Skip to main content
SpringerLink
Log in

Magnetic resonance imaging of patellofemoral osteoarthritis: intertester reliability and associations with knee pain and function

  • Original Article
  • Published:
Clinical Rheumatology Aims and scope Submit manuscript

Abstract

Objectives

We examined the intertester reliability of patellofemoral compartment (PFC) osteoarthritis (OA) severity using magnetic resonance images (MRI) and a modified Kellgren and Lawrence (K&L) system. Second, we determined if these grades were associated with clinical tests of PFC involvement or self-reported pain/difficulty with stair climbing. Third, we assessed the association between PFC OA severity and knee pain or disability, after accounting for potential confounders including tibiofemoral OA severity.

Method

We examined the 9-year Osteoarthritis Initiative data from 114 subjects in the year prior to undergoing knee arthroplasty. The weighted kappa (κw) was used to determine intertester reliability, and the Pearson chi-square was used to assess associations among PFC OA scores and clinical tests. Multiple regressions were used to determine independent associations between self-reported pain/function and PFC OA.

Results

Reliability was substantial (κw = 0.73 (SE = 0.05)). Chi-square associations between PFC OA severity and clinical tests were not significant (p > 0.05). Multiple regression models between PFC OA and self-reported pain or function scores were not significant (p > 0.05).

Conclusions

MRI-based measures of PFC OA were highly reliable indicating that musculoskeletal radiologists can reliably grade the PFCs of subjects using MRI. The extent of PFC OA is not associated with either clinical tests of PFC involvement or activities associated with PFC pain in persons with moderate to severe symptomatic tibiofemoral and PFC OA.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Felson DT, Naimark A, Anderson J, Kazis L, Castelli W, Meenan RF (1987) The prevalence of knee osteoarthritis in the elderly. The Framingham osteoarthritis study. Arthritis Rheum 30:914–918. https://doi.org/10.1002/art.1780300811

    Article  CAS  PubMed  Google Scholar 

  2. McAlindon TE, Snow S, Cooper C, Dieppe PA (1992) Radiographic patterns of osteoarthritis of the knee joint in the community: the importance of the patellofemoral joint. Ann Rheum Dis 51:844–849. https://doi.org/10.1136/ard.51.7.844

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Schiphof D, Van Middelkoop M, De Klerk BM et al (2014) Crepitus is a first indication of patellofemoral osteoarthritis (and not of tibiofemoral osteoarthritis). Osteoarthr Cartil 22:631–638. https://doi.org/10.1016/j.joca.2014.02.008

    Article  CAS  Google Scholar 

  4. Lester G (2012) The Osteoarthritis Initiative: a NIH public-private partnership. HSS J 8:62–63. https://doi.org/10.1007/s11420-011-9235-y

    Article  PubMed  Google Scholar 

  5. Riddle DL, Jiranek WA, Hayes CW (2014) Use of a validated algorithm to judge the appropriateness of total knee arthroplasty in the United States: a multicenter longitudinal cohort study. Arthritis Rheumatol 66:2134–2143. https://doi.org/10.1002/art.38685

    Article  PubMed  PubMed Central  Google Scholar 

  6. Kobayashi S, Peduto A, Simic M, Fransen M, Refshauge K, Mah J, Pappas E (2018) Can we have an overall osteoarthritis severity score for the patellofemoral joint using magnetic resonance imaging? Reliability and validity. Clin Rheumatol 37:1091–1098. https://doi.org/10.1007/s10067-017-3888-y

    Article  PubMed  Google Scholar 

  7. Hunter DJ, Guermazi A, Lo GH, Grainger AJ, Conaghan PG, Boudreau RM, Roemer FW (2011) Evolution of semi-quantitative whole joint assessment of knee OA: MOAKS (MRI Osteoarthritis Knee Score). Osteoarthr Cartil 19:990–1002. https://doi.org/10.1016/j.joca.2011.05.004

    Article  CAS  Google Scholar 

  8. Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174

    Article  CAS  PubMed  Google Scholar 

  9. Maricar N, Callaghan MJ, Parkes MJ, Felson DT, O’Neill TW (2016) Interobserver and intraobserver reliability of clinical assessments in knee osteoarthritis. J Rheumatol 43:2171–2178. https://doi.org/10.3899/jrheum.150835

    Article  PubMed  PubMed Central  Google Scholar 

  10. Cibere J, Thorne A, Bellamy N, Greidanus N, Chalmers A, Mahomed N, Shojania K, Kopec J, Esdaile JM (2004) Reliability of the knee examination in osteoarthritis. Arthritis Rheum 50:458–468. https://doi.org/10.1002/art.23310

    Article  PubMed  Google Scholar 

  11. Décary S, Frémont P, Pelletier B, Fallaha M, Belzile S, Martel-Pelletier J, Pelletier JP, Feldman D, Sylvestre MP, Vendittoli PA, Desmeules F (2018) Validity of combining history elements and physical examination tests to diagnose patellofemoral pain. Arch Phys Med Rehabil 99:607–614. https://doi.org/10.1016/j.apmr.2017.10.014

    Article  PubMed  Google Scholar 

  12. Briani RV, Pazzinatto MF, Waiteman MC, de Oliveira Silva D, de Azevedo FM (2018) Association between increase in vertical ground reaction force loading rate and pain level in women with patellofemoral pain after a patellofemoral joint loading protocol. Knee 25:398–405. https://doi.org/10.1016/j.knee.2018.03.009

    Article  PubMed  Google Scholar 

  13. Escobar A, Quintana JM, Arostegui I et al (2003) Development of explicit criteria for total knee replacement. Int J Technol Assess Health Care 19:57–70

    Article  PubMed  Google Scholar 

  14. Kothari M, Guermazi A, von IG et al (2004) Fixed-flexion radiography of the knee provides reproducible joint space width measurements in osteoarthritis. EurRadiol 14:1568–1573

    Google Scholar 

  15. Paradowski PT, Lohmander LS, Englund M (2016) Osteoarthritis of the knee after meniscal resection: long term radiographic evaluation of disease progression. Osteoarthr Cartil 24:794–800. https://doi.org/10.1016/j.joca.2015.12.002

    Article  CAS  Google Scholar 

  16. Parsons C, Fuggle NR, Edwards MH et al (2018) Concordance between clinical and radiographic evaluations of knee osteoarthritis. Aging Clin Exp Res 30:17–25. https://doi.org/10.1007/s40520-017-0847-z

    Article  PubMed  Google Scholar 

  17. Heng HY, Bin Abd Razak HR, Mitra AK (2015) Radiographic grading of the patellofemoral joint is more accurate in skyline compared to lateral views. Ann Transl Med 3:263

    PubMed  PubMed Central  Google Scholar 

  18. Kellgren JH, Lawrence JS (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16:494–502

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Cibere J, Bellamy N, Thorne A, Esdaile JM, McGorm KJ, Chalmers A, Huang S, Peloso P, Shojania K, Singer J, Wong H, Kopec J (2004) Reliability of the knee examination in osteoarthritis: effect of standardization. Arthritis Rheum 50:458–468

    Article  PubMed  Google Scholar 

  20. Katz JN, Chang LC, Sangha O et al (1996) Can comorbidity be measured by questionnaire rather than medical record review? Med Care 34:73–84

    Article  CAS  PubMed  Google Scholar 

  21. Bellamy N (2005) The WOMAC knee and hip osteoarthritis indices: development, validation, globalization and influence on the development of the AUSCAN hand osteoarthritis indices. Clin Exp Rheumatol 23:S148–S153

    CAS  PubMed  Google Scholar 

  22. McConnell S, Kolopack P, Davis AM (2001) The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC): a review of its utility and measurement properties. Arthritis Rheum 45:453–461

    Article  CAS  PubMed  Google Scholar 

  23. Sim J, Wright CC (2005) The kappa statistic in reliability studies: use, interpretation, and sample size requirements. PhysTher 85:257–268

    Google Scholar 

  24. Chapple CM, Nicholson H, Baxter GD, Abbott JH (2011) Patient characteristics that predict progression of knee osteoarthritis: a systematic review of prognostic studies. Arthritis Care Res (Hoboken) 63:1115–1125

    Article  Google Scholar 

  25. Neogi T (2013) The epidemiology and impact of pain in osteoarthritis. Osteoarthr Cartil 21:1145–1153

    Article  CAS  Google Scholar 

  26. Neogi T, Felson D, Niu J, Nevitt M, Lewis CE, Aliabadi P, Sack B, Torner J, Bradley L, Zhang Y (2009) Association between radiographic features of knee osteoarthritis and pain: results from two cohort studies. BMJ 339:b2844

    Article  PubMed  PubMed Central  Google Scholar 

  27. Duncan R, Peat G, Thomas E, Wood L, Hay E, Croft P (2008) How do pain and function vary with compartmental distribution and severity of radiographic knee osteoarthritis? Rheumatology 47:1704–1707. https://doi.org/10.1093/rheumatology/ken339

    Article  CAS  PubMed  Google Scholar 

  28. Szebenyi B, Hollander AP, Dieppe P, Quilty B, Duddy J, Clarke S, Kirwan JR (2006) Associations between pain, function, and radiographic features in osteoarthritis of the knee. Arthritis Rheum 54:230–235. https://doi.org/10.1002/art.21534

    Article  PubMed  Google Scholar 

  29. Tubach F, Ravaud P, Martin-Mola E, Awada H, Bellamy N, Bombardier C, Felson DT, Hajjaj-Hassouni N, Hochberg M, Logeart I, Matucci-Cerinic M, van de Laar M, van der Heijde D, Dougados M (2012) Minimum clinically important improvement and patient acceptable symptom state in pain and function in rheumatoid arthritis, ankylosing spondylitis, chronic back pain, hand osteoarthritis, and hip and knee osteoarthritis: results from a prospective multina. Arthritis Care Res (Hoboken) 64:1699–1707

    Article  CAS  Google Scholar 

  30. Tubach F, Ravaud P, Baron G et al (2005) Evaluation of clinically relevant changes in patient reported outcomes in knee and hip osteoarthritis: the minimal clinically important improvement. Ann Rheum Dis 64:29–33

    Article  CAS  PubMed  Google Scholar 

  31. Danoff JR, Goel R, Sutton R, Maltenfort MG, Austin MS (2018) How much pain is significant? Defining the minimal clinically important difference for the visual analog scale for pain after total joint arthroplasty. J Arthroplast 33:S71–S75. https://doi.org/10.1016/j.arth.2018.02.029

    Article  Google Scholar 

Download references

Role of the funding source

The OAI is a public–private partnership comprised of five contracts funded by the National Institutes of Health. Private funding partners include Merck Research Laboratories; Novartis Pharmaceuticals Corporation, GlaxoSmithKline; and Pfizer, Inc. The authors of the current paper are not part of the OAI investigative team. The funding source played no role in the conduct or reporting of this study.

Funding

The OAI is a public-private partnership comprised of five contracts (N01-AR-2-2258; N01-AR-2-2259; N01-AR-2-2260; N01-AR-2-2261; N01-AR-2-2262) funded by the National Institutes of Health, a branch of the Department of Health and Human Services, and conducted by the OAI Study Investigators. Private funding partners include Merck Research Laboratories; Novartis Pharmaceuticals Corporation, GlaxoSmithKline; and Pfizer, Inc. Private sector funding for the OAI is managed by the Foundation for the National Institutes of Health. This manuscript was prepared using an OAI public use data set and does not necessarily reflect the opinions or views of the OAI investigators, the NIH, or the private funding partners.

Author information

Authors and Affiliations

  1. Departments of Physical Therapy, Orthopaedic Surgery and Rheumatology, Basement, West Hospital, Room B-100, Virginia Commonwealth University, Richmond, VA, 23298-0224, USA

    Daniel L. Riddle

  2. Department of Radiology, Virginia Commonwealth University Health System, Richmond, VA, 23298, USA

    Josephina A. Vossen & Kevin B. Hoover

Authors
  1. Daniel L. Riddle
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Josephina A. Vossen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kevin B. Hoover
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Daniel L. Riddle.

Ethics declarations

The study was approved by the Institutional Review Boards at the following sites: (1) University of Pittsburgh in Pittsburgh, Pennsylvania; (2) University of Maryland in Baltimore, Maryland; (3) Ohio State University in Columbus, Ohio; and (4) Memorial Hospital of Rhode Island, in Pawtucket, Rhode Island. All subjects signed an IRB-approved consent form prior to participation.

Disclosures

None.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Riddle, D.L., Vossen, J.A. & Hoover, K.B. Magnetic resonance imaging of patellofemoral osteoarthritis: intertester reliability and associations with knee pain and function. Clin Rheumatol 38, 1469–1476 (2019). https://doi.org/10.1007/s10067-018-04414-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10067-018-04414-z

Keywords

Search

Navigation