Association of patellar bone marrow lesions with knee pain, patellar cartilage defect and patellar cartilage volume loss in older adults: a cohort study.
OBJECTIVE
To examine the cross-sectional and longitudinal associations of patellar bone marrow lesion (BMLs) with knee pain, cartilage defects and cartilage volume in older adults.


METHODS
A total of 904 randomly selected subjects (mean 62.4 years, 49.9% female) were studied. Fat suppressed T1-weighted spoiled gradient recall and T2-weighted fast spin echo magnetic resonance imaging (MRI) sequences were used to assess cartilage volume, cartilage defects and/or BMLs at baseline (n = 904) and 2.6 (range: 1.4-4.8) years' follow-up (n = 414). Knee pain was assessed by self-administered Western Ontario McMaster Osteoarthritis Index (WOMAC) questionnaire at baseline (n = 904) and follow-up (n = 790).


RESULTS
The prevalence of any patellar BMLs was 19% and was higher in those with tibiofemoral BMLs. In multivariable analyses, patellar BMLs were positively associated with any knee pain at baseline and an increase in knee pain when going up/down stairs (odds ratio (OR): 1.67, 95% confidence interval (CI): 1.08, 2.59) but not with other knee pain subscales. Patella BMLs were also associated with patellar cartilage defects both at baseline and change over time (OR: 1.76, 95% CI: 1.00, 3.70) but not tibiofemoral defects. Patellar BMLs were negatively associated with baseline and change in patella cartilage volume (β: -2.10%, 95% CI: -3.39%, -0.80%). These associations remained significant after further adjustment for tibiofemoral BMLs.


CONCLUSIONS
Patellar BMLs were consistently associated with increased knee pain especially going up/down stairs, increased patellar cartilage defects, and decreased patellar cartilage volume cross-sectionally and longitudinally, suggesting a predominantly compartment specific role for patellar BMLs.
Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia; Department of General Surgery, Yan'an Hospital of Kunming Medical University, Kunming Yan'an Hospital, Kunming, China.
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J
Wang
Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia.
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B
Antony
Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia.
Z
Z
Zhu
Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia; Department of Orthopaedics, 3rd Affiliated Hospital of Southern Medical University, Guangzhou, China.
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W
Han
Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia; Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China.
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F
Pan
Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia.
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X
Wang
Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia.
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X
Jin
Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia; Department of Orthopaedics, 3rd Affiliated Hospital of Southern Medical University, Guangzhou, China.
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Z
Liu
Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
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F
Cicuttini
Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia.
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G
Jones
Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia; Arthritis Research Institute, 1st Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia. Electronic address: Changhai.Ding@utas.edu.au.
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C
Ding
D000368:Aged; D000369:Aged, 80 and over; D018771:Arthralgia / Q000209:etiology*; D001853:Bone Marrow / Q000473:pathology*; D002358:Cartilage, Articular / Q000473:pathology*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010147:Pain Measurement; D010329:Patella / Q000473:pathology*
Bone marrow lesion; Cartilage defect; Cartilage volume; Patella