title: Patellofemoral Bone Marrow Lesions: Natural History and Associations With Pain and Structure.
abstract: To describe the natural history of patellofemoral (PF) joint bone marrow lesions (BMLs) over 2.6 years and associations between changes in PF joint BMLs, knee pain, and knee cartilage morphology in older adults over 5 years.
  
  
  
  A prospective population-based cohort study of men and women ages 50-80 years (mean age 63 years, n = 406) was performed. PF joint BMLs, knee cartilage volume, and cartilage defect scores (range 0-4) were measured using the Whole-Organ Magnetic Resonance Imaging Score system at baseline and at 2.6 years. Knee pain was assessed by Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores at baseline and at 5 years.
  
  
  
  At baseline, 27% (n = 109) had PF joint BMLs; 24% of these increased (WOMAC score change of ≥1) at followup, 44% persisted, 32% decreased, and 21% resolved completely. Of those without PF joint BMLs at baseline, 20% of participants developed PF joint BMLs over 2.6 years. In multivariable analyses, a change in PF joint BMLs was deleteriously associated with a change in total knee pain (β = 0.67, 95% confidence interval [95% CI] 0.03, 1.31) and knee pain when going up/down stairs (β = 0.24, 95% CI 0.04, 0.44) over 5 years. Baseline PF joint and tibiofemoral joint cartilage volume were protective for PF joint BMLs (relative risk [RR] 0.69, 95% CI 0.52, 0.90 for PF joint), while baseline PF joint cartilage defects were associated with an increase in PF joint BMLs (RR 1.73, 95% CI 1.38, 2.17) over 2.6 years. TF joint cartilage defects were not associated with increases in PF joint BMLs.
  
  
  
  PF joint BMLs are not static, and change is clinically relevant. PF joint cartilage morphology predicts increases in PF joint BMLs.
authors.affiliation: Zhaohua Zhu, PhD, Xingzhong Jin, PhD, Benny Antony, PhD, Weiyu Han, PhD, Laura L. Laslett, PhD, Graeme Jones, MD, PhD: Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia.
authors.forename: Zhaohua
authors.initials: Z
authors.lastname: Zhu
authors.affiliation: Changhai Ding, PhD: Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia, Monash University, Melbourne, Victoria, Australia, and Arthritis Research Institute, First Affliliated Hospital of Anhui Medical University, Hefei, Anhui, China.
authors.forename: Changhai
authors.initials: C
authors.lastname: Ding
authors.affiliation: Zhaohua Zhu, PhD, Xingzhong Jin, PhD, Benny Antony, PhD, Weiyu Han, PhD, Laura L. Laslett, PhD, Graeme Jones, MD, PhD: Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia.
authors.forename: Xingzhong
authors.initials: X
authors.lastname: Jin
authors.affiliation: Zhaohua Zhu, PhD, Xingzhong Jin, PhD, Benny Antony, PhD, Weiyu Han, PhD, Laura L. Laslett, PhD, Graeme Jones, MD, PhD: Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia.
authors.forename: Benny
authors.initials: B
authors.lastname: Antony
authors.affiliation: Zhaohua Zhu, PhD, Xingzhong Jin, PhD, Benny Antony, PhD, Weiyu Han, PhD, Laura L. Laslett, PhD, Graeme Jones, MD, PhD: Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia.
authors.forename: Weiyu
authors.initials: W
authors.lastname: Han
authors.affiliation: Zhaohua Zhu, PhD, Xingzhong Jin, PhD, Benny Antony, PhD, Weiyu Han, PhD, Laura L. Laslett, PhD, Graeme Jones, MD, PhD: Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia.
authors.forename: Laura L
authors.identifier: 0000-0002-4336-0095
authors.initials: LL
authors.lastname: Laslett
authors.affiliation: Monash University, Melbourne, Victoria, Australia.
authors.forename: Flavia
authors.initials: F
authors.lastname: Cicuttini
authors.affiliation: Zhaohua Zhu, PhD, Xingzhong Jin, PhD, Benny Antony, PhD, Weiyu Han, PhD, Laura L. Laslett, PhD, Graeme Jones, MD, PhD: Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia. g.jones@utas.edu.au.
authors.forename: Graeme
authors.initials: G
authors.lastname: Jones
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018771:Arthralgia / Q000209:etiology / Q000473:pathology*; D001855:Bone Marrow Diseases / Q000150:complications / Q000473:pathology*; D002358:Cartilage, Articular / Q000473:pathology; D005260:Female; D006801:Humans; D007592:Joint Diseases / Q000150:complications / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010147:Pain Measurement; D057071:Patellofemoral Joint / Q000473:pathology*; D011446:Prospective Studies; D013997:Time Factors