI) 2.5 and 4.5 years post-surgery. Nine healthy controls underwent knee MRI at the ~ 2-year intervals. Tibial cartilage volume, TFJ cartilage defects and BMLs were assessed from MRI.ResultsFor both ACLR groups, medial and lateral tibial cartilage volume increased over 2 years (P < 0.05). Isolated ACLR group had greater annual percentage increase in lateral tibial cartilage volume compared with controls and with the combined group (P = 0.03). Cartilage defects remained unchanged across groups. Both ACLR groups showed more lateral tibia BML regression compared with controls (P = 0.04). Baseline cartilage defects score was positively associated with cartilage volume increase at lateral tibia (P = 0.002) while baseline BMLs score was inversely related to medial tibia cartilage volume increase (P = 0.001) in the pooled ACLR group.ConclusionsTibial cartilage hypertrophy was apparent in ACLR knees from 2.5 to 4.5 years post-surgery and was partly dependent upon meniscal status together with the nature and location of the underlying pathology at baseline. Magnitude and direction of change in joint pathologies (i.e., cartilage defects, BMLs) were less predictable and either remained stable or improved over follow-up.

Characteristics of coexisting patellofemoral joint osteoarthritis and tibiofemoral joint osteoarthritis in an Indonesian population: A cross-sectional study at a tertiary teaching hospital

IntroductionHistorically, the diagnosis and treatment of osteoarthritis has been focused on the tibiofemoral joint solely. For the last two decades, the role of patellofemoral joint and its involvement on the degenerative joint disease has been investigated. To date, no data existed regarding patellofemoral osteoarthritis in our country, Indonesia. MethodsWe performed a cross sectional study comprising of patients diagnosed with knee osteoarthritis in Fatmawati General Hospital, a tertiary teaching hospital in Jakarta, Indonesia. The subjects underwent knee radiograph from anteroposterior, lateral and skyline views. ResultsA total of 66 subjects were included, 80% of the subjects were diagnosed with combined patellofemoral and tibiofibular joint osteoarthritis Kellgren-Lawrence grade III-IV. The Western Ontario and McMaster Universities Osteoarthritis Index score was measured 69.3 points, as this might be correlated with the advancement of the disease. ConclusionsCombined patellofemoral and tibiofemoral osteoarthritis constitutes a large portion of patients with knee osteoarthitis.

Immediate and short-term effects of gait retraining on the knee joint moments and symptoms in patients with early tibiofemoral joint osteoarthritis: a randomized controlled trial

To evaluate the effectiveness of a knee adduction moment (KAM) gait retraining in patients with early knee osteoarthritis up to 6 months post-training. We conducted a single blinded randomized controlled trial on a total of 23 patients with early knee osteoarthritis who were randomly allocated to the gait retraining group and walking exercise group. Twenty of them completed the corresponding training and the 6-month evaluation. We measured KAM, knee flexion moment (KFM) and western ontario and McMaster universities osteoarthritis index (WOMAC) osteoarthritis index before, immediate after, and 6 months after training. A repeated measures analysis of covariance (ANCOVA) was used to compare KAM, KFM and WOMAC osteoarthritis index scores across the three time points i.e., pre-training, post-training, and 6-month follow-up with gender, knee osteoarthritis severity, and pre-training KAM, KFM and WOMAC scores set as covariates. Post-hoc analyses were conducted when indicated. Significant time×group interactions were found for both KAM and WOMAC osteoarthritis index scores (P<0.002). No interaction was found for KFM (P=0.123). KAM after gait retraining was significantly lower than the pre-training value (P<0.001) and such effect was maintained at 6-month follow-up (P=0.01). There was no significant difference in the KAM across time in the walking exercise group (P>0.208). WOMAC osteoarthritis index score after training and score at the 6-month follow-up were significantly improved in the gait retraining group (P=0.001), while the WOMAC osteoarthritis index score remained similar. Gait retraining is an effective intervention to reduce KAM during walking and to improve the symptoms of patients with early knee osteoarthritis in short term.

Use of Diagnostic Performance of Clinical Examination Measures and Pain Presentation to Identify Patellofemoral Joint Osteoarthritis.

To assess the diagnostic performance of a comprehensive set of tests and measures to discriminate patellofemoral (PF) from tibiofemoral (TF) osteoarthritis (OA). The Clinical Assessment of the Knee Study is a study of knee pain in the general population. The presence of PF crepitus and pain with PF compression were assessed. Anterior knee pain was determined using a knee pain map. Pain with climbing/descending stairs and walking on level ground were assessed with the Western Ontario and McMaster Universities Osteoarthritis Index. Radiographs were used to define the compartment(s) of the knee affected by OA (no OA, isolated/predominant PF joint OA, and isolated/predominant TF joint OA). In knees with mixed OA, knees with more severe PF joint OA were included in the isolated/predominant PF group (the same was done for TF joint OA). We determined the sensitivity, specificity, positive predictive value (PPV), negative predictive value, and positive likelihood ratio (LR+) for each test and measure individually, and the combination of these measures, in distinguishing knees with PF joint OA from knees with TF joint OA or no OA. There were 745 knees included in the study. No measure had high sensitivity and specificity. Pain with climbing/descending stairs had the greatest sensitivity (90%) but poor specificity (15%). The combination of definite crepitus with no pain on walking had the greatest specificity (96%), PPV (53%), and LR+ (1.8), but poor sensitivity (7%). Typical clinical examination findings and knee pain patterns commonly thought to represent underlying PF joint pathology do not discriminate knees with PF joint OA from knees without OA or TF joint OA.

Finite Element Analysis of Normal Tibiofemoral Joint and Knee Osteoarthritis: a Comparison Study Validated Through Geometrical Measurements

Objectives: A comparison study of normal tibiofemoral joint and knee osteoarthritis is done to analyse the displacement, stress and strain values. Statistical Analysis: Osteoarthritis (OA) is a general type of arthritis in which there is a gradual loss of cartilage from the joints. Global Burden of Disease 2000 estimated that about 10% of the world’s population who are greater than 60 years of age have symptomatic issues that can be attributed to OA. The COPCORD investigations in India for the year 2011 concluded that the rough occurrence of clinically diagnosed knee OA was greater in the urban (5.5%) than the rustic group of people (3.3%). Methods: Magnetic resonance imaging (MRI) is thought to be an inexorably essential instrument for in vivo investigations of musculoskeletal biomechanics. Magnetic resonance images were obtained for two subjects in the age group of 40-45 years. Three dimensional models of a normal and OA knee joint are obtained using Mimics Research software 17 and FEA is done using ANSYS 14 software to determine displacement, stress and strain values. Findings: Finite Element models are powerful tools to foresee the impacts of various parameters required in knee agony and joint degradation and to give data generally hard to acquire from analyses. The 3D model of normal and OA knee joint further helps to design the prosthesis of knee for the treatment of osteoarthritis. Finite Element Analysis (FEA) result includes the stresses and strains induced in the knee articular cartilages and meniscus during single-leg stance. Displacement, stress and strain values for OA knee are higher than the normal knee joint. Hooke’s law of modulus of elasticity is verified in this work. Then finite element model (FEM) is validated through geometrical measurements such as Joint space width, cartilage thickness and meniscus thickness. Improvements: This data can be combined with other analysis and modeling tools, for example, gait analysis and FE modeling to test hypotheses concerning joint function and the impacts of wounds.

Survival and clinical results of a modified "crosse de hockey" procedure for chronic isolated patellofemoral joint osteoarthritis: mid-term follow-up

BackgroundThe optimum treatment for isolated patellofemoral joint osteoarthritis (PFJ-OA) remains controversial. The aim of this study was to assess the mid-term clinical results of a modified crosse de hockey procedure for the treatment of isolated PFJ-OA.Materials and methodsWe assessed 37 knees in 31 patients treated by a modified crosse de hockey procedure. The mean age was 57.6 years (range, 46–75 years) and mean follow-up was 90.1 months (range, 24–216 months). We evaluated clinical and radiographic outcomes, as well as complication rates at the mid-term follow-up.ResultsThe Kujala score (mean improvement of 46.7, P < 0.001) and the Fulkerson score (mean improvement of 19, P = 0.001) were significantly higher compared to preoperative values. Overall clinical results rated excellent in 24.3 %, very good in 21.6 %, good in 35.1 %, fair in 13.5 %, and poor in 5.4 % of knees. Patellar tilting (P = 0.015) and congruence angle (P = 0.018) significantly improved postoperatively. On the other hand, the Insall-Salvati index decreased at the time of follow-up, although it remained in the physiologic range. Postoperatively, consecutive disease progression in the tibiofemoral joint and patellofemoral joint osteoarthritis were 18.9 and 5.4 %, respectively. The operative complication rate was 5.4 % in this case series. These percentages were lower than those of alternative tibial tuberosity osteotomy techniques.ConclusionIn most patients with chronic isolated PFJ-OA, tibial tuberosity osteotomy by modified crosse de hockey is a reliable procedure that provides good/excellent mid-term clinical results.Level of evidenceLevel IV.

Clinical Impact of Coexisting Patellofemoral Osteoarthritis in Japanese Patients With Medial Knee Osteoarthritis.

To evaluate the clinical impact in knee osteoarthritis (OA) of coexisting patellofemoral (PF) joint OA (PFOA) in Japanese patients with medial tibiofemoral (TF) joint OA (TFOA). Patients with medial knee OA (n = 143) were enrolled. The radiographic severity of the TF and PF joints, anatomic axis angle of the TF joint, patellar alignment, trochlear morphology, patellar height, and passive range of motion (ROM) of the painful knee were evaluated. Additionally, the Japanese Knee Osteoarthritis Measure (JKOM) was used to investigate the association between the presence of PFOA and clinical symptoms. PFOA was present in 98 of 143 patients (68.5%) with medial knee OA. Quantile regression analysis revealed that coexisting PFOA was associated with the pain-related subcategory of the JKOM. Furthermore, multiple logistic regression analysis showed that coexisting PFOA was associated with higher odds of reporting knee pain on using stairs while ascending (odds ratio [OR] 4.81 [95% confidence interval (95% CI) 1.73, 14.3]) and descending (OR 3.86 [95% CI 1.44, 10.8]). A more varus knee alignment and lower knee flexion ROM, which are features of patients with coexisting PFOA, were associated with knee pain while ascending/descending stairs. However, patellar alignment, trochlear morphology, and patellar height were not significantly associated with knee pain. PFOA coexisting with medial knee OA was associated with worse clinical symptoms, particularly while ascending/descending stairs, although patellar alignment did not contribute to reporting knee pain. Further studies that include evaluation of the PF joint are warranted to develop a basis for an optimal intervention based on compartmental involvement.

Are "Patellofemoral Symptoms" Truly Related to the Patellofemoral Joint?

PurposeThe pattern of symptoms of knee osteoarthritis has been thought to be indicative of specific compartment involvement. This study investigated whether there was a true correlation between patellofemoral joint (PFJ) symptoms and unicompartmental patellofemoral arthritis.Materials and MethodsA prospective analysis of 34 patients rendered to be suffering from PFJ osteoarthritis and subsequently undergoing unicompartmental patellofemoral arthroplasty (PFA) was performed. A control cohort of 32 patients suffering from medial tibiofemoral joint (MTFJ) osteoarthritis was included in the analysis. Four questions derived from the Oxford knee score questionnaire, traditionally deemed to be indicative of PFJ osteoarthritis, were combined to create a PFJ subscore and statistically analyzed for their potential relationship with PFJ osteoarthritis and outcomes following PFA.ResultsThe PFJ subscore indicated slightly worse pathology in patients undergoing PFA compared to MTFJ replacement, but the difference was not significant (9.7 and 9.6, respectively; p=0.851). The improvement in PFJ symptoms was higher in those undergoing PFA compared to MTFJ surgery; however, the difference was not statistically significant (3.7 and 2.2 respectively, p=0.074).ConclusionsWe were unable to prove that these symptoms were predictive of PFJ pathology in the preoperative setting, nor were they useful in interpreting which symptoms would likely improve following PFA.

Patterns of Coexisting Lesions Detected on Magnetic Resonance Imaging and Relationship to Incident Knee Osteoarthritis: The Multicenter Osteoarthritis Study.

To identify patterns of coexisting lesions seen on magnetic resonance imaging (MRI) in knees that are free of radiographic osteoarthritis (OA) and to examine the relationship of these MRI-detected lesions to incident OA. Study subjects were individuals enrolled in the Multicenter Osteoarthritis Study, a prospective cohort study. In each subject, 1 knee in which radiographic OA was absent in both the tibiofemoral and patellofemoral joints at baseline was selected for study, with followup for 84 months. We used a novel approach, latent class analysis, to group the constellation of MRI lesions in each joint, i.e., cartilage damage, bone marrow lesion, meniscal tear, meniscal extrusion, synovitis, and effusion, into a manageable number of subgroups. The association of these subgroups with incident radiographic OA in the same joint was assessed using logistic regression. Among 885 eligible knees (203 with incident disease in the tibiofemoral joint, 64 with incident disease in the patellofemoral joint), 4 latent subgroups in the tibiofemoral joint were identified (described briefly as minimal lesions, mild lesions, moderate lesions [but limited meniscal lesions], and severe lesions). The odds ratios of incident tibiofemoral joint OA in the latter 3 subgroups (compared to the knees with minimal lesions as the referent) were 5.6, 1.8, and 5.0, respectively. A similar set of 4 subgroups in the patellofemoral joint was identified, except that the fourth subgroup had limited meniscal lesions. The odds ratios of incident disease in the patellofemoral joint were 3.8, 5.1, and 13.7 in the subgroups with mild lesions, moderate lesions, and severe lesions, respectively. Different patterns of coexisting MRI lesions, which have different implications with regard to risk of knee OA, were identified. Meniscal damage seemed to play a different role in the development of incident disease in tibiofemoral versus patellofemoral joints.

Patellofemoral arthroplasty: outcomes and factors associated with early progression of tibiofemoral arthritis.

The purpose of this study was to review the results of patellofemoral arthroplasty (PFA) performed by a single surgeon at a single institution in order to determine factors associated with clinical outcomes and progression of tibiofemoral degenerative joint disease. Sixty-one patients with isolated patellofemoral osteoarthritis were treated with a PFA by a single surgeon between 2003 and 2009. Fifty-nine patients were available for analysis with a mean follow-up of 4 years (range 2-6 years). Patients were evaluated by measuring range of motion and with the use of the Knee Society clinical rating system, the Tegner Activity Level Scale, and the UCLA Activity Score. In addition, preoperative radiographs were evaluated for patellofemoral and tibiofemoral compartment osteoarthritis and presence of trochlear dysplasia, and post-operative radiographs were reviewed for progression of tibiofemoral degenerative arthritis. Furthermore, multivariate statistical methods were applied to study factors that had potential to influence the final outcome. There was no statistically significant association between age, gender, history of prior knee surgery, patellar height, patellofemoral osteoarthritis severity, patellar and femoral component size, or performance of lateral release with patient pain and function (as measured by the Knee Society scores) or progression of tibiofemoral joint osteoarthritis at final follow-up. Increased preoperative body mass index (BMI) was associated with lower post-operative Knee Society function scores (p=0.03). Patients with preoperative trochlear dysplasia had significantly less radiographic evidence of tibiofemoral joint osteoarthritis progression compared with patients without trochlear dysplasia at final follow-up (p<0.0001). In this study, patients with preoperative radiographic evidence of trochlear dysplasia experienced less progression of tibiofemoral degenerative joint disease than patients without trochlear dysplasia at a mean follow-up of 4 years. IV.