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Lateral displacement, sulcus angle and trochlear angle are associated with early patellofemoral osteoarthritis following anterior cruciate ligament reconstruction

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Patellofemoral osteoarthritis (PFOA) occurs in approximately half of anterior cruciate ligament (ACL)-injured knees within 10–15 years of trauma. Risk factors for post-traumatic PFOA are poorly understood. Patellofemoral alignment and trochlear morphology may be associated with PFOA following ACL reconstruction (ACLR), and understanding these relationships, particularly early in the post-surgical time period, may guide effective early intervention strategies. In this study, patellofemoral alignment and trochlear morphology were investigated in relation to radiographic features of early PFOA 1-year post-ACLR.

Methods

Participants (aged 18–50 years) had undergone ACLR approximately 1 year prior to being assessed. Early PFOA was defined as presence of a definite patellofemoral osteophyte on lateral or skyline radiograph. Sagittal and axial plane alignment and trochlear morphology were estimated using MRI. Using logistic regression, the relationship between alignment or morphology and presence of osteophytes was evaluated.

Results

Of 111 participants [age 30 ± 8.5; 41 (37%) women], 19 (17%) had definite osteophytes, only two of whom had had patellofemoral chondral lesions noted intra-operatively. One measure of patellar alignment (bisect offset OR 1.1 [95% confidence interval 1.0, 1.2]) and two measures of trochlear morphology (sulcus angle OR 1.1 [1.0, 1.2], trochlear angle OR 1.2 [1.0, 1.5]) were associated with patellofemoral osteophytes.

Conclusions

Patellofemoral malalignment and/or altered trochlear morphology were associated with PFOA 1 year following ACLR compared to individuals post-ACLR without these features. Clarifying the role of alignment and morphology in post-traumatic PFOA may contribute to improving early intervention strategies aimed at secondary prevention.

Level of evidence

IV.

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Abbreviations

3D VISTA:

Three-dimensional volume isotropic turbo spin echo acquisition

ACL:

Anterior cruciate ligament

ACLR:

Anterior cruciate ligament reconstruction

ANOVA:

Analysis of variance

BMI:

Body mass index

CI:

Confidence interval

ICC:

Intra-class correlation coefficients

MRI:

Magnetic resonance imaging

OA:

Osteoarthritis

OR:

Odds ratio

PF:

Patellofemoral

SEM:

Standard error of measure

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Acknowledgements

We gratefully acknowledge support for this work, including funding from the Queensland Orthopaedic Physiotherapy Network, a University of Melbourne Research Collaboration grant and a University of British Columbia research grant. E. Macri received funding support from the Australian Endeavour Award Research Fellowship and Vanier Canada Graduate Scholarship (CIHR). A. Culvenor received funding from the European Union Seventh Framework Programme (Grant Agreement Number 607510).

Authors’ contributions

EM, KC, AG and KK formulated the research question with input from HM and TW. KC, AG, HM, TW developed the original study design, and EM, KC, AG, TR and KK developed the secondary study design. HM and TW completed all surgeries. AG completed data collection. TR developed software program for analysing alignment and morphology and trained EM in software use. KC and AG evaluated X-rays for OA findings. EM and KC developed protocol for analysing alignment and morphology. EM completed alignment and morphology measures. EM did statistical analysis with intellectual input from KC, AG, KK. EM led manuscript writing with intellectual input from all authors. All authors read and approved the final manuscript.

Author information

Authors and Affiliations

  1. Department of Family Practice, Centre for Hip Health and Mobility, University of British Columbia, 2635 Laurel Street, Vancouver, BC, V5Z 1M9, Canada

    Erin M. Macri & Karim M. Khan

  2. Institute of Anatomy, Paracelsus Medical University Salzburg, Strubergasse 21, 5020, Salzburg, Austria

    Adam G. Culvenor

  3. School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, VIC, 3086, Australia

    Adam G. Culvenor & Kay M. Crossley

  4. Park Clinic Orthopaedics, St. Vincent′s Private Hospital, 166 Gipps Street, East Melbourne, VIC, 3002, Australia

    Hayden G. Morris

  5. OrthoSport Victoria, Epworth Healthcare, Level 5, 89 Bridge Road, Richmond, VIC, 3121, Australia

    Timothy S. Whitehead

  6. Department of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, St. Lucia, QLD, 4072, Australia

    Trevor G. Russell

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  1. Erin M. Macri
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Corresponding author

Correspondence to Kay M. Crossley.

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Conflict of interest

The authors declare that they have no conflict of interest.

Funding

This work was supported by the Queensland Orthopaedic Physiotherapy Network, a University of Melbourne Research Collaboration grant and a University of British Columbia research grant. E. Macri received funding support from the Australian Endeavour Award Research Fellowship and Vanier Canada Graduate Scholarship (CIHR). A. Culvenor received funding from the European Union Seventh Framework Programme (Grant Agreement Number 607510). Dr. Whitehead reports personal fees from a Smith and Nephew Clinical Fellowship and personal fees from Smith and Nephew speaking engagement, outside the submitted work. Dr. Morris reports personal fees from Oceania Orthopaedics Clinical Fellowship, outside the submitted work.

Ethical approval

This study was approved by the appropriate ethics committees (The University of Melbourne, ID 1136167, and The University of Queensland, IDs 2012000567 and 2013001448) and have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki.

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Participants provided written informed consent prior to participation.

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Macri, E.M., Culvenor, A.G., Morris, H.G. et al. Lateral displacement, sulcus angle and trochlear angle are associated with early patellofemoral osteoarthritis following anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 26, 2622–2629 (2018). https://doi.org/10.1007/s00167-017-4571-1

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