Firefighters Have a Higher Incidence of Trochlear Chondral Lesions than the Normal Population

Abstract

Background

Firefighters’ knees are subjected to significant dynamic and static forces, resulting in increased knee complaints and a higher relative risk of osteoarthrosis, compared with aged-matched office workers. Firefighters wear or carry a total of 80 to 100 lbs. of gear while performing intensive physical activity.

Purpose/Question

The purpose of this study was to determine whether a central femoral trochlear lesion was observed in firefighters undergoing knee arthroscopy for other diagnoses.

Methods

A retrospective chart review of 159 knees in 146 firefighters undergoing arthroscopy for treatment of acute meniscal injury or anterior cruciate ligament reconstruction over a 14-year period was undertaken. Patient demographics, physical examination results, trochlear lesion size and grade, and firehouse type (engine vs. ladder company) and firefighter position (seniority) were recorded. Comparisons of characteristics in those with and without trochlear lesions were performed.

Results

The average patient age was 42.2 years (range, 27 to 64 years). Ninety-eight knees (62%) had trochlear lesions and 33 knees (51%) had matching patellar lesions. Patients with lesions were older (43.2 vs. 40.5 years). Mean trochlear lesion size was 19.5 ± 13.7 mm by 18.9 ± 12.4 mm. Lesion grade distribution was grade 1 or 2 in 24 knees (24%) and grade 3 or 4 in 67 knees (44%). Trochlear lesion presence was associated with a body mass index of over 30. Current engine company members had more advanced lesions.

Conclusions

A “firefighter’s trochlea” was present in the majority of firefighters undergoing knee arthroscopy. Higher age and longer tenure as a firefighter prior to surgery were associated with more advanced lesions. Firefighters working in engine companies at the time of arthroscopy were at a greater risk of developing low-grade lesions but not high-grade lesions. Firefighters move between ladder and engine companies, thus a definitive association with company type cannot be reached in this retrospective study. This lesion may reflect the increase in patellofemoral biomechanical stresses secondary to the physical demands of the occupation.

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Acknowledgements

We wish to thank Halley Smith for her contributions to the preparation of this manuscript.

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Correspondence to Jacqueline M. Brady MD.

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Conflict of Interest

Jacqueline M. Brady, MD, Haydée C. Brown, MD, Halley Smith, BA, Dana A. Mannor, MD, Anne M. Kelly, MD, and Jo A. Hannafin, MD, PhD, declare that they have no conflicts of interest. Joseph T. Nguyen, MPH, reports receiving support in part from the Clinical Translational Science Center (CTSC), National Center for Advancing Translational Sciences (NCATS), grant no. UL1-RR024996. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding source, NCATS, based in Rockville, MD.

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All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2013.

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Informed consent was waived from all patients for being included in this study.

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Level of Evidence: Prognostic Study: Level IV

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Brady, J.M., Brown, H.C., Nguyen, J.T. et al. Firefighters Have a Higher Incidence of Trochlear Chondral Lesions than the Normal Population. HSS Jrnl 14, 153–158 (2018). https://doi.org/10.1007/s11420-017-9599-8

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Keywords

  • firefighters
  • knee arthroscopy
  • trochlear lesion