Increased BMI associated with patellofemoral cartilage strain after acute, dynamic loading
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Patients with an increased BMI exhibit increased patellar and trochlear cartilage strain after acute, dynamic loading, according to recently presented results.
“It has been shown that a common sequence in the development of radiographic knee osteoarthritis (OA) in symptomatic adults is altered in the patellofemoral joint with progression strongly related to the subsequent onset of tibiofemoral joint OA,” Krystal S. Tamayo said in her presentation at the Orthopaedic Research Society Annual Meeting.
“Therefore, isolated, symptomatic patellofemoral joint OA may be a marker - even a target - for early management of knee OA,” she added.
To track patellofemoral cartilage changes in active, obese patients, Tamayo and colleagues at Duke University radiographically analyzed patellofemoral cartilage thickness of 15 subjects. Eight patients had normal BMI (between 18 kg/m2 and 25 kg/m2) and seven patients had high BMI (between 30 kg/m2 and 36 kg/m2), according to the study.
Tamayo and colleagues took radiographic measurements before and after exercise and compiled 3D mesh models to examine patellar and trochlear cartilage thickness and strain.
Researchers noted no interaction between BMI and bone; however, they observed a “significant main effect of BMI on mean patellofemoral cartilage strains” after 20 minutes of walking, Tamayo said. Mean patellofemoral cartilage strain was 1.7% in the normal BMI group and 5.4% in the high BMI group.
“In conclusion, increased BMI was associated with elevated in vivo patellofemoral cartilage strains following dynamic loading,” Tamayo said. “This may help elucidate the onset and progression of patellofemoral joint OA in obese individuals.”
Perspective
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Anterior knee pain is a common complaint seen in the orthopedist’s office but it is still relatively poorly understood. Obesity is well known as a risk factor for both patellofemoral pain and arthritis, but the direct effects of weight on patellofemoral joint cartilage are not well studied. This study by Krystal S. Tamayo and colleagues provides a perspective on the in vivo effects of BMI on patellofemoral cartilage changes on MRI in a young patient population. They showed that the normal physiologic activity of ambulation causes more compressive strain on the patellofemoral cartilage in obese patients.
There are several limitations to this study. There were a small number of patients, and patellofemoral pain was not directly assessed. Therefore, it is unknown if there is a relationship between changes in patellar cartilage thickness and the perception of pain.
Despite these limitations, this study highlights the impact of BMI on the patellofemoral cartilage from a novel perspective. Physical therapy and weight loss exercises for obese patients should minimize their impact on the patellofemoral joint.
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Tamayo KS, et al. Podium presentation 0085. Presented at: Orthopaedic Research Society Annual Meeting; Feb. 12-16, 2021 (virtual meeting).
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