The Association Between Patellofemoral Congruance and Functionality of the Knee Joint in Patients with Chondromalacia Patella

Yıl 2020, Cilt: 4 Sayı: 3, 96 - 102, 12.12.2020

Fatih Hakan Tufanoğlu , Fatih Bağcıer

https://doi.org/10.46332/aemj.772367

Öz

Purpose: Chondromalacia patella (CMP) is characterized by anterior knee pain with patellar degeneration. Our study was undertaken to assess the association between patellofemoral congruence and knee functionality in patients with anterior knee pain who were diagnosed with CMP based on magnetic resonance imaging. (MRI)

Materials and methods: The study was designed as a single-center, cross-sectional study. The sociodemographic of the patients were recorded. 36 patients with 48 knee MRI examinations were involved and grouped based on the Modified Outer bridge Grading system: Early-stage (Stage 1-2) and advanced-stage CMP (Stage 3-4). Physical exam findings (Clark’s test, patellar compression test, patellar tilt test, J sign), level of functionality (WOMAC), and MRI parameters were evaluated.

Results: The mean age and duration of the pain were significantly higher in patients with advanced stage CMP (p > 0.05) (Table 3). The two groups did not differ in terms of Insall-Salvati index and patellar translation (p > 0.05). Patella alta and patella baja were detected in 3 and 5 patients with early-stage CMP and in 4 and 4 patients with advanced-stage CMP respectively. (p < 0.001).

Conclusion: Advanced stage CMP is associated with reduced functionality. However, patients with early or advanced stage CMP did not differ significantly with regard to MRI. Since clinical and imaging findings are not correlated with subjective complaints regarding patellofemoral joint, studies involving larger populations are warranted. 

Anahtar Kelimeler

Patellar chondromalacia, magnetic resonance imaging, physical examination

Kondromalazi Patella Tanılı Hastalarda Patellofemoral Uyum ile Diz Ekleminin Fonksiyonelliği Arasındaki İlişki

Öz

Amaç: Kondromalazi patella, anterior diz ağrısı ile karakterize olan patellar kartilaj dejenerasyonudur. Bu çalışmada anterior diz ağrısı ile polikliniğimize başvuran ve manyetik rezonans görüntüleme ile kondromalazi patella (KMP) tanısı koyduğumuz hastalarda patellofemoral uyum ile diz fonksiyonelliği arasındaki ilişki değerlendirildi.

Araçlar ve Yöntem: Çalışmamız tek merkezli kesitsel çalışma olarak dizayn edildi. Hastaların sosyodemografik özellikleri kaydedildi. Çalışmamız 36 hastanın 48 diz manyetik rezonans görüntülemesi (MRG) üzerinde gerçekleştirildi. Hastalar; Modifiye Outerbridge skalasına göre dört evreye, erken (Evre 1-2) ve ileri evre KMP (Evre 3-4) olarak iki gruba ayrıldı. Hastaların fizik muayene bulguları (Clark testi, patellar kompresyon testi, patellar tilt testi, J bulgusu), fonksiyonellik düzeyleri (WOMAC) ve MRG görüntüleme parametreleri değerlendirildi.

Bulgular: Gruplar arası kıyaslamada ileri evre grubunun yaş ortalaması ve ağrı süresi istatistiksel olarak anlamlı düzeyde yüksekti (p<0,001). MRG parametrelerinde gruplar arası farklılık tespit edilmedi (p>0.05). Erken evre grubunda 3 hastada patella alta, 5 hastada patella baja, ileri evre grubunda 4 hastada patella alta, 4 hastada patella baja tanısı konuldu. Fonksiyonellik parametreleri kıyaslandığında ileri evre grubunda, erken evre grubuna kıyasla istatistiksel olarak anlamlı düzeyde yükseklik tespit edilmiştir (p<0,001).

Sonuç: KMP hastalarında ileri evrelerde hastaların fonksiyonelliği azalmaktadır. MRG parametreleri, erken evre ve ileri evre KMP hastaları arasında farklılık göstermemiştir. Patellofemoral eklemde subjektif yakınmalarla, klinik ve görüntüleme bulguları korelasyon göstermediğinden bu konuda daha geniş popülasyonun dahil olduğu çalışmalara ihtiyaç duyulmaktadır. 

Anahtar Kelimeler

fizik muayene, kondromalazi patella, manyetik rezonans görüntüleme

Kaynakça

• 1. Özkoç G. Patellar Kondromalazi. TOTBİD Dergisi. 2012;11(4):335-338.
• 2. Dos Santos RL, Souza ML, Dos Santos FA. Neuromuscular electric stimulation in patellofemoral dysfunction: riterature review. Acta Ortop Bras. 2013;21(1):52-58.
• 3. Hartley A, Robinson MM. Practical Joint Assessment: Lower Quadrant A Sports Medicine Manual. 2. Ed. USA;Mosby Inc;1995.
• 4. Arnheim DD, Bonacci JA, Kauth WO, Prentice WE. Principles of athletic training. 11th Edition. USA;McGraw-Hill;2002.
• 5. Doberstein ST, Romeyn RL, Reineke DM. The diagnostic value of the Clarke sign in assessing chondromalacia patella. J Athl Train. 2008;43(2):190-196.
• 6. Demehri S, Thawait GK, Williams AA, et al. Imaging characteristics of contralateral asymptomatic patellofemoral joints in patients with unilateral instability. Radiology. 2014;273(3):821-830.
• 7. Thomas S, Rupiper D, Stacy GS. Imaging of the patellofemoral joint. Clin Sports Med. 2014;33(3):413-436.
• 8. Merchant AC. Classification of patellofemoral disorders. Arthroscopy. 1988;4(4):235-240.
• 9. Horton MG, Hall TL. Quadriceps femoris muscle angle: normal values and relationships with gender and selected skeletal measures. Phys Ther. 1989;69(11):897-901.
• 10. Aglietti P, Buzzi R, Insall JN. Surgery of the Knee. 2. Ed. USA;Churchill Living-stone;1993.
• 11. Bakhtiary AH, Fatemi E. Open versus closed kinetic chain exercises for patellar chondromalacia. Br J Sports Med. 2008;42(2):99-102.
• 12. Biedert RM, Sanchis-Alfonso V. Sources of anterior knee pain. Clin Sports Med. 2002;21(3):335-347.
• 13. Aydoğdu S. Patellofemoral eklem hastalıklarının sınıflandırması. TOTBİD Dergisi. 2012;11(4):284-289.
• 14. Stratford P, Kennedy D, Woodhouse L, Spadoni G. Measurement properties of the WOMAC LK 3.1 pain scale. Osteoarthritis and cartilage. 2007;15(3):266-272.
• 15. Chhabra A, Subhawong TK, Carrino JA. A systematised MRI approach to evaluating the patellofemoral joint. Skeletal Radiol. 2011;40(4):375-387.
• 16. Koskinen SK, Taimela S, Nelimarkka O, Komu M, Kujala UM. Magnetic resonance imaging of patellofemoral relationships. Skeletal Radiol. 1993;22(8):403-410.
• 17. Aysin IK, Askin A, Mete BD, Guvendi E, Aysin M, Kocyigit H. Investigation of the Relationship between Anterior Knee Pain and Chondromalacia Patellae and Patellofemoral Malalignment. Eurasian J Med. 2018;50(1):28-33
• 18. Saddik D, McNally E, Richardson M. MRI of Hoffa’s fat pad. Skeletal Radiol. 2004;33(8):433-444.
• 19. Hoffa A. The influence of the adipose tissue with regard to the pathology of the knee joint. J Am Med Assoc. 1904;43(12):795-796.
• 20. Davies AP, Costa ML, Donnell ST, Glasgow MM, Shepstone L. The sulcus angle and malalignment of the extensor mechanism of the knee. J Bone Joint Surg 2000;82(8):1162-1166.
• 21. Baysal O, Baysal B, Altay Z, Yologlu S. Comparison of MRI graded cartilage and MRI based volume measurement in knee osteoarthritis. Swiss Med Wkly. 2004;134(19-20):283-288.
• 22. Yang B, Tan H, Yang L, Dai G, Guo BJO. Correlating anatomy and congruence of the patellofemoral joint with cartilage lesions. Orthopedics. 2009;32(1):20.
• 23. Dixit S, Difiori JP, Burton M, Mines B. Management of patellofemoral pain syndrome. Am Fam Physician. 2007;75(2):194-202.
• 24. Fredericson M, Yoon K. Physical examination and patellofemoral pain syndrome. Am J Phys Med Rehabil. 2006;85(3):234-243.
• 25. Feller JA, Amis AA, Andrish JT, Arendt EA, Erasmus PJ, Powers CM. Surgical biomechanics of the patellofemoral joint. Arthroscopy. 2007;23(5):542-553.
• 26. 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):721-727.
• 27. Tuna BK, Semiz-Oysu A, Pekar B, Bukte Y, Hayirlioglu A. The association of patellofemoral joint morphology with chondromalacia patella: a quantitative MRI analysis. Clin Imaging. 2014;38(4):495-498.
• 28. Endo Y, Schweitzer ME, Bordalo-Rodrigues M, Rokito AS, Babb JS. MRI quantitative morphologic analysis of patellofemoral region: lack of correlation with chondromalacia patellae at surgery. AJR Am J Roentgenol. 2007;189(5):1165-1168.
• 29. Jibri Z, Martin D, Mansour R, Kamath SJSr. The association of infrapatellar fat pad oedema with patellar maltracking: a case–control study. Skeletal Radiol. 2012;41(8):925-931.
• 30. Houghton KM. Review for the generalist: evaluation of anterior knee pain. Pediatr Rheumatol Online J. 2007;5(8).
• 31. Kalichman L, Zhang Y, Niu J, et al. The association between patellar alignment and patellofemoral joint osteoarthritis features—an MRI study. Rheumatology. 2007;46(8):1303-1308.
• 32. Simmons JE, Cameron JC. Patella alta and recurrent dislocation of the patella. Clin Orthop Relat Res. 1992;(274):265-269.
• 33. Kettunen JA, Visuri T, Harilainen A, Sandelin J, Kujala UM. Primary cartilage lesions and outcome among subjects with patellofemoral pain syndrome. Knee Surg Sports Traumatol Arthrosc. 2005;13(2):131-134.
• 34. Fulkerson JP, Tennant R, Jaivin JS, Grunnet M. Histologic evidence of retinacular nerve injury associated with patellofemoral malalignment. Clin Orthop Relat Res. 1985;(197):196-205.
• 35. Jensen R, Hystad T, Kvale A, Baerheim A. Quantitative sensory testing of patients with long lasting patellofemoral pain syndrome. Eur J Pain. 2007;11(6):665-676.