Relationship between trochlear morphology and lateral patellar cartilage defect using MR Imaging

Abstract

Aim: The present study aimed to compare trochlear morphology observed on magnetic resonance imaging (MRI) between patients with lateral patellar cartilage defect and age-matched-pair control patients without cartilage defect.
Methods: A total of 75 patients with MRI-verified grade 3/4 lateral patellar cartilage defect were compared with matched-pair control patients without cartilage defects of the patellofemoral joints. Axial sequences were used to detect and evaluate patellar cartilage defects. Trochlear morphology was assessed on the basis of lateral trochlear inclination (LTI), medial trochlear inclination (MTI), sulcus angle (SA), trochlear facet asymmetry (FA), and trochlear width (TW) on axial MR images.
Results: SA was higher for both sexes in the cartilage defect group than in the control group (p < 0.05). LTI of the cartilage defect group was significantly lower than that of the control group, particularly in females (p < 0.05). There were no significant differences in MTI between the two groups for either sex (p > 0.05). FA for both sexes was significantly lower in the cartilage defect group than in the control group (p < 0.05). TW was significantly higher in the cartilage defect group than in the control group (p < 0.05). Finally, TW of females in the cartilage defect group was significantly higher than that of females in the control group (p < 0.05).
Conclusion: Flattened lateral trochlea is a risk factor for structural damage to the cartilage of the lateral patellofemoral joint, particularly in females.

Keywords

• patellofemoral joint,magnetic resonance imaging,chondromalacia patella,magnetic resonance imaging

MR görüntüleme kullanarak troklear morfoloji ve lateral patellar kartilaj defekti arasındaki ilişki

Öz

Amaç: Bu çalışmada lateral patellar kartilaj defektli hastalar ile yaş-taraf eşleştirilmesi yapılmış kartilaj lezyonu olmayan kontrol hastaları arasında manyetik rezonans görüntüleme (MRG) ile gözlenen troklear morfolojiyi karşılaştırmayı amaçladık.
Yöntem : MRG ile tanımlanan grade 3/4 lateral patellar kartilaj defektli toplam 75 hasta patellofemoral eklemde kartilaj defekti olmayan yaş-taraf eşleştirilmiş kontrol hastaları ile karşılaştırıldı. Aksiyal kesitler patellar kartilaj defektini saptamada kullanıldı. Troklear morfoloji lateral troklear inklinasyon ( LTI) , medial troklear inklinasyon ( MTI), sulkus açısı (SA) , troklear faset asimetrisi (FA) ve troklear genişlik (TG) ile aksiyel kesitlerde değerlendirildi.
Bulgular : SA kontrol grubu ile karşılaştırıldığında her iki cinsiyet için defekt grubunda büyüktü (p < 0.05). Kartilaj defekt grubunda LTI kontrol grubu ile karşılaştırıldığında , özellikle kadınlarda belirgin olmak üzere ,düşüktü (p < 0.05). Her iki cinsiyet için her iki grup arasında MTI 'da istatistiksel olarak anlamlı fark bulunmadı (p > 0.05). Her iki cinsiyet için kartilaj defekt grubunda FA kontrol grubu ile karşılaştırıldığında düşük idi(p < 0.05). TG kontrol grubu ile karşılaştırıldığında defekt grubunda büyüktü (p < 0.05). Ayrıca,kartilaj defekt grubundaki kadınlarda TG kontrol grubundan büyüktü (p < 0.05).
Sonuç: Düzleşmiş lateral troklea özellikle kadınlarda lateral patellofemoral eklemde kartilajda yapısal zedelenme için risk faktörüdür.

Anahtar Kelimeler

• patellofemoral eklem,kondromalazik patella,magnetik rezonans görüntüleme

Kaynakça

1. 1. Duran S, Cavusoglu M, Kocadal O, Sakman B. Association between trochlear morphology and chondromalacia patella: an MRI study Clinical Imaging. 2017;41:7-10.
2. 2. Berenbaum F, Eymard F, Houard X. Osteoarthritis, inflammation and obesity. Curr Opin Rheumatol. 2013 ; 25 : 114-8.
3. 3. Mehl J, Feucht MJ, Bode G, Dovi-Akue D, Südkamp NP,Niemeyer P .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. 2014 ;24:838-46.
4. 4. Tuna BK, Semiz-Oysu A, Pekar B, Bukte Y, Hayırlıoglu A.The association of patellofemoral joint morphology with chondromalacia patella: a quantitative MRI analysis. Clinical Imaging. 2014;38:495-8.
5. 5. Tsavalas N, Katonis P, Karantanas AH. Knee joint anterior malalignment and patellofemoral osteoarthritis: an MRI study. Eur Radiol. 2012;22:418-28.
6. 6. Sebro R, Weintraub S. Knee morphometric and aligment measurements with MR imaging in young adults with central cartilage lesions of the patella and trochlea. Diagn Interv Imaging. 2017;98:429-40.
7. 7. Weintraub S, Sebro R. Superolateral hoffa's fat pad edema and trochlear sulcal angle are associated with isolated medial patellofemoral compartment osteoarthritis. Can Assoc Radiol J. 2018;69:450-7.
8. 8. Pihlajamaki HK, Kuikka PI, Leppanen 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;92:927-34.

9. 9. Recht MP, Piraino DW, Paletta GA, Schils JP, Belhobek GH. Accuracy of fat-supppressed three -dimensional spoiled gradient-echo FLASH MR imaging in the detection of patellofemoral articular cartilage abnormalities. Radiology. 1996;198:209-12.
10. 10. Harris JD, Brophy RH, Jia G,Price B, Knopp P,Siston RA et al. Sensivity of magnetic resonance imaging for detection patellofemoral articular cartilage defect. Arthroscopy. 2012;28:1728-37.
11. 11. 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;194:721-7.
12. 12. Macri EM, Felson DT, Zhang Y, Gurmazi A, Roemer FW,Crossley KM et al. Patellofemoral morphology and aligment :refence values and dose-response patterns for the relation to MRI features of patellofemoral osteoarthritis. Osteoarthritis Cartil. 2017;25:1690-7.
13. 13. Sebro R, Weintraub S.Association between lateral patellar osteoarthrosis and knee morphology and aligment in young adults. Clin Radiol. 2017;72:793.e11-793.e18.
14. 14. Noehren B, Duncan S, Lattermann C. Radiographic parameters associated with lateral patella degeneration in young patients. Knee Surg Sports Traumatol Arthrosc. 2012;20:2385-90.
15. 15. Stefanik JJ, Roemer FW, Zumwalt AC,Zhu Y, Gross KD, Lynch JA et al. Association between measures of trochlear morphology and structural features of patellofemoral joint osteoarthritis on MRI: the MOST study. J Orthop Res. 2012;30:1-8.
16. 16. Kalichman L, Zhang Y, Niu J ,Goggins J, Gale D, Felson DT, et al .The association between patellar alignment and patellofemoral joint osteoarthritis features-an MRI study. Rheumatology (Oxford). 2007;46:1303-8.
17. 17. Freedman BR, Sheehan FT, Lerner AL. MRI-based analysis of patellofemoral cartilage contact, thickness, and aligment in extension, and during moderate and deep flexion. Knee. 2015;22:405-10.
18. 18. Besier TF, Garry EG, Scott LD, Fredericson M, Beaupre GS. The influence of femoral internal and external rotation on cartilage stresses within the patellofemoral joint. J Orthop Res. 2008;26:1627-35.
19. 19. Harbaugh CM, Wilson NA, Sheehan FT. Correlating femoral shape with patellar kinematics in patients with patellofemoral pain. J Orthop Res. 2010;28:865-72.
20. 20. 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;471:2641-8.