Özdemir Meltem, Kavak Rasime Pelin
Department of Radiology, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey.
Indian J Orthop. 2019 Nov-Dec;53(6):682-688. doi: 10.4103/ortho.IJOrtho_655_18.
The aim of this study was to investigate the frequency of chondromalacia patella (CMP) and to evaluate its relation with trochlear morphometric and patellofemoral alignment measurements as well as with edema in superolateral region of Hoffa's fat pad (SHFP) in military recruits with anterior knee pain (AKP).
Knee magnetic resonance imaging examinations of 288 military recruits with AKP were retrospectively evaluated. Patellar cartilage lesions were graded using modified Noyes system. Quantitative measurements of trochlear morphology (sulcus angle, trochlear sulcus depth, and lateral trochlear inclination [LTI]) and patellofemoral alignment (patellar translation [PT], lateral patellofemoral angle (LPA), Insall-Salvati index, and tibial tuberosity-trochlear groove distance) were made. The SHFP region was assessed for the presence of edema. Mean values of measurements in knees with and without CMP and in knees with early and advanced stage CMP were compared.
We found CMP in 169 (58.7%) patients. Patients with CMP demonstrated a significantly greater sulcus angle ( = 0.012), smaller LTI ( = 0.004), greater PT ( = 0.01), smaller LPA ( = 0.036), greater Insall-Salvati ratio ( = 0.034), and higher incidence of SHFP edema ( = 0.001) compared to those without CMP. While none of the measurements were associated with the severity of cartilage damage, the incidence of SHFP edema was significantly correlated with the severity of CMP ( = 0.001).
CMP is a common disorder among military recruits with AKP. Patellofemoral malalignment is an important contributory factor in the development of CMP, and the presence of edema in SHFP may be a strong indicator of underlying severe CMP in this population.
本研究旨在调查髌骨软化症（CMP）的发生率，并评估其与军事新兵前膝痛（AKP）患者的滑车形态测量、髌股关节对线测量以及 Hoffa 脂肪垫（SHFP）上外侧区域水肿之间的关系。
回顾性评估 288 例患有 AKP 的军事新兵的膝关节磁共振成像检查。使用改良的 Noyes 系统对髌软骨损伤进行分级。对滑车形态（沟角、滑车沟深度和外侧滑车倾斜度 [LTI]）和髌股关节对线（髌骨移位 [PT]、外侧髌股角 [LPA]、Insall-Salvati 指数和胫骨结节 - 滑车沟距离）进行定量测量。评估 SHFP 区域是否存在水肿。比较有和没有 CMP 的膝关节以及早期和晚期 CMP 膝关节的测量平均值。
我们在 169 例（58.7%）患者中发现了 CMP。与没有 CMP 的患者相比，患有 CMP 的患者表现出明显更大的沟角（ = 0.012）、更小的 LTI（ = 0.004）、更大的 PT（ = 0.01）、更小的 LPA（ = 0.036）、更大的 Insall-Salvati 比值（ = 0.034）以及更高的 SHFP 水肿发生率（ = 0.001）。虽然没有一项测量与软骨损伤的严重程度相关，但 SHFP 水肿的发生率与 CMP 的严重程度显著相关（ = 0.001）。
CMP 是患有 AKP 的军事新兵中的常见病症。髌股关节排列不齐是 CMP 发生发展的重要促成因素，并且 SHFP 中水肿的存在可能是该人群潜在严重 CMP 的有力指标。
