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Kneeling as a risk factor of patellofemoral joint cartilage damage worsening: an exploratory analysis on the Osteoarthritis Initiative

  • Musculoskeletal
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Abstract

Objectives

To determine whether kneeling activity is associated with the MRI measures of patellofemoral (PF) joint cartilage damage worsening in subjects with/without patella alta (PA).

Methods

Baseline and 24-month 3-T MR images and semi-quantitative MRI Osteoarthritis Knee Score (MOAKS) of PF joint of 600 subjects from the FNIH study, a nested study within the Osteoarthritis Initiative (OAI), were extracted. At baseline visit, subjects were asked how many days per week they participated in kneeling activities lasted ≥ 30 min. Insall-Salvati ratio (ISR) (patellar tendon/patellar height) was measured on baseline MRIs by a musculoskeletal radiologist; ISR ≥ 1.3 was considered PA. Regression analysis adjusted for confounding variables was used to assess the impact of kneeling on worsening of MOAKS cartilage over 24 months. The potential moderating effect of PA was evaluated using adjusted regression analysis.

Results

Six hundred subjects (58.8% female, years, BMI = 30.7 ± 4.8 kg/m2) were included; 13.7%, 6.2%, and 5.5% of participants reported 1 day, 2–5 days, and ≥ 6 days of kneeling activities per week. A higher frequency of kneeling activity was associated with the increased risk of MOAKS cartilage score worsening (adjusted OR (95% CI): 2.33 (1.08–5.06)). Stratification analysis showed that only ≥ 6 days/week of kneeling activities was associated with the worsening of MOAKS cartilage scores (2.74 (1.03–7.27)). When we included the presence of PA in regression models, the OR (95% CI) for the association between kneeling and PF cartilage damage will decrease to 1.26 (0.78–2.04), suggesting the potential role of PA as the moderator variable.

Conclusion

Extensive kneeling activity (≥ 6 days/week) may be associated with the MRI-based worsening of PF cartilage damage, specifically in subjects with an underlying patella alta.

Key Points

• Frequent daily kneeling activity is associated with a higher risk of patellofemoral cartilage damage resulting in patellofemoral osteoarthritis.

• The cartilage damage associated with extensive kneeling activity may be worse in subjects with an underlying patella alta (i.e., high-riding patella).

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Abbreviations

BMI:

Body mass index

DMOADs:

Disease-modifying OA drugs

FNIH:

Foundation for the National Institute of Health study participants

JSN:

Joint space narrowing

MOAKS:

MRI Osteoarthritis Knee Score

OAI:

Osteoarthritis Initiative

PA:

Patella alta

PF:

Patellofemoral

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Acknowledgments

The authors would be thankful to participants and staff involved in FNIH and OAI projects. Several grants and direct or in-kind contributions provide the publically available data from the FNIH OA Biomarkers Consortium Project, including AbbVie, Amgen, Arthritis Foundation, Artialis; Bioiberica, BioVendor, DePuy, Flexion Therapeutics, GSK, IBEX, IDS, Merck Serono, Quidel, Rottapharm | Madaus, Sanofi, Stryker, the Pivotal OAI MRI Analyses (POMA) study, NIH HHSN2682010000 21C, and the Osteoarthritis Research Society International. The OAI is a public-private partnership comprised of five contracts (N01-AR-2-2258; N01-AR-2-2259; N01-AR-2-2260; N01-AR-2-2261; N01-AR-2-2262) funded by the National Institutes of Health, a branch of the Department of Health and Human Services, and conducted by the OAI Study Investigators. Private funding partners include Merck Research Laboratories; Novartis Pharmaceuticals Corporation, GlaxoSmithKline; and Pfizer, Inc. Private sector funding for the OAI is managed by the Foundation for the National Institutes of Health. This manuscript was prepared using an OAI public use data set and does not necessarily reflect the opinions or views of the OAI investigators, the NIH, or the private funding partners.

Funding

The authors state that this work has not received any funding.

Author information

Authors and Affiliations

  1. Russell H. Morgan Department of Radiology, Johns Hopkins University, Baltimore, MD, USA

    Arya Haj-Mirzaian, Bahram Mohajer & Shadpour Demehri

  2. Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 N Caroline St, JHOC 5165, Baltimore, MD, 21287, USA

    Arya Haj-Mirzaian

  3. Department of Radiology, Boston University School of Medicine, Boston, MA, USA

    Ali Guermazi & Frank W. Roemer

  4. Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany

    Frank W. Roemer

  5. Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD, USA

    Bashir Zikria

Authors
  1. Arya Haj-Mirzaian
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Corresponding author

Correspondence to Arya Haj-Mirzaian.

Ethics declarations

Guarantor

The scientific guarantor of this publication is Dr. Shadpour Demehri.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in the osteoarthritis initiative (OAI) study.

Written informed consent was not directly required for this study, since we have used the data of OAI study.

Ethical approval

Institutional Review Board approval was obtained.

The study has received ethics board approval by the institutional review board at the University of California, San Francisco (OAI Coordinating Center; Approval Number: 10-00532), and all enrolled subjects gave informed consent.

Study subjects or cohorts overlap

Osteoarthritis Initiative (OAI) is a well-known publicly available dataset. Some study subjects or cohorts have been previously reported in in studies published using the OAI and/or FNIH study.

List of studies on OAI dataset can be found in the online address of https://nda.nih.gov/oai/publications.

Methodology

• retrospective

• case-control

• multicenter study

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Haj-Mirzaian, A., Mohajer, B., Guermazi, A. et al. Kneeling as a risk factor of patellofemoral joint cartilage damage worsening: an exploratory analysis on the Osteoarthritis Initiative. Eur Radiol 31, 2601–2609 (2021). https://doi.org/10.1007/s00330-020-07337-z

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