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Anatomic Risk Factors for Focal Cartilage Lesions in the Patella and Trochlea: A Case-Control Study.
Am J Sports Med 2019; 47(10):2444-2453AJ

Abstract

BACKGROUND

Focal cartilage lesions in the patellofemoral (PF) joint are common. Several studies correlated PF risk factors with PF instability, anterior knee pain, and PF arthritis; however, there is a lack of evidence correlating those factors to PF focal cartilage lesions.

PURPOSE

To evaluate the influence of the anatomic PF risk factors in patients with isolated focal PF cartilage lesions.

STUDY DESIGN

Cross-sectional study; Level of evidence, 3.

METHODS

Patients with isolated PF focal cartilage lesions were included in the cartilage lesion group, and patients with other pathologies and normal PF cartilage were included in the control group. Multiple PF risk factors were accessed on magnetic resonance imaging scans: patellar morphology (patellar width, patellar thickness, and patellar angle), trochlear morphology (trochlear sulcus angle, lateral condyle index, and trochlear sulcus depth), patellar height (Insall-Salvati ratio and Caton-Deschamps index), axial patellar positioning (patellar tilt, angle of Fulkerson), and quadriceps vector (tibial tuberosity-trochlear groove distance).

RESULTS

A total of 135 patients were included in the cartilage lesion group and 100 in the control group. As compared with the control group, the cartilage lesion group had a higher sulcus angle (P = .0007), lower trochlear sulcus depth (P < .0001), lower angle of Fulkerson (P < .0001), lower patellar width (P = .0003), and higher Insall-Salvati ratio (P < .0001). From the patients in the cartilage lesion group, 36% had trochlear dysplasia; 27.6%, patella alta; and 24.7%, abnormal patellar tilt. These parameters were more frequent in the cartilage lesion group (P < .0001). Trochlear lesions were more frequent in men, presented at an older age, and had fewer associated anatomic risk factors. Patellar lesions, conversely, were more frequent in women, presented at younger age, and were more closely associated with anatomic risk factors.

CONCLUSION

PF anatomic abnormalities are significantly more common in patients with full-thickness PF cartilage lesions. Trochlear dysplasia, patella alta, and excessive lateral patellar tilt are the most common correlated factors, especially in patellar lesions.

Authors+Show Affiliations

Universidade Federal de São Paulo Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina/UNIFESP, São Paulo, Brazil. Center for Regenerative Medicine and Center of Cartilage Repair, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA.Department of Orthopedic Surgery, Brigham and Women's Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.Department of Orthopedic Surgery, Medical School, University of Minnesota, Minneapolis, Minnesota, USA.School of Medicine, Indiana University, OrthoIndy and OrthoIndy Hospital, Greenwood and Indianapolis, Indiana, USA.Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31287712

Citation

Ambra, Luiz Felipe, et al. "Anatomic Risk Factors for Focal Cartilage Lesions in the Patella and Trochlea: a Case-Control Study." The American Journal of Sports Medicine, vol. 47, no. 10, 2019, pp. 2444-2453.
Ambra LF, Hinckel BB, Arendt EA, et al. Anatomic Risk Factors for Focal Cartilage Lesions in the Patella and Trochlea: A Case-Control Study. Am J Sports Med. 2019;47(10):2444-2453.
Ambra, L. F., Hinckel, B. B., Arendt, E. A., Farr, J., & Gomoll, A. H. (2019). Anatomic Risk Factors for Focal Cartilage Lesions in the Patella and Trochlea: A Case-Control Study. The American Journal of Sports Medicine, 47(10), pp. 2444-2453. doi:10.1177/0363546519859320.
Ambra LF, et al. Anatomic Risk Factors for Focal Cartilage Lesions in the Patella and Trochlea: a Case-Control Study. Am J Sports Med. 2019;47(10):2444-2453. PubMed PMID: 31287712.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Anatomic Risk Factors for Focal Cartilage Lesions in the Patella and Trochlea: A Case-Control Study. AU - Ambra,Luiz Felipe, AU - Hinckel,Betina B, AU - Arendt,Elizabeth A, AU - Farr,Jack, AU - Gomoll,Andreas H, Y1 - 2019/07/09/ PY - 2019/7/10/pubmed PY - 2019/7/10/medline PY - 2019/7/10/entrez KW - anatomic risk factors KW - cartilage lesions KW - cartilage repair KW - cartilage restoration KW - patellofemoral KW - patellofemoral risk factors SP - 2444 EP - 2453 JF - The American journal of sports medicine JO - Am J Sports Med VL - 47 IS - 10 N2 - BACKGROUND: Focal cartilage lesions in the patellofemoral (PF) joint are common. Several studies correlated PF risk factors with PF instability, anterior knee pain, and PF arthritis; however, there is a lack of evidence correlating those factors to PF focal cartilage lesions. PURPOSE: To evaluate the influence of the anatomic PF risk factors in patients with isolated focal PF cartilage lesions. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: Patients with isolated PF focal cartilage lesions were included in the cartilage lesion group, and patients with other pathologies and normal PF cartilage were included in the control group. Multiple PF risk factors were accessed on magnetic resonance imaging scans: patellar morphology (patellar width, patellar thickness, and patellar angle), trochlear morphology (trochlear sulcus angle, lateral condyle index, and trochlear sulcus depth), patellar height (Insall-Salvati ratio and Caton-Deschamps index), axial patellar positioning (patellar tilt, angle of Fulkerson), and quadriceps vector (tibial tuberosity-trochlear groove distance). RESULTS: A total of 135 patients were included in the cartilage lesion group and 100 in the control group. As compared with the control group, the cartilage lesion group had a higher sulcus angle (P = .0007), lower trochlear sulcus depth (P < .0001), lower angle of Fulkerson (P < .0001), lower patellar width (P = .0003), and higher Insall-Salvati ratio (P < .0001). From the patients in the cartilage lesion group, 36% had trochlear dysplasia; 27.6%, patella alta; and 24.7%, abnormal patellar tilt. These parameters were more frequent in the cartilage lesion group (P < .0001). Trochlear lesions were more frequent in men, presented at an older age, and had fewer associated anatomic risk factors. Patellar lesions, conversely, were more frequent in women, presented at younger age, and were more closely associated with anatomic risk factors. CONCLUSION: PF anatomic abnormalities are significantly more common in patients with full-thickness PF cartilage lesions. Trochlear dysplasia, patella alta, and excessive lateral patellar tilt are the most common correlated factors, especially in patellar lesions. SN - 1552-3365 UR - https://www.unboundmedicine.com/medline/citation/31287712/Anatomic_Risk_Factors_for_Focal_Cartilage_Lesions_in_the_Patella_and_Trochlea:_A_Case-Control_Study L2 - http://journals.sagepub.com/doi/full/10.1177/0363546519859320?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -