Stefanik J J, Gross K D, Guermazi A, Felson D T, Roemer F W, Zhang Y, Niu J, Segal N A, Lewis C E, Nevitt M, Neogi T
Department of Physical Therapy and Athletic Training, Boston University, Boston, MA, USA.
Department of Physical Therapy, MGHIHP, Boston, MA, USA.
Osteoarthritis Cartilage. 2015 Apr;23(4):565-70. doi: 10.1016/j.joca.2014.12.023. Epub 2015 Jan 7.
To examine the relation of cartilage loss and bone marrow lesions (BMLs) in the medial and lateral patellofemoral joint (PFJ) to knee pain.
We categorized the location of full-thickness cartilage loss and BMLs in the PFJ on knee magnetic resonance imaging (MRIs) from the Multicenter Osteoarthritis (MOST) and Framingham Osteoarthritis (FOA) Studies as no damage, isolated medial, isolated lateral, or both medial and lateral (mixed). We determined the relation of MRI lesions in each PFJ region to prevalent knee pain. Differences in knee pain severity were compared among categories of PFJ full-thickness cartilage loss and BMLs using quantile regression.
In MOST (n = 1137 knees), compared with knees without full-thickness cartilage loss, knees with isolated lateral or mixed PFJ full-thickness cartilage loss had 1.9 (1.3, 2.8) and 1.9 (1.2, 2.9) times the odds of knee pain, respectively, while isolated medial cartilage loss had no association with knee pain. BMLs in both the medial and lateral PFJ had 1.5 (1.1, 2.0) times the odds of knee pain compared with knees without BMLs. Knee pain severity was lowest in knees with isolated medial PFJ cartilage loss or BMLs. In FOA (n = 934 knees), neither isolated medial nor lateral cartilage loss was associated with knee pain, whereas isolated BMLs in either region were associated with pain.
Results were not completely concordant but suggest that knee pain risk and severity is greatest with cartilage loss isolated to (MOST) or inclusive of (MOST and FOA) the lateral PFJ. While BMLs in either the medial or lateral PFJ are related to pain.
研究髌股关节（PFJ）内侧和外侧的软骨损伤及骨髓损伤（BMLs）与膝关节疼痛的关系。
我们将多中心骨关节炎（MOST）和弗雷明汉骨关节炎（FOA）研究中膝关节磁共振成像（MRI）上PFJ全层软骨损伤和BMLs的位置分为无损伤、单纯内侧、单纯外侧或内侧和外侧均有（混合）。我们确定了每个PFJ区域的MRI损伤与膝关节疼痛的关系。使用分位数回归比较PFJ全层软骨损伤和BMLs各分类之间膝关节疼痛严重程度的差异。
在MOST研究（n = 1137例膝关节）中，与无全层软骨损伤的膝关节相比，单纯外侧或混合性PFJ全层软骨损伤的膝关节发生膝关节疼痛的几率分别为1.9（1.3，2.8）倍和1.9（1.2，2.9）倍，而单纯内侧软骨损伤与膝关节疼痛无关。与无BMLs的膝关节相比，PFJ内侧和外侧均有BMLs的膝关节发生膝关节疼痛的几率为1.5（1.1，2.0）倍。单纯PFJ内侧软骨损伤或BMLs的膝关节疼痛严重程度最低。在FOA研究（n = 934例膝关节）中，单纯内侧或外侧软骨损伤均与膝关节疼痛无关，而任一区域的单纯BMLs与疼痛相关。
结果并不完全一致，但表明孤立于外侧PFJ（MOST研究）或包含外侧PFJ（MOST和FOA研究）的软骨损伤时，膝关节疼痛风险和严重程度最高。而PFJ内侧或外侧的BMLs均与疼痛有关。
