Skip to main content
SpringerLink
Log in

Chondromalacia Patella among Military Recruits with Anterior Knee Pain: Prevalence and Association with Patellofemoral Malalignment

  • Original Article
  • Published:
Indian Journal of Orthopaedics Aims and scope Submit manuscript

Abstract

Background

The aim of this study was to investigate the frequency of chondromalacia patella (CMP) and to evaluate its relation with trochlear morphometric and patellofemoral alignment measurements as well as with edema in superolateral region of Hoffa’s fat pad (SHFP) in military recruits with anterior knee pain (AKP).

Materials and Methods

Knee magnetic resonance imaging examinations of 288 military recruits with AKP were retrospectively evaluated. Patellar cartilage lesions were graded using modified Noyes system. Quantitative measurements of trochlear morphology (sulcus angle, trochlear sulcus depth, and lateral trochlear inclination [LTI]) and patellofemoral alignment (patellar translation [PT], lateral patellofemoral angle (LPA), Insall-Salvati index, and tibial tuberosity-trochlear groove distance) were made. The SHFP region was assessed for the presence of edema. Mean values of measurements in knees with and without CMP and in knees with early and advanced stage CMP were compared.

Results

We found CMP in 169 (58.7%) patients. Patients with CMP demonstrated a significantly greater sulcus angle (P = 0.012), smaller LTI (P = 0.004), greater PT (P = 0.01), smaller LPA (P = 0.036), greater Insall-Salvati ratio (P = 0.034), and higher incidence of SHFP edema (P = 0.001) compared to those without CMP. While none of the measurements were associated with the severity of cartilage damage, the incidence of SHFP edema was significantly correlated with the severity of CMP (P = 0.001).

Conclusion

CMP is a common disorder among military recruits with AKP. Patellofemoral malalignment is an important contributory factor in the development of CMP, and the presence of edema in SHFP may be a strong indicator of underlying severe CMP in this population.

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

Similar content being viewed by others

References

  1. Powers CM, Bolgla LA, Callaghan MJ, Collins N, Sheehan FT. Patellofemoral pain: Proximal, distal, and local factors, 2nd İnternational Research Retreat. J Orthop Sports Phys Ther 2012;42:A1-54.

    Article  PubMed  Google Scholar 

  2. Sanchis-Alfonso V, Dye SF. How to deal with anterior knee pain in the active young patient. Sports Health 2017;9:346–51.

    Article  PubMed  Google Scholar 

  3. Pihlajamäki HK, Kuikka PI, Leppänen VV, Kiuru MJ, Mattila VM. Reliability of clinical findings and magnetic resonance imaging for the diagnosis of chondromalacia patellae. J Bone Joint Surg Am 2010;92:927–34.

    Article  PubMed  Google Scholar 

  4. Shen J, Qin L, Yao WW, Li M. The significance of magnetic resonance imaging in severe femoral trochlear dysplasia assessment. Exp Ther Med 2017;14:5438–44.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Duran S, Cavusoglu M, Kocadal O, Sakman B. Association between trochlear morphology and chondromalacia patella: An MRI study. Clin Imaging 2017;41:7–10.

    Article  PubMed  Google Scholar 

  6. Miller RH. Knee injuries. In: Canale ST, editor. Campbell’s Operative Orthopaedics. 10th ed. St. Louis, MO: Mosby, Inc.; 2003. p. 2313–9.

    Google Scholar 

  7. Mehl J, Feucht MJ, Bode G, Dovi-Akue D, Südkamp NR Niemeyer P. Association between patellar cartilage defects and patellofemoral geometry: A matched-pair MRI comparison of patients with and without isolated patellar cartilage defects. Knee Surg Sports Traumatol Arthrosc 2016;24:838–46.

    Article  PubMed  Google Scholar 

  8. Sebro R, Weintraub S. Association between lateral patellar osteoarthrosis and knee morphology and alignment in young adults. Clin Radiol 2017;72:793.e11–8.

    Article  CAS  Google Scholar 

  9. Resorlu H, Zateri C, Nusran G, Goksel F, Aylanc N. The relation between chondromalacia patella and meniscal tear and the sulcus angle/trochlear depth ratio as a powerful predictor. J Back Musculoskelet Rehabil 2017;30:603–8.

    Article  PubMed  Google Scholar 

  10. Lu W, Yang J, Chen S, Zhu Y, Zhu C. Abnormal patella height based on Insall-Salvati ratio and its correlation with patellar cartilage lesions: An extremity-dedicated low-field magnetic resonance imaging analysis of 1703 Chinese cases. Scand J Surg 2016;105:197–203.

    Article  CAS  PubMed  Google Scholar 

  11. Thakkar RS, Del Grande F, Wadhwa V, Chalian M, Andreisek G, Carrino JA, et al. Patellar instability: CT and MRI measurements and their correlation with internal derangement findings. Knee Surg Sports Traumatol Arthrosc 2016;24:3021–8.

    Article  PubMed  Google Scholar 

  12. Subhawong TK, Eng J, Carrino JA, Chhabra A. Superolateral Hoffa’s fat pad edema: Association with patellofemoral maltracking and impingement. AJR Am J Roentgenol 2010;195:1367–73.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Dorotka R, Jimenez-Boj E, Kypta A, Kollar B. The patellofemoral pain syndrome in recruits undergoing military training: A prospective 2-year followup study. Mil Med 2003;168:337–40.

    Article  PubMed  Google Scholar 

  14. Wills AK, Ramasamy A, Ewins DJ, Etherington J. The incidence and occupational outcome of overuse anterior knee pain during army recruit training. J R Army Med Corps 2004;150:264–9.

    Article  CAS  PubMed  Google Scholar 

  15. Milgrom C, Finestone A, Eldad A, Shlamkovitch N. Patellofemoral pain caused by overactivity. A prospective study of risk factors in infantry recruits. J Bone Joint Surg Am 1991;73:1041–3.

    Article  CAS  PubMed  Google Scholar 

  16. Gold GE, Chen CA, Koo S, Hargreaves BA, Bangerter NK. Recent advances in MRI of articular cartilage. AJR Am J Roentgenol 2009;193:628–38.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Chhabra A, Subhawong TK, Carrino JA. A systematised MRI approach to evaluating the patellofemoral joint. Skeletal Radiol 2011;40:375–87.

    Article  PubMed  Google Scholar 

  18. Pfirrmann CW, Zanetti M, Romero J, Hodler J. Femoral trochlear dysplasia: MR findings. Radiology 2000;216:858–64.

    Article  CAS  PubMed  Google Scholar 

  19. Mesquita RDT, Lopes PMM, Castro M, Cardoso R, Lisboa/PT, Paranhos-Porto/PT, et al. Patellar Instability- What a Radiologist Should Know! ECR 2014 Poster No:C-2236. DOI: 10.1594/ecr2014/C-2236.

  20. Katchburian MV, Bull AM, Shih YF, Heatley FW, Amis AA. Measurement of patellar tracking: assessment and analysis of the literature. Clin Orthop Relat Res 2003;(412):241–59.

    Article  Google Scholar 

  21. Wilson T. The measurement of patellar alignment in patellofemoral pain syndrome: Are we confusing assumptions with evidence? J Orthop Sports Phys Ther 2007;37:330–41.

    Article  PubMed  Google Scholar 

  22. Miller TT, Staron RB, Feldman F. Patellar height on sagittal MR imaging of the knee. AJR Am J Roentgenol 1996;167:339–41.

    Article  CAS  PubMed  Google Scholar 

  23. Hinckel BB, Gobbi RG, Filho EN, Pécora JR, Camanho GL, Rodrigues MB, et al. Are the osseous and tendinous-cartilaginous tibial tuberosity-trochlear groove distances the same on CT and MRI? Skeletal Radiol 2015;44:1085–93.

    Article  PubMed  Google Scholar 

  24. Wittstein JR, Bartlett EC, Easterbrook J, Byrd JC. Magnetic resonance imaging evaluation of patellofemoral malalignment. Arthroscopy 2006;22:643–9.

    Article  PubMed  Google Scholar 

  25. Smith BE, Selfe J, Thacker D, Hendrick P, Bateman M, Moffatt F, et al. Incidence and prevalence of patellofemoral pain: A systematic review and meta-analysis. PLoS One 2018;13:e0190892.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Zhang H, Kong XQ, Cheng C, Liang MH. A correlative study between prevalence of chondromalacia patellae and sports injury in 4068 students. Chin J Traumatol 2003;6:370–4.

    PubMed  Google Scholar 

  27. Noehren B, Duncan S, Lattermann C. Radiographic parameters associated with lateral patella degeneration in young patients. Knee Surg Sports Traumatol Arthrosc 2012;20:2385–90.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Ali SA, Helmer R, Terk MR. Analysis of the patellofemoral region on MRI: Association of abnormal trochlear morphology with severe cartilage defects. AJR Am J Roentgenol 2010;194:721–7.

    Article  PubMed  Google Scholar 

  29. Mehta K, Wissman R, England E, D’heurle A, Newton K, Kenter K, et al. Superolateral Hoffa’s fat pad edema in collegiate volleyball players. J Comput Assist Tomogr 2015;39:945–50.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology Ziraat Mah, University of Health Sciences, Dişkapı Yıldırım Beyazıt Training and Research Hospital, Şehit Ömer Halisdemir Cad. No: 20, Altidağ, Ankara, Turkey

    Meltem Özdemir & Rasime Pelin Kavak

Authors
  1. Meltem Özdemir
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rasime Pelin Kavak
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Meltem Özdemir.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Özdemir, M., Kavak, R.P. Chondromalacia Patella among Military Recruits with Anterior Knee Pain: Prevalence and Association with Patellofemoral Malalignment. JOIO 53, 682–688 (2019). https://doi.org/10.4103/ortho.IJOrtho_655_18

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.4103/ortho.IJOrtho_655_18

Keywords

Search

Navigation