Prevalence of chondromalacia patella according to patella type and patellofemoral geometry

a retrospective study

Authors

Keywords:

Patellofemoral pain syndrome, Chondromalacia patellae, Patellofemoral joint

Abstract

BACKGROUND: The relationships between the morphometric structure of the patellofemoral joint, patella type and chondromalacia patella are still a matter of debate. OBJECTIVE: To identify the prevalence of chondromalacia patella by determining the patella type and making patellofemoral morphometric measurements. DESIGN AND SETTING: Retrospective cohort study in an orthopedics and traumatology clinic in Turkey, conducted between June 2017 and November 2019. METHODS: This study involved 562 knees of 522 patients with anterior knee pain (246 males and 316 females; mean age 46.59 years). The patients were grouped according to presence of chondromalacia patella (group I) or absence of chondromalacia patella (group II). The patella type, lateral trochlear inclination, medial trochlear inclination, trochlear angle, sulcus angle, patellar tilt and Insall-Salvati index were assessed. Group comparisons were made using chi-square tests or Student t tests. The r value was used to determine the magnitude of relationships between pairs of variables. RESULTS: Among the 562 knees evaluated, 265 (50.71%) presented type I patella, 195 (36.7%) type II, 100 (12.3%) type III and 2 (0.3%) type IV. Group I consisted of 448 knees and group II consisted of 114 knees. Significant differences were found between the groups in terms of age, gender, patella type and lateral inclination angles (P < 0.05). CONCLUSION: Detecting the patella type and making lateral inclination measurements in patients with anterior knee pain are of great importance for diagnosing suspected chondromalacia patella, particularly in the early degenerative period.

Downloads

Download data is not yet available.

Author Biographies

Muhsin Dursun, Department of Orthopedics and Traumatology, EPC Special Hospital

MD, PhD. Physician, Department of Orthopedics and Traumatology, EPC Special Hospital, Adana, Turkey.

Murat Ozsahın, Department of Orthopedics and Traumatology, EPC Special Hospital

MD, PhD. Physician, Department of Orthopedics and Traumatology, Middle East Special Hospital, Adana, Turkey.

Guray Altun, Department of Orthopedics and Traumatology, EPC Special Hospital

MD, PhD. Physician, Department of Orthopedics and Traumatology, University of Health Sciences Umraniye Training and Research Hospital, Istanbul, Turkey.

References

Curl WW, Krome J, Gordon ES, et al. Cartilage injuries: a review of 31,516 knee arthroscopies. Arthroscopy. 1997;13(4):456-60. PMID: 9276052; https://doi.org/10.1016/s0749-8063(97)90124-9

Hjelle K, Solheim E, Strand T, Muri R, Brittberg M. Articular cartilage defects in 1,000 knee arthroscopies. Arthroscopy. 2002;18(7):730-4. PMID: 12209430; https://doi.org/10.1053/jars.2002.32839

Potter HG, Linklater JM, Allen AA, Hannafin JA, Haas SB. Magnetic resonance imaging of articular cartilage in the knee. An evaluation with use of fast-spin-echo imaging. J Bone Joint Surg Am. 1998;80(9):1276-84. PMID: 9759811; https://doi.org/10.2106/00004623-199809000-00005.

Duran S, Cavusoglu M, Kocadal O, Sakman B. Association between trochlear morphology and chondromalacia patella: an MRI study. Clin Imaging. 2017;41:7-10. PMID: 27723501; https://doi.org/10.1016/j.clinimag.2016.09.008.

Mehl J, Feucht MJ, Bode G, et al. Association between patellar cartilage defects and patellofemoral geometry: a matched-pair MRI comparison of patients with and without isolated patellar cartilage defects. Knee Surg Sports Traumatol Arthrosc. 2016;24(3):838-46. PMID: 25354557; https://doi.org/10.1007/s00167-014-3385-7.

Ali SA, Helmer R, Terk MR. Analysis of the patellofemoral region on MRI: association of abnormal trochlear morphology with severe cartilage defects. AJR Am J Roentgenol. 2010;194(3):721-7. PMID: 20173151; https://doi.org/10.2214/ajr.09.3008.

Stefanik JJ, Roemer FW, Zumwalt AC, et al. Association between measures of trochlear morphology and structural features of patellofemoral joint osteoarthritis on MRI: the MOST study. J Orthop Res. 2012;30(1):1-8. PMID: 21710542; https://doi.org/10.1002/jor.21486.

Stefanik JJ, Zumwalt AC, Segal NA, Lynch JA, Powers CM. Association between measures of patella height, morphologic features of the trochlea, and patellofemoral joint alignment: the MOST study. Clin Orthop Relat Res. 2013;471(8):2641-8. PMID: 23546847; https://doi.org/10.1007/s11999-013-2942-6.

Harbaugh CM, Wilson NA, Sheehan FT. Correlating femoral shape with patellar kinematics in patients with patellofemoral pain. J Orthop Res. 2010;28(7):865-72. PMID: 20108348; https://doi.org/10.1002/jor.21101.

Carrillon Y, Abidi H, Dejour D, et al. Patellar instability: assessment on MR images by measuring the lateral trochlear inclination-initial experience. Radiology. 2000;216(2):582-5. PMID: 10924589; https://doi.org/10.1148/radiology.216.2.r00au07582.

Macri EM, Felson DT, Zhang Y, et al. Patellofemoral morphology and alignment: reference values and dose-response patterns for the relation to MRI features of patellofemoral osteoarthritis. Osteoarthritis Cartilage. 2017;25(10):1690-7. PMID: 28648740; https://doi.org/10.1016/j.joca.2017.06.005.

Paiva M, Blønd L, Hölmich P, et al. Quality assessment of radiological measurements of trochlear dysplasia; a literature review. Knee Surg Sports Traumatol Arthrosc. 2018;26(3):746-55. PMID: 28315921; https://doi.org/10.1007/s00167-017-4520-z.

Noehren B, Duncan S, Lattermann C. Radiographic parameters associated with lateral patella degeneration in young patients. Knee Surg Sports Traumatol Arthrosc. 2012;20(12):2385-90. PMID: 22258652; https://doi.org/10.1007/s00167-012-1884-y.

Yang B, Tan H, Yang L, Dai G, Guo B. Correlating anatomy and congruence of the patellofemoral joint with cartilage lesions. Orthopedics. 2009;32(1):20. PMID: 19226043; https://doi.org/10.3928/01477447-20090101-27.

Baumgartl F. Anatomische und klinische Bedeutung des Femoropatellargelenkes [Anatomical and clinical importance of the femoropatellar joint]. Zentralbl Chir. 1966;91(14):506-16. PMID: 5984732.

van Eck CF, Kingston RS, Crues JV, Kharrazi FD. Magnetic Resonance Imaging for Patellofemoral Chondromalacia: Is There a Role for T2 Mapping? Orthop J Sports Med. 2017;5(11):2325967117740554. PMID: 29204454; https://doi.org/10.1177/2325967117740554.

Huberti HH, Hayes WC. Patellofemoral contact pressures. The influence of q-angle and tendofemoral contact. J Bone Joint Surg Am. 1984;66(5):715-24. PMID: 6725318.

Pascual-Garrido C, Slabaugh MA, L’Heureux DR, Friel NA, Cole BJ. Recommendations and treatment outcomes for patellofemoral articular cartilage defects with autologous chondrocyte implantation: prospective evaluation at average 4-year follow-up. Am J Sports Med. 2009;37 Suppl 1:33S-41S. PMID: 19861699; https://doi.org/10.1177/0363546509349605.

Mouzopoulos G, Borbon C, Siebold R. Patellar chondral defects: a review of a challenging entity. Knee Surg Sports Traumatol Arthrosc. 2011;19(12):1990-2001. PMID: 21607740; https://doi.org/10.1007/s00167-011-1546-5.

Rubenstein JD, Li JG, Majumdar S, Henkelman RM. Image resolution and signal-to-noise ratio requirements for MR imaging of degenerative cartilage. AJR Am J Roentgenol. 1997;169(4):1089-96. PMID: 9308470; https://doi.org/10.2214/ajr.169.4.9308470.

Bredella MA, Tirman PF, Peterfy CG, et al. Accuracy of T2-weighted fast spin-echo MR imaging with fat saturation in detecting cartilage defects in the knee: comparison with arthroscopy in 130 patients. AJR Am J Roentgenol. 1999;172(4):1073-80. PMID: 10587150; https://doi.org/10.2214/ajr.172.4.10587150.

Harris JD, Brophy RH, Jia G, et al. Sensitivity of magnetic resonance imaging for detection of patellofemoral articular cartilage defects. Arthroscopy. 2012;28(11):1728-37. PMID: 22749495; https://doi.org/10.1016/j.arthro.2012.03.018.

Pihlajamäki HK, Kuikka PI, Leppänen VV, Kiuru MJ, Mattila VM. Reliability of clinical findings and magnetic resonance imaging for the diagnosis of chondromalacia patellae. J Bone Joint Surg Am. 2010;92(4):927-34. PMID: 20360517; https://doi.org/10.2106/jbjs.h.01527.

Arslan E, Acar T, Adıbelli ZH. Türk toplumunda patellar kondromalazi: Prevalansı ve patella tipleri ile olan ilişkisi. İzmir Tepecik Eğitim Hastanesi Dergisi. 2018;28(2):83-8. Available from: https://www.acarindex.com/i-zmir-tepecik-egitim-hastanesi-dergisi/turk-toplumunda-patellar-kondromalazi-prevalansi-ve-patella-tipleri-ile-olan-iliskisi-234157 Accessed in 2022 (Jul 18).

Demirağ B, Kaplan T, Köseoğlu E. Türk Toplumundaki Erişkinlerde Patella Tiplerinin Dağılımı. Uludağ Üniversitesi Tıp Fakültesi Dergisi. 2004;30(2):71-4. Available from: https://atif.sobiad.com/index.jsp?modul=makale-goruntule&id=gbbg3XgBu-adCBSEJfl7&alan=saglik. Accessed in 2022 (Jul 18).

Hayirlioglu A, Doganay H, Yilmabasar MG, Pekar RB. The evaluation of the association between patella types and chondromalacia patella by magnetic resonance imaging. Imaging. 2015;2(2):21-8. https://doi.org/10.5430/ijdi.v2n2p21.

Türkmen İ, Işık Y. Association between patellofemoral congruence and patellofemoral chondropathy in patients with anterior knee pain: A T2 mapping knee MRI study. Eklem Hastalik Cerrahisi. 2018;29(2):93-9. PMID: 30016608; https://doi.org/10.5606/ehc.2018.60364.

Downloads

Published

2022-11-03

How to Cite

1.
Dursun M, Ozsahın M, Altun G. Prevalence of chondromalacia patella according to patella type and patellofemoral geometry: a retrospective study. Sao Paulo Med J [Internet]. 2022 Nov. 3 [cited 2025 Mar. 12];140(6):755-61. Available from: https://periodicosapm.emnuvens.com.br/spmj/article/view/1093

Issue

Section

Original Article