Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Skeletal Radiol. 2021 Jul;50(7):1399-1409. doi: 10.1007/s00256-020-03684-6. Epub 2021 Jan 6.
To evaluate adults with history of Osgood Schlatter disease (OSD) for imaging features of lateral patellofemoral maltracking.
In a span of four years, 10,181 unique non-contrast knee MRIs were performed on patients aged 20-50. Patients with acute trauma, prior surgery, and synovial pathologies were excluded. 171 exams had imaging findings of OSD, and an age-matched control group of 342 patients without OSD was randomly selected. Two radiologists retrospectively reviewed MRIs for features of lateral patellofemoral maltracking. Maltracking was defined as edema in superolateral Hoffa's fat or a tibial tuberosity-trochlear groove (TT-TG) distance ≥20 mm with either patellar tilt/translation. Binomial logistic regression identified predictors of maltracking in OSD. Optimal TT-TG distance to indicate maltracking was determined by receiver operating characteristic curve.
59% (101/171) of the knees with OSD showed findings of maltracking, with patella alta, trochlear dysplasia, and quadriceps tendinosis as significant predictors of maltracking (p < 0.001). Patellofemoral chondrosis was present in 63% (107/171), with maltracking contributing to higher grade chondrosis more so than increasing age (OR 8.4 versus 1.07). 13 mm was the optimal cut-off TT-TG distance to indicate maltracking (sensitivity 83%, specificity 80%). The prevalence of maltracking in the control group was 15% (p < 0.001 compared with the OSD group).
Adults with sequelae of OSD are at high risk of maltracking and are likely to develop patellofemoral chondrosis. A lower threshold for identifying maltracking patients, including a lower cut-off TT-TG distance can help identify those at risk. Radiologists should maintain a high index of suspicion for maltracking in adults with OSD to guide clinical intervention.
评估患有 Osgood-Schlatter 病（OSD）的成年人出现外侧髌股轨迹不良的影像学特征。
在四年期间，对年龄在 20-50 岁的患者进行了 10181 次非对比膝关节 MRI 检查。排除了急性创伤、既往手术和滑膜病变的患者。171 例检查发现 OSD 的影像学表现，随机选择了 342 例无 OSD 的年龄匹配对照组。两名放射科医生回顾性地对 MRI 检查外侧髌股轨迹不良的特征进行了评估。轨迹不良定义为外侧 Hoffa 脂肪水肿或胫骨结节滑车沟（TT-TG）距离≥20mm 伴有髌骨倾斜/平移。二项逻辑回归确定了 OSD 中轨迹不良的预测因素。通过受试者工作特征曲线确定 TT-TG 距离的最佳值来指示轨迹不良。
171 例 OSD 膝关节中 59%（101/171）存在轨迹不良的表现，髌骨高位、滑车发育不良和股四头肌肌腱病是轨迹不良的显著预测因素（p<0.001）。171 例 OSD 膝关节中有 63%（107/171）存在髌股关节软骨退变，轨迹不良比年龄增长更能导致更高等级的软骨退变（OR 8.4 比 1.07）。TT-TG 距离 13mm 是指示轨迹不良的最佳截断值（敏感性 83%，特异性 80%）。对照组中轨迹不良的患病率为 15%（与 OSD 组相比，p<0.001）。
患有 OSD 后遗症的成年人发生轨迹不良的风险较高，并且很可能发生髌股关节软骨退变。降低识别轨迹不良患者的阈值，包括降低 TT-TG 距离的截断值，可以帮助识别有风险的患者。放射科医生应在 OSD 成年患者中保持对轨迹不良的高度怀疑，以指导临床干预。
