Macri Erin M, Crossley Kay M, Hart Harvi F, d'Entremont Agnes G, Forster Bruce B, Ratzlaff Charles R, Wilson David R, Khan Karim M
Department of Family Practice, The University of British Columbia, Vancouver, Canada.
Department of General Practice; Department of Orthopaedics and Sport Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands.
BMJ Open Sport Exerc Med. 2020 Dec 9;6(1):e000877. doi: 10.1136/bmjsem-2020-000877. eCollection 2020.
To explore clinical characteristics in individuals with patellofemoral osteoarthritis (PFOA) compared to individually-matched asymptomatic controls. We also explored associations between functional performance and patient-reported symptoms with patellofemoral alignment.
We assessed 15 individuals with PFOA and 15 individually-matched asymptomatic controls. In addition to physical examination and patient-reported questionnaires, we evaluated functional performance, lower extremity strength and range of motion, and patellar alignment (using MRI). We analysed group differences with Wilcoxon's matched-pairs signed rank tests, and within-group associations with Spearman's rank correlations.
We included 24 (80%) women with median (IQR) age of 56 (9) years and BMI of 22.8 (5.9) kg/m. Individuals with PFOA reported lower quality of life (8/100 points lower EQ-5D-5L, p=0.02), and performed worse on two functional tests: repeated one-leg rises (median 16 fewer rises, p=0.04) and timed stair climb (1.2 s slower, p=0.03). There were no differences in strength tests performed or range of motion. Patellar proximal translation correlated with worse functional performance and worse patient-reported pain, function and self-efficacy, while lateral translation and lateral tilt correlated with worse knee-related quality of life (Spearman's r ranging from 0.5 to 0.7).
Functional performance was worse in individuals with PFOA, despite those individuals having no significant differences on lower extremity strength testing. Patellofemoral alignment was associated with worse functional performance as well as worse patient-reported outcomes, and it may represent one mechanism underpinning PFOA-related symptoms.
探讨髌股关节炎（PFOA）患者相较于个体匹配的无症状对照者的临床特征。我们还探究了功能表现及患者报告的症状与髌股关节对线之间的关联。
我们评估了15例PFOA患者和15例个体匹配的无症状对照者。除体格检查和患者报告问卷外，我们还评估了功能表现、下肢力量和活动范围以及髌骨关节对线（使用MRI）。我们使用Wilcoxon配对符号秩检验分析组间差异，使用Spearman秩相关分析组内关联。
我们纳入了24名（80%）女性，年龄中位数（IQR）为56（9）岁，体重指数为22.8（5.9）kg/m²。PFOA患者报告生活质量较低（EQ-5D-5L低8/100分，p=0.02），并且在两项功能测试中表现较差：重复单腿抬高（中位数少16次，p=0.04）和定时爬楼梯（慢1.2秒，p=0.03）。在力量测试或活动范围方面没有差异。髌骨近端移位与较差的功能表现以及较差的患者报告疼痛、功能和自我效能相关，而外侧移位和外侧倾斜与较差的膝关节相关生活质量相关（Spearman相关系数r范围为0.5至0.7）。
PFOA患者的功能表现较差，尽管这些患者在下肢力量测试中没有显著差异。髌股关节对线与较差的功能表现以及较差的患者报告结局相关，它可能是PFOA相关症状的一种潜在机制。
