title: The diagnostic performance of anterior knee pain and activity-related pain in identifying knees with structural damage in the patellofemoral joint: the Multicenter Osteoarthritis Study.
abstract: OBJECTIVE
  To determine the diagnostic test performance of location of pain and activity-related pain in identifying knees with patellofemoral joint (PFJ) structural damage.
  
  
  METHODS
  The Multicenter Osteoarthritis Study is a US National Institutes of Health-funded cohort study of older adults with or at risk of knee osteoarthritis. Subjects identified painful areas around the knee on a knee pain map and the Western Ontario and McMaster Universities Osteoarthritis Index was used to assess pain with stairs and walking on level ground. Cartilage damage and bone marrow lesions were assessed from knee magnetic resonance imaging. We determined the sensitivity, specificity, positive and negative predictive values for presence of anterior knee pain (AKP), pain with stairs, absence of pain while walking on level ground, and combinations of tests in discriminating knees with isolated PFJ structural damage from those with isolated tibiofemoral joint (TFJ) or no structural damage. Knees with mixed PFJ/TFJ damage were removed from our analyses because of the inability to determine which compartment was causing pain.
  
  
  RESULTS
  There were 407 knees that met our inclusion criteria. "Any" AKP had a sensitivity of 60% and specificity of 53%; and if AKP was the only area of pain, the sensitivity dropped to 27% but specificity rose to 81%. Absence of moderate pain with walking on level ground had the greatest sensitivity (93%) but poor specificity (13%). The combination of "isolated" AKP and moderate pain with stairs had poor sensitivity (9%) but the greatest specificity (97%) of strategies tested.
  
  
  CONCLUSIONS
  Commonly used questions purported to identify knees with PFJ structural damage do not identify this condition with great accuracy.
authors.affiliation: From Boston University, Boston, Massachusetts; the University of California, San Francisco, California; the University of Alabama, Birmingham, Alabama; the University of Iowa, Iowa City, Iowa, USA; Klinikum Augsburg, Augsburg, Germany.J.J. Stefanik, MSPT, PhD, Research Assistant Professor of Physical Therapy and Athletic Training; T. Neogi, MD, PhD, Associate Professor of Medicine; J. Niu, DSc, Clinical Epidemiology and Research Training Unit; A. Guermazi, MD, PhD, Professor of Radiology; D.T. Felson, MD, MPH, Professor of Medicine, Boston University; F.W. Roemer, MD, Associate Professor, Klinikum Augsburg; M.C. Nevitt, PhD, Professor of Epidemiology and Biostatistics, University of California, San Francisco; C.E. Lewis, MD, Professor of Medicine, University of Alabama; N.A. Segal, MD, Associate Professor of Orthopedics and Rehabilitation, University of Iowa. stefanik@bu.edu.
authors.forename: Joshua J
authors.initials: JJ
authors.lastname: Stefanik
authors.affiliation: From Boston University, Boston, Massachusetts; the University of California, San Francisco, California; the University of Alabama, Birmingham, Alabama; the University of Iowa, Iowa City, Iowa, USA; Klinikum Augsburg, Augsburg, Germany.J.J. Stefanik, MSPT, PhD, Research Assistant Professor of Physical Therapy and Athletic Training; T. Neogi, MD, PhD, Associate Professor of Medicine; J. Niu, DSc, Clinical Epidemiology and Research Training Unit; A. Guermazi, MD, PhD, Professor of Radiology; D.T. Felson, MD, MPH, Professor of Medicine, Boston University; F.W. Roemer, MD, Associate Professor, Klinikum Augsburg; M.C. Nevitt, PhD, Professor of Epidemiology and Biostatistics, University of California, San Francisco; C.E. Lewis, MD, Professor of Medicine, University of Alabama; N.A. Segal, MD, Associate Professor of Orthopedics and Rehabilitation, University of Iowa.
authors.forename: Tuhina
authors.initials: T
authors.lastname: Neogi
authors.affiliation: From Boston University, Boston, Massachusetts; the University of California, San Francisco, California; the University of Alabama, Birmingham, Alabama; the University of Iowa, Iowa City, Iowa, USA; Klinikum Augsburg, Augsburg, Germany.J.J. Stefanik, MSPT, PhD, Research Assistant Professor of Physical Therapy and Athletic Training; T. Neogi, MD, PhD, Associate Professor of Medicine; J. Niu, DSc, Clinical Epidemiology and Research Training Unit; A. Guermazi, MD, PhD, Professor of Radiology; D.T. Felson, MD, MPH, Professor of Medicine, Boston University; F.W. Roemer, MD, Associate Professor, Klinikum Augsburg; M.C. Nevitt, PhD, Professor of Epidemiology and Biostatistics, University of California, San Francisco; C.E. Lewis, MD, Professor of Medicine, University of Alabama; N.A. Segal, MD, Associate Professor of Orthopedics and Rehabilitation, University of Iowa.
authors.forename: Jingbo
authors.initials: J
authors.lastname: Niu
authors.affiliation: From Boston University, Boston, Massachusetts; the University of California, San Francisco, California; the University of Alabama, Birmingham, Alabama; the University of Iowa, Iowa City, Iowa, USA; Klinikum Augsburg, Augsburg, Germany.J.J. Stefanik, MSPT, PhD, Research Assistant Professor of Physical Therapy and Athletic Training; T. Neogi, MD, PhD, Associate Professor of Medicine; J. Niu, DSc, Clinical Epidemiology and Research Training Unit; A. Guermazi, MD, PhD, Professor of Radiology; D.T. Felson, MD, MPH, Professor of Medicine, Boston University; F.W. Roemer, MD, Associate Professor, Klinikum Augsburg; M.C. Nevitt, PhD, Professor of Epidemiology and Biostatistics, University of California, San Francisco; C.E. Lewis, MD, Professor of Medicine, University of Alabama; N.A. Segal, MD, Associate Professor of Orthopedics and Rehabilitation, University of Iowa.
authors.forename: Frank W
authors.initials: FW
authors.lastname: Roemer
authors.affiliation: From Boston University, Boston, Massachusetts; the University of California, San Francisco, California; the University of Alabama, Birmingham, Alabama; the University of Iowa, Iowa City, Iowa, USA; Klinikum Augsburg, Augsburg, Germany.J.J. Stefanik, MSPT, PhD, Research Assistant Professor of Physical Therapy and Athletic Training; T. Neogi, MD, PhD, Associate Professor of Medicine; J. Niu, DSc, Clinical Epidemiology and Research Training Unit; A. Guermazi, MD, PhD, Professor of Radiology; D.T. Felson, MD, MPH, Professor of Medicine, Boston University; F.W. Roemer, MD, Associate Professor, Klinikum Augsburg; M.C. Nevitt, PhD, Professor of Epidemiology and Biostatistics, University of California, San Francisco; C.E. Lewis, MD, Professor of Medicine, University of Alabama; N.A. Segal, MD, Associate Professor of Orthopedics and Rehabilitation, University of Iowa.
authors.forename: Neil A
authors.initials: NA
authors.lastname: Segal
authors.affiliation: From Boston University, Boston, Massachusetts; the University of California, San Francisco, California; the University of Alabama, Birmingham, Alabama; the University of Iowa, Iowa City, Iowa, USA; Klinikum Augsburg, Augsburg, Germany.J.J. Stefanik, MSPT, PhD, Research Assistant Professor of Physical Therapy and Athletic Training; T. Neogi, MD, PhD, Associate Professor of Medicine; J. Niu, DSc, Clinical Epidemiology and Research Training Unit; A. Guermazi, MD, PhD, Professor of Radiology; D.T. Felson, MD, MPH, Professor of Medicine, Boston University; F.W. Roemer, MD, Associate Professor, Klinikum Augsburg; M.C. Nevitt, PhD, Professor of Epidemiology and Biostatistics, University of California, San Francisco; C.E. Lewis, MD, Professor of Medicine, University of Alabama; N.A. Segal, MD, Associate Professor of Orthopedics and Rehabilitation, University of Iowa.
authors.forename: Cora E
authors.initials: CE
authors.lastname: Lewis
authors.affiliation: From Boston University, Boston, Massachusetts; the University of California, San Francisco, California; the University of Alabama, Birmingham, Alabama; the University of Iowa, Iowa City, Iowa, USA; Klinikum Augsburg, Augsburg, Germany.J.J. Stefanik, MSPT, PhD, Research Assistant Professor of Physical Therapy and Athletic Training; T. Neogi, MD, PhD, Associate Professor of Medicine; J. Niu, DSc, Clinical Epidemiology and Research Training Unit; A. Guermazi, MD, PhD, Professor of Radiology; D.T. Felson, MD, MPH, Professor of Medicine, Boston University; F.W. Roemer, MD, Associate Professor, Klinikum Augsburg; M.C. Nevitt, PhD, Professor of Epidemiology and Biostatistics, University of California, San Francisco; C.E. Lewis, MD, Professor of Medicine, University of Alabama; N.A. Segal, MD, Associate Professor of Orthopedics and Rehabilitation, University of Iowa.
authors.forename: Michael
authors.initials: M
authors.lastname: Nevitt
authors.affiliation: From Boston University, Boston, Massachusetts; the University of California, San Francisco, California; the University of Alabama, Birmingham, Alabama; the University of Iowa, Iowa City, Iowa, USA; Klinikum Augsburg, Augsburg, Germany.J.J. Stefanik, MSPT, PhD, Research Assistant Professor of Physical Therapy and Athletic Training; T. Neogi, MD, PhD, Associate Professor of Medicine; J. Niu, DSc, Clinical Epidemiology and Research Training Unit; A. Guermazi, MD, PhD, Professor of Radiology; D.T. Felson, MD, MPH, Professor of Medicine, Boston University; F.W. Roemer, MD, Associate Professor, Klinikum Augsburg; M.C. Nevitt, PhD, Professor of Epidemiology and Biostatistics, University of California, San Francisco; C.E. Lewis, MD, Professor of Medicine, University of Alabama; N.A. Segal, MD, Associate Professor of Orthopedics and Rehabilitation, University of Iowa.
authors.forename: Ali
authors.initials: A
authors.lastname: Guermazi
authors.affiliation: From Boston University, Boston, Massachusetts; the University of California, San Francisco, California; the University of Alabama, Birmingham, Alabama; the University of Iowa, Iowa City, Iowa, USA; Klinikum Augsburg, Augsburg, Germany.J.J. Stefanik, MSPT, PhD, Research Assistant Professor of Physical Therapy and Athletic Training; T. Neogi, MD, PhD, Associate Professor of Medicine; J. Niu, DSc, Clinical Epidemiology and Research Training Unit; A. Guermazi, MD, PhD, Professor of Radiology; D.T. Felson, MD, MPH, Professor of Medicine, Boston University; F.W. Roemer, MD, Associate Professor, Klinikum Augsburg; M.C. Nevitt, PhD, Professor of Epidemiology and Biostatistics, University of California, San Francisco; C.E. Lewis, MD, Professor of Medicine, University of Alabama; N.A. Segal, MD, Associate Professor of Orthopedics and Rehabilitation, University of Iowa.
authors.forename: David T
authors.initials: DT
authors.lastname: Felson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018771:Arthralgia / Q000175:diagnosis* / Q000473:pathology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology*; D010147:Pain Measurement; D057071:Patellofemoral Joint / Q000473:pathology*; D011446:Prospective Studies; D012307:Risk Factors; D057566:Self Report; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
keywords: MAGNETIC RESONANCE IMAGING; OSTEOARTHRITIS; PAIN