title: The associations between indices of patellofemoral geometry and knee pain and patella cartilage volume: a cross-sectional study.
abstract: BACKGROUND
  Whilst patellofemoral pain is one of the most common musculoskeletal disorders presenting to orthopaedic clinics, sports clinics, and general practices, factors contributing to its development in the absence of a defined arthropathy, such as osteoarthritis (OA), are unclear.The aim of this cross-sectional study was to describe the relationships between parameters of patellofemoral geometry (patella inclination, sulcus angle and patella height) and knee pain and patella cartilage volume.
  
  
  METHODS
  240 community-based adults aged 25-60 years were recruited to take part in a study of obesity and musculoskeletal health. Magnetic resonance imaging (MRI) of the dominant knee was used to determine the lateral condyle-patella angle, sulcus angle, and Insall-Salvati ratio, as well as patella cartilage and bone volumes. Pain was assessed by the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) VA pain subscale.
  
  
  RESULTS
  Increased lateral condyle-patella angle (increased medial patella inclination) was associated with a reduction in WOMAC pain score (Regression coefficient -1.57, 95% CI -3.05, -0.09) and increased medial patella cartilage volume (Regression coefficient 51.38 mm3, 95% CI 1.68, 101.08 mm3). Higher riding patella as indicated by increased Insall-Salvati ratio was associated with decreased medial patella cartilage volume (Regression coefficient -3187 mm3, 95% CI -5510, -864 mm3). There was a trend for increased lateral patella cartilage volume associated with increased (shallower) sulcus angle (Regression coefficient 43.27 mm3, 95% CI -2.43, 88.98 mm3).
  
  
  CONCLUSIONS
  These results suggest both symptomatic and structural benefits associated with a more medially inclined patella while a high-riding patella may be detrimental to patella cartilage. This provides additional theoretical support for the current use of corrective strategies for patella malalignment that are aimed at medial patella translation, although longitudinal studies will be needed to further substantiate this.
authors.affiliation: School of Public Health and Preventive Medicine, Monash University, Commercial Road, Melbourne, 3004, Australia. Stephanie.Tanamas@med.monash.edu.au
authors.forename: Stephanie K
authors.initials: SK
authors.lastname: Tanamas
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Teichtahl
authors.forename: Anita E
authors.initials: AE
authors.lastname: Wluka
authors.forename: Yuanyuan
authors.initials: Y
authors.lastname: Wang
authors.forename: Miranda
authors.initials: M
authors.lastname: Davies-Tuck
authors.forename: Donna M
authors.initials: DM
authors.lastname: Urquhart
authors.forename: Graeme
authors.initials: G
authors.lastname: Jones
authors.forename: Flavia M
authors.initials: FM
authors.lastname: Cicuttini
mesh_terms: D000328:Adult; D000886:Anthropometry; D018771:Arthralgia / Q000209:etiology / Q000473:pathology* / Q000503:physiopathology; D002358:Cartilage, Articular / Q000473:pathology* / Q000503:physiopathology; D003430:Cross-Sectional Studies; D005260:Female; D005269:Femur / Q000473:pathology* / Q000503:physiopathology; D006801:Humans; D007719:Knee Joint / Q000473:pathology* / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009068:Movement / Q000502:physiology; D010329:Patella / Q000473:pathology* / Q000503:physiopathology; D017847:Patellar Ligament / Q000473:pathology / Q000503:physiopathology; D011237:Predictive Value of Tests; D016059:Range of Motion, Articular / Q000502:physiology
references.citation: Ann Rheum Dis. 2006 Apr;65(4):520-4
references.pmid: 16126799
references.citation: Arthroscopy. 1993;9(2):159-63
references.pmid: 8461073
references.citation: J Rheumatol. 1988 Dec;15(12):1833-40
references.pmid: 3068365
references.citation: Rheumatology (Oxford). 2007 Jul;46(7):1057-62
references.pmid: 17500072
references.citation: Arthritis Rheum. 2000 Nov;43(11):2543-9
references.pmid: 11083279
references.citation: Arthroscopy. 1999 Nov-Dec;15(8):841-51
references.pmid: 10564862
references.citation: Rheumatology (Oxford). 2008 Mar;47(3):368-74
references.pmid: 18263594
references.citation: AJR Am J Roentgenol. 2007 Feb;188(2):433-40
references.pmid: 17242253
references.citation: Eur Radiol. 2000;10(7):1051-5
references.pmid: 11003396
references.citation: Clin Exp Rheumatol. 2003 May-Jun;21(3):321-6
references.pmid: 12846050
references.citation: J Bone Joint Surg Br. 1994 Sep;76(5):807-9
references.pmid: 8083274
references.citation: Knee Surg Sports Traumatol Arthrosc. 1994;2(1):19-26
references.pmid: 7584171
references.citation: J Orthop Sports Phys Ther. 2004 Sep;34(9):504-10
references.pmid: 15493518
references.citation: Clin Orthop Relat Res. 1991 Apr;(265):241-52
references.pmid: 2009665
references.citation: Radiology. 2000 Sep;216(3):858-64
references.pmid: 10966723
references.citation: J Rheumatol. 2004 Jul;31(7):1369-72
references.pmid: 15229959
references.citation: Rheumatology (Oxford). 2007 Aug;46(8):1303-8
references.pmid: 17525117
references.citation: J Orthop Sports Phys Ther. 2003 Nov;33(11):671-6
references.pmid: 14669962
references.citation: Acta Orthop Scand. 1998 Oct;69(5):489-92
references.pmid: 9855230
references.citation: J Bone Joint Surg Am. 2007 Aug;89(8):1749-55
references.pmid: 17671014
references.citation: Skeletal Radiol. 2005 Mar;34(3):130-5
references.pmid: 15517249
references.citation: J Bone Joint Surg Am. 2000 Nov;82(11):1639-50
references.pmid: 11097456
references.citation: Arthroscopy. 2007 May;23(5):542-53
references.pmid: 17478287
references.citation: Physiother Theory Pract. 2006 Jun;22(3):105-18
references.pmid: 16848349
references.citation: Ann Rheum Dis. 1997 Jul;56(7):401-2
references.pmid: 9485999
references.citation: Arthroscopy. 2006 Jun;22(6):643-9
references.pmid: 16762703
references.citation: J Bone Joint Surg Br. 1989 Nov;71(5):788-92
references.pmid: 2584248
references.citation: Radiology. 1971 Oct;101(1):101-4
references.pmid: 5111961
references.citation: Clin J Sport Med. 1997 Jan;7(1):28-31
references.pmid: 9117522
references.citation: Knee. 2008 Jan;15(1):3-8
references.pmid: 18023186
references.citation: Acta Orthop Scand. 1970;41(5):578-88
references.pmid: 5507904
references.citation: Res Sports Med. 2006 Jul-Sep;14(3):215-23
references.pmid: 16967773
references.citation: Clin Orthop Relat Res. 2002 Sep;(402):260-9
references.pmid: 12218492
references.citation: Osteoarthritis Cartilage. 2007 Dec;15(12):1437-42
references.pmid: 17560134
references.citation: Magn Reson Med. 2002 Mar;47(3):554-61
references.pmid: 11870843
references.citation: Br J Sports Med. 2002 Apr;36(2):95-101
references.pmid: 11916889
references.citation: Osteoarthritis Cartilage. 2008 Jan;16(1):131-5
references.pmid: 17869546
references.citation: BMJ. 2003 Jul 19;327(7407):135
references.pmid: 12869456
references.citation: J Orthop Res. 2009 May;27(5):561-70
references.pmid: 19009601
references.citation: Osteoarthritis Cartilage. 2007 Oct;15(10):1120-7
references.pmid: 17502158
references.citation: Am J Sports Med. 1996 Jan-Feb;24(1):52-60
references.pmid: 8638754
references.citation: J Bone Joint Surg Br. 2009 Mar;91(3):344-50
references.pmid: 19258610
references.citation: Skeletal Radiol. 2004 Aug;33(8):445-50
references.pmid: 15221214
references.citation: Am J Sports Med. 2006 Aug;34(8):1254-61
references.pmid: 16567459
references.citation: Phys Ther. 2000 Oct;80(10):965-78
references.pmid: 11002432
references.citation: Acta Orthop Belg. 2004 Dec;70(6):545-50
references.pmid: 15669454
references.citation: BMC Musculoskelet Disord. 2008 Mar 19;9:36
references.pmid: 18366679
references.citation: Arthritis Res Ther. 2007;9(2):R26
references.pmid: 17343731
references.citation: J Bone Joint Surg Br. 2000 Nov;82(8):1162-6
references.pmid: 11132279