Patellofemoral morphology linked with maltracking in adolescents with patellofemoral pain
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Researchers of this study found patellofemoral morphology was altered and had an impact on maltracking in adolescents with patellofemoral pain.
Researchers used 3D MRIs from a previous study to measure patellar width, trochlear width, lateral patellar width, trochlea and patella depth, Wiberg index, patellar-height ratio, lateral trochlear inclination, cartilage length and lateral femoral shaft length. Shape parameters between adolescents with patellofemoral and control patients were also compared. The relationship between morphology, kinematics and pain were assessed with Pearson correlations and stepwise linear regression models.
Results showed adolescents with patellofemoral pain compared with controls had larger sulci (6.6 mm vs. 6 mm), lateral patellar width (23.1 mm vs. 21.4 mm) and patellar-trochlear width ratio (1.2 mm vs. 1.1 mm). In both adolescents with patellofemoral pain and controls and in the entire population, shape was associated with kinematics. Wiberg index, lateral shaft length and patellar-height ratio were correlated with medial shift in adolescents with patellofemoral pain. Patellar-height ratio and lateral patellar tilt were moderately correlated.
In adolescents with patellofemoral pain, half of the variation in patellar shift was due to the patellar-height ratio and Wiberg index, according to researchers. There were no linear correlations found with pain. – by Monica Jaramillo
Disclosure: Fick reports he received funding support through the NIH Medical Research Scholars Program and contributions from the Doris Duke Charitable Foundation, Genentech and the American Association for Dental Research.
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Daniel W. Green, MD, MS, FACS
Patellofemoral pain is a common cause of adolescent knee pain. Researchers at the NIH in Bethesda, Maryland, led by Cameron Fick investigated patellofemoral morphology and its association with patellofemoral pain in the adolescent patient. Specifically, the investigators measured patellofemoral morphology comparing MRIs with 20 controls vs. 20 adolescents with idiopathic patellofemoral pain that was not associated clinically with patella instability.
Interestingly, the idiopathic patellofemoral (PF) pain group had a deeper sulcus and they speculate that there may be two groups of PF pain patients — one with PF instability and one group without instability. In addition to deeper femoral sulci, adolescents with PF pain were noted to have increased lateral patellar width and patellotrochlear width ratio.
It is my opinion that these radiographic findings probably will not directly change or modify clinicians’ current approach to adolescent idiopathic PF pain. However, hopefully this study will stimulate further research and potentially new treatment approaches to this common form of adolescent knee pain and disability.
Fellowship associate director
Orthopedic surgery, pediatrics, sports medicine
New York
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