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• W2329127791 abstract "Purpose: Patellofemoral osteoarthritis (PFOA) has recently been suggested as a possible early stage of knee osteoarthritis (OA). Recent studies have reported a higher prevalence, pain severity and limitation on function in patients with isolated PFOA compared to patients with isolated tibiofemoral OA. It has been proposed that patellofemoral pain (PFF), a common knee condition affecting a large proportion of adolescents and young adults, might be a precursor to PFOA. Both knee conditions share common characteristics in terms of symptoms and biomechanics, though longitudinal evidence is missing. It is hypothesized that alterations in patellofemoral joint mechanics like maltracking, joint laxity and muscular dysfunction lead to pain and ultimately to joint degeneration. This can possibly be explained by a reduction in contact area resulting in increased joint contact stresses and cartilage degeneration. Therefore, joint shape might be the common factor that links PFOA and PFP. The objective of the present study is therefore to strengthen the causal link between PFP and PFOA by investigating the shape of the patella using 2D statistical shape models and compare these to healthy controls. Methods: Subjects were selected from two different data sets: the baseline data from the cohort hip and cohort knee (CHECK) study and a long-term follow up of a randomized clinical trial (RCT) on the effectiveness of exercise therapy in patients with PFP (aged 22–45 years). From the CHECK cohort, a group with radiographic PFOA (aged 44–58 years) and a control group with no signs of knee pain or stiffness (aged 44–58 years) were selected for the present study. Measurements in both studies included a questionnaire and lateral and skyline radiographs. Two separate statistical shape models were created from the skyline and lateral radiographs using the freely available software am_tools, designed by T.F. Cootes. The statistical shape models were constructed using a 30-point model and were restricted to only describe 95% of the total shape variation in our datasets. The models yield sets of independent measures called modes that represent specific shape variants of the patella. A general linear model was used to assess the association between standardized shape modes and the presence of PFOA, PFP and the healthy control subjects. We used a Bonferroni correction for multiple comparisons to assess statistical significant differences between groups. For significant modes a post hoc analysis was done between separate groups, where a P-value <0.05 was set as a statistical significant difference between the groups. Results: The study population consisted of 56 subjects with PFOA (age 54 (2.7), BMI 29(5.1), 89% females), 32 patients with PFP (age 32 (8.5), BMI 23 (3.4), 72% females) and 80 controls (age 52 (3.5), BMI 25 (3.6), 74% female). The skyline shape model showed a significant difference between groups for mode 1, 8 and 10 (P < 0.004). Post hoc analyses revealed significant differences in skyline shape between PFP and both PFOA and healthy control subjects for mode 1 (see Table 1). In addition, significant differences were found between the control subjects and both PFOA and PFP subjects in mode 8. Mode 10 showed a significant difference between the PFOA group compared to both control and PFP groups. The lateral shape model showed significant differences between groups for mode 5 and 7 (P<0.003). Post hoc analysis showed significant differences in lateral patella shape between control subjects and both PFOA and PFP subjects in mode 5. Additionally, mode 7 showed significant shape differences between the PFOA and the PFP group. Conclusions: Two shape variants showed significant differences between healthy control subjects and both PFOA and PFP subjects, but were similar between PFOA and PFP subjects. The first shape aspect indicates that both PFOA and PFP groups have the vertical ledge of the patella positioned more to the lateral side on the posterior side of the patella (Figure 1, skyline mode 8, black) compared to the healthy control group. Additionally, both PFOA and PFP subjects seem to have a rounder inferior-posterior area on their patella (figure 1, lateral mode 5, red) compared to the control subjects. Our results further strengthen the potential link between both impairments.Tabled 1Table 1. Post hoc analysis of standardized modes between separate groups, displaying mean differences (MD) and P-values.Control vs PFOAControl vs PFPPFP vs PFOAMDP-valueMDP-valueMDP-valueSkyline mode 10.22(0.090)2.01(0.000)2.22(0.000)Skyline mode 80.54(0.011)0.56(0.026)0.02(1.000)Skyline mode 100.72(0.000)0.09(1.000)0.64(0.011)Lateral mode 50.58(0.004)0.55(0.025)0.03(1.000)Lateral mode 70.34(0.168)0.43(0.118)0.77(0.002)bolt indicates statistical significant difference (p<0.05). Open table in a new tab bolt indicates statistical significant difference (p<0.05)." @default.
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• W2329127791 date "2016-04-01" @default.
• W2329127791 modified "2023-09-23" @default.
• W2329127791 title "Statistical shape modelling of the patella: Patients with patellofemoral pain and patellofemoral osteoarthritis share similar aberrant shape aspects compared to healthy controls" @default.
• W2329127791 doi "https://doi.org/10.1016/j.joca.2016.01.471" @default.
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