Patellar maltracking is prevalent among patellofemoral pain subjects with patella alta: An upright, weightbearing MRI study

Department of Bioengineering, Stanford University James H. Clark Center, Room S-331, 318 Campus Drive, Stanford, California. .
Journal of Orthopaedic Research (Impact Factor: 2.99). 03/2013; 31(3). DOI: 10.1002/jor.22256
Source: PubMed


The purpose of this study is to determine if patellar maltracking is more prevalent among patellofemoral (PF) pain subjects with patella alta compared to subjects with normal patella height. We imaged 37 PF pain and 15 pain free subjects in an open-configuration magnetic resonance imaging scanner while they stood in a weightbearing posture. We measured patella height using the Caton-Deschamps, Blackburne-Peel, Insall-Salvati, Modified Insall-Salvati, and Patellotrochlear indices, and classified the subjects into patella alta and normal patella height groups. We measured patella tilt and bisect offset from oblique-axial plane images, and classified the subjects into maltracking and normal tracking groups. Patellar maltracking was more prevalent among PF pain subjects with patella alta compared to PF pain subjects with normal patella height (two-tailed Fisher's exact test, p < 0.050). Using the Caton-Deschamps index, 67% (8/12) of PF pain subjects with patella alta were maltrackers, whereas only 16% (4/25) of PF pain subjects with normal patella height were maltrackers. Patellofemoral pain subjects classified as maltrackers displayed a greater patella height compared to the pain free and PF pain subjects classified as normal trackers (two-tailed unpaired t-tests with Bonferroni correction, p < 0.017). This study adds to our understanding of PF pain in two ways-(1) we demonstrate that patellar maltracking is more prevalent in PF pain subjects with patella alta compared to subjects with normal patella height; and (2) we show greater patella height in PF pain subjects compared to pain free subjects using four indices commonly used in clinics. © 2012 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.

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    • "Previous studies reported significant differences in patellar lateral translation , spin, and tilt between symptomatic and asymptomatic individuals [6] [7]. PFPS is also more prevalent in patients with patella alta, whose patella is high positioned [8]. As a common cause of PFPS, PF arthritis is also associated with incongruent sliding between the patella and femoral sulcus [9]. "
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    ABSTRACT: Patellofemoral (PF) maltracking is a critical factor predisposing to PF pain syndrome. Many novel techniques of measuring patellar tracking remain research tools. This study aimed to develop a method to measure the in vivo patellar tracking and finite helical axis (FHA) by using a static magnetic resonance (MR) based methodology. The geometrical models of PF joint at 0°, 45°, 60°, 90°, and 120° of knee flexion were developed from MR images. The approximate patellar tracking was derived from the discrete PF models with a spline interpolation algorithm. The patellar tracking was validated with the previous in vitro and in vivo experiments. The patellar FHA throughout knee flexion was calculated. In the present case, the FHA drew an “L-shaped” curve in the sagittal section. This methodology could advance the examination of PF kinematics in clinics, and may also provide preliminary knowledge on patellar FHA study.
    Full-text · Article · Sep 2014 · Medical Engineering & Physics
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    • "The height of the patella was found to be positively associated with lateral displacement and tilt of the patella, but only at full knee extension . This finding is consistent with previous studies which reported that patellar height was related to patellar malalignment at 0° of knee flexion [15] [16], but not at 20°, 40°, or 60° of knee flexion [16]. This finding is logical as a higher vertical position of the patella at full knee extension would result in the patella being positioned above the bony confine of the trochlea. "
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    ABSTRACT: Patellar malalignment is thought to be an etiological factor with respect to the development of patellofemoral pain. Although previous studies have suggested that the geometry of the femoral trochlea and the height of the patella play an important role in determining patellar alignment, no investigation has systematically examined these relationships during weight bearing. The aim of this study was to determine whether patellar height and/or trochlear geometry predicts patellar alignment (lateral patellar displacement and lateral patellar tilt) during weight bearing. MR images of the patellofemoral joint were acquired from 36 participants during weight bearing (25% of body weight) at 4 knee flexion angles (0°, 20°, 40° and 60°). Using the axial images, patellar alignment (lateral displacement and tilt) and femoral trochlear geometry (sulcus angle and inclination of the lateral femoral trochlea) were measured. Patellar height (Insall-Salvati ratio) was measured on reconstructed sagittal plane images. Stepwise regression analysis revealed that at 0° of knee flexion, the height of the patella was the best predictor of lateral patellar tilt while the lateral trochlea inclination angle was the best predictor of lateral patellar displacement. Lateral trochlear inclination was the best predictor of patellar lateral displacement and tilt at 20°, 40° and 60° of knee flexion. Similar to a previous study performed under non-weight bearing condition, our findings suggest that lateral trochlear inclination is an important determinant of patellar alignment in weight bearing. Level III.
    Full-text · Article · Aug 2013 · The Knee
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    ABSTRACT: Increasing step rate has been shown to elicit changes in joint kinematics and kinetics during running, and has been suggested as a possible rehabilitation strategy for runners with patellofemoral pain. The purpose of this study was to determine how altering step rate affects internal muscle forces and patellofemoral joint loads, and then to determine what kinematic and kinetic factors best predict changes in joint loading. We recorded whole body kinematics of 30 healthy adults running on an instrumented treadmill at three step rate conditions (90%, 100%, and 110% of preferred step rate). We then used a 3D lower extremity musculoskeletal model to estimate muscle, patellar tendon, and patellofemoral joint forces throughout the running gait cycles. Additionally, linear regression analysis allowed us to ascertain the relative influence of limb posture and external loads on patellofemoral joint force. Increasing step rate to 110% of preferred reduced peak patellofemoral joint force by 14%. Peak muscle forces were also altered as a result of the increased step rate with hip, knee and ankle extensor forces, and hip abductor forces all reduced in mid-stance. Compared to the 90% step rate condition, there was a concomitant increase in peak rectus femoris and hamstring loads during early and late swing, respectively, at higher step rates. Peak stance phase knee flexion decreased with increasing step rate, and was found to be the most important predictor of the reduction in patellofemoral joint loading. Increasing step rate is an effective strategy to reduce patellofemoral joint forces and could be effective in modulating biomechanical factors that can contribute to patellofemoral pain.
    Full-text · Article · Aug 2013 · Medicine and science in sports and exercise
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