Erasmus MC, Rotterdam, The Netherlands, and University of Delaware, Newark.
Boston University and Boston Imaging Core Lab, Boston, Massachusetts.
Arthritis Care Res (Hoboken). 2022 Sep;74(9):1533-1540. doi: 10.1002/acr.24604. Epub 2022 Jun 8.
The lack of strong association between knee osteoarthritis (OA) structural features and pain continues to perplex researchers and clinicians. Evaluating the patellofemoral joint in addition to the tibiofemoral joint alone has contributed to explaining this structure-pain discordance, hence justifying a more comprehensive evaluation of whole-knee OA and pain. The present study, therefore, was undertaken to evaluate the association between patellofemoral and tibiofemoral OA features with localized anterior knee pain (AKP) using 2 study designs.
Using cross-sectional data from the Multicenter Osteoarthritis Study, our first approach was a within-person, knee-matched design in which we identified participants with unilateral AKP. We then assessed magnetic resonance imaging (MRI)-derived OA features (cartilage damage, bone marrow lesions [BMLs], osteophytes, and inflammation) in both knees and evaluated the association of patellofemoral and tibiofemoral OA features to unilateral AKP. In our second approach, MRIs from 1 knee per person were scored, and we evaluated the association of OA features to AKP in participants with AKP and participants with no frequent knee pain.
Using the first approach (n = 71, 66% women, mean ± SD age 69 ± 8 years), lateral patellofemoral osteophytes (odds ratio [OR] 5.0 [95% confidence interval (95% CI) 1.7-14.6]), whole-knee joint effusion-synovitis (OR 4.7 [95% CI 1.3-16.2]), and infrapatellar synovitis (OR 2.8 [95% CI 1.0-7.8]) were associated with AKP. Using the second approach (n = 882, 59% women, mean ± SD age 69 ± 7 years), lateral and medial patellofemoral cartilage damage (prevalence ratio [PR] 2.3 [95% CI 1.3-4.0] and PR 1.9 [95% CI 1.1-3.3], respectively) and lateral patellofemoral BMLs (PR 2.6 [95% CI 1.5-4.7]) were associated with AKP.
Patellofemoral but not tibiofemoral joint OA features and inflammation were associated with AKP.
膝关节骨关节炎（OA）结构特征与疼痛之间缺乏强烈关联，这一现象一直困扰着研究人员和临床医生。仅评估胫股关节而不评估髌股关节，有助于解释这种结构-疼痛不匹配现象，因此有必要更全面地评估全膝关节 OA 和疼痛。因此，本研究采用两种研究设计，评估髌股和胫股 OA 特征与局限性前膝痛（AKP）之间的关系。
本研究使用多中心骨关节炎研究的横断面数据，首先采用个体内、膝关节匹配设计，确定单侧 AKP 患者。然后，我们评估了双侧膝关节的磁共振成像（MRI）衍生的 OA 特征（软骨损伤、骨髓病变[BML]、骨赘和炎症），并评估了髌股和胫股 OA 特征与单侧 AKP 的关系。在第二种方法中，对每个人的一只膝关节进行 MRI 评分，并评估 AKP 患者和无频繁膝关节疼痛患者的 OA 特征与 AKP 的关系。
采用第一种方法（n=71，66%为女性，平均年龄 69±8 岁），外侧髌股骨赘（比值比[OR] 5.0[95%置信区间（95%CI）1.7-14.6]）、全膝关节积液-滑膜炎（OR 4.7[95%CI 1.3-16.2]）和髌下滑膜炎（OR 2.8[95%CI 1.0-7.8]）与 AKP 相关。采用第二种方法（n=882，59%为女性，平均年龄 69±7 岁），外侧和内侧髌股软骨损伤（患病率比[PR] 2.3[95%CI 1.3-4.0]和 PR 1.9[95%CI 1.1-3.3]）和外侧髌股 BML（PR 2.6[95%CI 1.5-4.7]）与 AKP 相关。
髌股关节而不是胫股关节 OA 特征和炎症与 AKP 相关。
