Department of Orthopedics, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China.
Orthop Surg. 2024 Dec;16(12):3151-3161. doi: 10.1111/os.14271. Epub 2024 Oct 15.
The risk factors for the degeneration of the patellofemoral joint (PFJ) have not been adequately and thoroughly studied. This study aimed to analyze the population distribution characteristics of patients with patellofemoral osteoarthritis (PFOA) and assess the correlation between PFOA and radiological parameters, including patella morphology, PFJ congruity, and patellar alignment. Moreover, the risk factors across various demographic groups were further analyzed.
A retrospective analysis was conducted to examine the population distribution characteristics of PFOA patients from September 2020 to September 2023. Radiological parameters of the PFJ were measured from the anteroposterior and lateral views of knee joint as well as axial view of patella using X-ray imaging and the PACS imaging system at the First Affiliated Hospital of Kunming Medical University. These parameters included patella morphology (patella type, width, thickness, and Wiberg index), PFJ congruity (patella height, Wiberg angle, sulcus angle, and lateral patella angle), and patellofemoral alignment (patella tilt angle, displacement, and lateral patellofemoral angle). PFOA severity was classified according to the Iwano PFJ radiological classification, and its correlation with the aforementioned parameters was examined. Additionally, risk factors for PFOA across different populations were further evaluated.
The study included 1080 patients according to the inclusion and exclusion criteria. Age, female gender, overweight or obesity, and manual workers were significantly associated with PFOA. Moreover, type III patella (OR = 3.03, p < 0.05), greater patella width (OR = 1.12, p = 0.01), sulcus angle (OR = 1.04, p < 0.01), patella tilt angle (OR = 1.13, p < 0.01), and patella displacement (OR = 1.22, p < 0.01) as well as smaller patella thickness (OR = 0.87, p < 0.01), Insall-Salvati index (OR = 0.24, p = 0.04), and lateral patellofemoral angle (OR = 0.93, p = 0.02) were identified as risk factors for PFOA. Furthermore, greater patella thickness (OR = 1.17, p < 0.05) and smaller patella displacement (OR = 0.79, p < 0.01) correlated with higher Kujala patellofemoral scores. Discrepancies in risk factors across different populations were also observed.
Older age, female gender, obesity, manual workers, and specific aberrations in patellofemoral parameters are predictive factors for PFOA. Additionally, greater patella thickness and smaller patella displacement were associated with increased severity of clinical symptoms. Thus, more attention should be paid to the discrepancies that exist in different populations.
髌股关节（PFJ）退变的危险因素尚未得到充分和彻底的研究。本研究旨在分析髌股关节炎（PFOA）患者的人群分布特征，并评估 PFOA 与影像学参数（包括髌骨形态、PFJ 吻合度和髌骨对线）之间的相关性。此外，还进一步分析了不同人群的危险因素。
对 2020 年 9 月至 2023 年 9 月期间在昆明医科大学第一附属医院就诊的 PFOA 患者的人群分布特征进行回顾性分析。使用 X 射线成像和 PACS 成像系统从膝关节的前后位和侧位以及髌骨的轴位测量 PFJ 的影像学参数，包括髌骨形态（髌骨类型、宽度、厚度和 Wiberg 指数）、PFJ 吻合度（髌骨高度、Wiberg 角、滑车角和外侧髌骨角）和髌股对线（髌骨倾斜角、髌骨位移和外侧髌股角）。根据 Iwano PFJ 放射学分类对 PFOA 严重程度进行分类，并检查其与上述参数的相关性。此外，还进一步评估了不同人群中 PFOA 的危险因素。
根据纳入和排除标准，本研究共纳入 1080 例患者。年龄、女性、超重或肥胖和体力劳动者与 PFOA 显著相关。此外，III 型髌骨（OR=3.03，p<0.05）、更大的髌骨宽度（OR=1.12，p=0.01）、滑车角（OR=1.04，p<0.01）、髌骨倾斜角（OR=1.13，p<0.01）和髌骨位移（OR=1.22，p<0.01）以及更小的髌骨厚度（OR=0.87，p<0.01）、Insall-Salvati 指数（OR=0.24，p=0.04）和外侧髌股角（OR=0.93，p=0.02）是 PFOA 的危险因素。此外，更大的髌骨厚度（OR=1.17，p<0.05）和更小的髌骨位移（OR=0.79，p<0.01）与更高的 Kujala 髌股关节评分相关。不同人群的危险因素也存在差异。
年龄较大、女性、肥胖、体力劳动者以及髌股参数的特定异常是 PFOA 的预测因素。此外，更大的髌骨厚度和更小的髌骨位移与临床症状的严重程度增加相关。因此，应更加关注不同人群之间存在的差异。
