Background: The origin of patellofemoral pain (PFP) may be associated with the inability of the patellofemoral joint cartilage to absorb and distribute patellofemoral joint forces.
Hypothesis: When compared with a pain-free control group, young active women with PFP will demonstrate differences in their baseline patellar cartilage thickness and transverse (T2) relaxation time, as well as a less adaptive response to an acute bout of joint loading.
Study Design: Controlled laboratory study; Level of evidence, 3.
Methods: Ten women between the ages of 23 to 37 years with PFP and 10 sex-, age-, and activity-matched pain-free controls participated. Quantitative magnetic resonance imaging of the patellofemoral joint was performed at baseline and after participants performed 50 deep knee bends. Differences in baseline cartilage thickness and T2 relaxation time, as well as the postexercise change in patellar cartilage thickness and T2 relaxation time, were compared between groups.
Results: Individuals with PFP demonstrated reductions in baseline cartilage thickness of 14.0% and 14.1% for the lateral patellar facet and total patellar cartilage, respectively. Similarly, individuals with PFP exhibited significantly lower postexercise cartilage thickness change for the lateral patellar facet (2.1% vs 8.9%) and the total patellar cartilage (4.4% vs 10.0%) when compared with the control group. No group differences in baseline or postexercise change in T2 relaxation time were found.
Conclusion: The findings suggest that a baseline reduction in patellar cartilage thickness and a reduced deformational behavior of patellar cartilage following an acute bout of loading are associated with presence of PFP symptoms.
AhmedAMBurkeDLYuA. In-vitro measurement of static pressure distribution in synovial joints: part II. Retropatellar surface. J Biomech Eng. 1983;105(3):226-236.
2.
ArmstrongTBullF. Development of the World Health Organization Global Physical Activity Questionnaire (GPAQ). J Public Health. 2006;14:66-70.
3.
BiedertRMSanchis-AlfonsoV. Sources of anterior knee pain. Clin Sports Med. 2002;21(3):335-347.
CicuttiniFWlukaAWangYStuckeyS. The determinants of change in patella cartilage volume in osteoarthritic knees. J Rheumatol. 2002;29(12):2615-2619.
6.
CicuttiniFMWangYYForbesAWlukaAEGlissonM. Comparison between patella cartilage volume and radiological assessment of the patellofemoral joint. Clin Exp Rheumatol. 2003;21(3):321-326.
7.
CicuttiniFMWlukaAEHankinJStuckeyS. Comparison of patella cartilage volume and radiography in the assessment of longitudinal joint change at the patellofemoral joint. J Rheumatol. 2004;31(7):1369-1372.
8.
DingCGarneroPCicuttiniFScottFCooleyHJonesG. Knee cartilage defects: association with early radiographic osteoarthritis, decreased cartilage volume, increased joint surface area and type II collagen breakdown. Osteoarthritis Cartilage. 2005;13(3):198-205.
9.
DraperCEBesierTFGoldGE. Is cartilage thickness different in young subjects with and without patellofemoral pain?Osteoarthritis Cartilage. 2006;14(9):931-937.
10.
DunnTCLuYJinHRiesMDMajumdarS. T2 relaxation time of cartilage at MR imaging: comparison with severity of knee osteoarthritis. Radiology. 2004;232(2):592-598.
11.
EcksteinFCharlesHCBuckRJ. Accuracy and precision of quantitative assessment of cartilage morphology by magnetic resonance imaging at 3.0T. Arthritis Rheum. 2005;52(10):3132-3136.
12.
EcksteinFFaberSMuhlbauerR. Functional adaptation of human joints to mechanical stimuli. Osteoarthritis Cartilage. 2002;10(1):44-50.
13.
EcksteinFGlaserC. Measuring cartilage morphology with quantitative magnetic resonance imaging. Semin Musculoskelet Radiol. 2004;8(4):329-353.
14.
EcksteinFHudelmaierMPutzR. The effects of exercise on human articular cartilage. J Anat. 2006;208(4):491-512.
15.
EcksteinFLembergerBGratzkeC. In vivo cartilage deformation after different types of activity and its dependence on physical training status. Ann Rheum Dis. 2005;64(2):291-295.
16.
EcksteinFLembergerBStammbergerTEnglmeierKHReiserM. Patellar cartilage deformation in vivo after static versus dynamic loading. J Biomech. 2000;33(7):819-825.
17.
EcksteinFTieschkyMFaberSEnglmeierKHReiserM. Functional analysis of articular cartilage deformation, recovery, and fluid flow following dynamic exercise in vivo. Anat Embryol (Berl). 1999;200(4):419-424.
18.
EcksteinFTieschkyMFaberSC. Effect of physical exercise on cartilage volume and thickness in vivo: MR imaging study. Radiology. 1998;207(1):243-248.
19.
FelsonDTNevittMC. Estrogen and osteoarthritis: how do we explain conflicting study results?Prev Med. 1999;28(5):445-448.
20.
FroimsonMIRatcliffeAGardnerTRMowVC. Differences in patellofemoral joint cartilage material properties and their significance to the etiology of cartilage surface fibrillation. Osteoarthritis Cartilage. 1997;5(6):377-386.
21.
FulkersonJPBuuckDA. Disorders of the Patellofemoral Joint. Philadelphia, PA: Lippincott Williams & Wilkins; 2004.
22.
GoodfellowJHungerfordDSWoodsC. Patello-femoral joint mechanics and pathology: 2. Chondromalacia patellae. J Bone Joint Surg Br. 1976;58(3):291-299.
23.
HannaFTeichtahlAJBellR. The cross-sectional relationship between fortnightly exercise and knee cartilage properties in healthy adult women in midlife. Menopause. 2007;14(5):830-834.
24.
HannaFWlukaAEEbelingPRO’SullivanRDavisSRCicuttiniFM. Determinants of change in patella cartilage volume in healthy subjects. J Rheumatol. 2006;33(8):1658-1661.
25.
HannaFSBellRJDavisSR. Factors affecting patella cartilage and bone in middle-aged women. Arthritis Rheum. 2007;57(2):272-278.
26.
Huber-BetzerHBrownTDMattheckC. Some effects of global joint morphology on local stress aberrations near imprecisely reduced intra-articular fractures. J Biomech. 1990;23(8):811-822.
27.
HudelmaierMGlaserCHoheJ. Age-related changes in the morphology and deformational behavior of knee joint cartilage. Arthritis Rheum. 2001;44(11):2556-2561.
28.
KimYJBonassarLJGrodzinskyAJ. The role of cartilage streaming potential, fluid flow and pressure in the stimulation of chondrocyte biosynthesis during dynamic compression. J Biomech. 1995;28(9):1055-1066.
29.
KujalaUMJaakkolaLHKoskinenSKTaimelaSHurmeMNelimarkkaO. Scoring of patellofemoral disorders. Arthroscopy. 1993;9(2):159-163.
30.
LammentaustaEKivirantaPNissiMJ. T2 relaxation time and delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) of human patellar cartilage at 1.5 T and 9.4 T: Relationships with tissue mechanical properties. J Orthop Res. 2006;24(3):366-374.
31.
LarbreJPDa SilvaJAMooreARJamesITScottDLWilloughbyDA. Cartilage contribution to gender differences in joint disease progression: a study with rat articular cartilage. Clin Exp Rheumatol. 1994;12(4):401-408.
LiGLopezORubashH. Variability of a three-dimensional finite element model constructed using magnetic resonance images of a knee for joint contact stress analysis. J Biomech Eng. 2001;123(4):341-346.
34.
LiessCLusseSKargerNHellerMGluerCC. Detection of changes in cartilage water content using MRI T2-mapping in vivo. Osteoarthritis Cartilage. 2002;10(12):907-913.
35.
LusseSClaassenHGehrkeT. Evaluation of water content by spatially resolved transverse relaxation times of human articular cartilage. Magn Reson Imaging. 2000;18(4):423-430.
36.
MosherTJDardzinskiBJ. Cartilage MRI T2 relaxation time mapping: overview and applications. Semin Musculoskelet Radiol. 2004;8(4):355-368.
37.
MosherTJDardzinskiBJSmithMB. Human articular cartilage: influence of aging and early symptomatic degeneration on the spatial variation of T2–preliminary findings at 3 T. Radiology. 2000;214(1):259-266.
38.
MosherTJSmithHDardzinskiBJSchmithorstVJSmithMB. MR imaging and T2 mapping of femoral cartilage: in vivo determination of the magic angle effect. AJR Am J Roentgenol. 2001;177(3):665-669.
39.
MowVCHolmesMHLaiWM. Fluid transport and mechanical properties of articular cartilage: a review. J Biomech. 1984;17(5):377-394.
40.
NieminenMTToyrasJLaasanenMSSilvennoinenJHelminenHJJurvelinJS. Prediction of biomechanical properties of articular cartilage with quantitative magnetic resonance imaging. J Biomech. 2004;37(3):321-328.
41.
OuterbridgeRE. The etiology of chondromalacia patellae. J Bone Joint Surg Br. 1961;43:752-757.
42.
OuterbridgeREDunlopJA. The problem of chondromalacia patellae. Clin Orthop Relat Res. 1975;110:177-196.
43.
RegatteRRAkellaSVLonnerJHKneelandJBReddyR. T1rho relaxation mapping in human osteoarthritis (OA) cartilage: comparison of T1rho with T2. J Magn Reson Imaging. 2006;23(4):547-553.
44.
ReillyDTMartensM. Experimental analysis of the quadriceps muscle force and patello-femoral joint reaction force for various activities. Acta Orthop Scand. 1972;43(2):126-137.
45.
SahRLKimYJDoongJYGrodzinskyAJPlaasAHSandyJD. Biosynthetic response of cartilage explants to dynamic compression. J Orthop Res. 1989;7(5):619-636.
46.
SimonWH. Scale effects in animal joints: I. Articular cartilage thickness and compressive stress. Arthritis Rheum. 1970;13(3):244-256.
47.
UttingMRDaviesGNewmanJH. Is anterior knee pain a predisposing factor to patellofemoral osteoarthritis?Knee. 2005;12(5):362-365.
48.
WheatonAJBorthakurADodgeGRKneelandJBSchumacherHRReddyR. Sodium magnetic resonance imaging of proteoglycan depletion in an in vivo model of osteoarthritis. Acad Radiol. 2004;11(1):21-28.
49.
WijayaratneSPTeichtahlAJWlukaAE. The determinants of change in patella cartilage volume: a cohort study of healthy middle-aged women. Rheumatology. 2008;47(9):1426-1429.
50.
YellowleyCEJacobsCRLiZZhouZDonahueHJ. Effects of fluid flow on intracellular calcium in bovine articular chondrocytes. Am J Physiol. 1997;273(1, pt 1):C30-C36.
