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Patellofemoral morphology measurements and their associations with tibiofemoral osteoarthritis-related structural damage: exploratory analysis on the osteoarthritis initiative

  • Musculoskeletal
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Abstract

Objectives

Given the coexistence and possible interactions between patellofemoral and tibiofemoral compartments, roles of patellofemoral morphology measurements in tibiofemoral osteoarthritis (OA) have not been investigated extensively. We aimed to determine whether patellofemoral morphology is associated with the presence and longitudinal worsening of tibiofemoral OA in participants of the Osteoarthritis Initiative (OAI).

Methods

Baseline knee MRIs of 600 participants were read by two independent blinded observers in consensus to determine patellofemoral morphology measurements including tibial tuberosity to trochlear groove (TT–TG) distance, trochlear groove depth (TGD), lateral patellar tilt (LPT), and Insall–Salvati ratio (ISR). Radiographic and MRI OA knee scoring (MOAKS) measurements were extracted from baseline and 2-year follow-up readings. Associations between baseline patellofemoral morphology metrics with radiographic medial tibiofemoral compartment (MTFC) joint space loss (> 0.7 mm, between baseline and 2nd–4th-year readings), and MRI-derived cartilage damage, bone marrow lesions (BMLs), and osteophytes (baseline to 2 years), were investigated using regression models adjusted for age, sex, body mass index, and knee alignment. P values were corrected using the Benjamini–Hochberg procedure.

Results

Patellofemoral morphology measurements were not associated with longitudinal joint space loss in the MTFC or MOAKS determinants. Only TT–TG distance was associated with the baseline number of subregions with cartilage defects (OR (95% CI), 1.09 (1.04–1.14), corrected p value ≤ 0.01), BMLs (OR (95% CI), 1.1 (1.04–1.17), corrected p value = 0.01), and osteophytes (OR (95% CI), 1.09 (1.05–1.14), corrected p value ≤ 0.01) in the lateral tibiofemoral compartment (LTFC), and worsening of LTFC cartilage defects over 2 years (OR (95% CI), 1.09 (1.03–1.16), corrected p value = 0.02).

Conclusions

Higher TT–TG distance was associated with concurrent MRI-derived OA-related structural damages and 2-year follow-up worsening only in LTFC. No associations were detected between patellofemoral morphology measurements and MTFC OA progression.

Key Points

• Of all patellofemoral morphology measurements, the only lateralization of the tibial tubercle may be considered as a risk factor for lateral (not medial) tibiofemoral osteoarthritis worsening.

• Patellofemoral morphology measurements of patella alta, trochlear dysplasia, patellar tilt, and lateralization of the tibial tubercle are not associated with radiographic and MRI-based medial tibiofemoral osteoarthritis worsening over 2 years.

• Using longitudinal MRI data, each millimeter increase of TT–TG distance is associated with a 9% (95% confidence interval, 3–16%) increase in odds of longitudinal cartilage defects in the lateral tibiofemoral (but not medial) compartment over 2 years.

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Abbreviations

BMI:

Body mass index

BMLs:

Bone marrow lesions

FNIH:

Foundation for the National Institutes of Health

ISR:

Insall–Salvati ratio

IW:

Intermediate-weighted

JSL:

Joint space loss

KL:

Kellgren–Lawrence

LPT:

Lateral patellar tilt

LTFC:

Lateral tibiofemoral compartment

MOAKS:

MRI osteoarthritis knee scoring

MTFC:

Medial tibiofemoral compartment

OA:

Osteoarthritis

OAI:

Osteoarthritis Initiative

PF:

Patellofemoral

TF:

Tibiofemoral

TGD:

Trochlear groove depth

TSE:

Turbo spin-echo

TT–TG:

Tibial tuberosity to trochlear groove

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Acknowledgments

The OAI project is a partnership between public and private sectors, including five contracts (N01-AR-2-2258, N01-AR-2-2259, N01-AR-2-2260, N01-AR-2-2261, and N01-AR-2-2262), which is conducted by investigators of the OAI study and is financially supported by the National Institutes of Health (NIH). Private funding partners are Merck Research Laboratories, Novartis Pharmaceuticals Corporation, GlaxoSmithKline, and Pfizer, Inc. The FNIH is the manager of financial support of the private sectors. In preparing this manuscript, OAI publicly available datasets were used, and the results of this work do not necessarily reflect the opinions of the OAI investigators, the NIH, or the private funding partners.

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.

Funding

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

Author information

Authors and Affiliations

  1. Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 N Caroline St, JHOC 4240, Baltimore, MD, 21287, USA

    Arya Haj-Mirzaian & Shadpour Demehri

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

    Ali Guermazi & Frank W. Roemer

  3. Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Science Institute, Tehran University of Medical Sciences, Tehran, Iran

    Farhad Pishgar

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

    Frank W. Roemer

  5. Department of Radiology, University of Massachusetts Medical School, Boston, MA, USA

    Christopher Sereni

  6. Department of Radiology, Florida Hospital, Maitland, FL, USA

    Michael Hakky

  7. Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Bashir Zikria

Authors
  1. Arya Haj-Mirzaian
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Corresponding author

Correspondence to Arya Haj-Mirzaian.

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Guarantor

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

Conflict of interest

AG received funding for consultation from MerckSerono, AstraZeneca, Genzyme, OrthoTrophix, and TissueGene, and as a shareholder and the president and from Boston Imaging Core Lab (BICL). FWR received funding from BICL as a shareholder and chief executive officer (CEO). SD received funding from Toshiba Medical Systems for consultation, and grants for a cone-beam computed tomographic clinical trial from GERRAF, and Carestream Health. The other authors declare that they did not have any competing interests. None of the authors had any competing interests that could influence the results of this work.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was not required for this study because we used open-access OAI database. All enrolled subjects in the OAI study gave informed consent.

Ethical approval

Institutional Review Board approval was not required because we used an open-access OAI database. The OAI 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).

Study subjects or cohorts overlap

Some study subjects or cohorts have been previously reported in the OAI database and OAI-related articles.

Methodology

• Prospective

• Observational/case–control

• Multicenter study

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Haj-Mirzaian, A., Guermazi, A., Pishgar, F. et al. Patellofemoral morphology measurements and their associations with tibiofemoral osteoarthritis-related structural damage: exploratory analysis on the osteoarthritis initiative. Eur Radiol 30, 128–140 (2020). https://doi.org/10.1007/s00330-019-06324-3

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