Skip to main content
SpringerLink
Log in

Correlation between varus knee malalignment and patellofemoral osteoarthritis

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To evaluate the relationship between patellofemoral osteoarthritis (OA) and varus OA of the knee with a focus on the location of joint space narrowing.

Methods

Eighty-five patients scheduled to undergo total knee arthroplasty caused by varus OA were enrolled in this study. The relationship between patellofemoral OA and varus knee malalignment was elucidated. To determine the alignment of the patellofemoral joint in varus knees, patellar tilt, and the tibial tuberosity–trochlear groove (TT–TG) distance were measured, and patellofemoral OA was classified using computed tomography.

Results

The femorotibial angles in patients with stage II–IV patellofemoral OA were significantly larger than those in patients with stage I patellofemoral OA, and the patellar tilt in patients with stage II–IV patellofemoral OA and the TT–TG distance in patients with stage IV patellofemoral OA were significantly larger than those in patients with stage I patellofemoral OA. The TT–TG distance was strongly correlated with patellar tilt (R 2 = 0.41, P < 0.001). Patellofemoral joint space narrowing was mainly noted at the lateral facet, and it was found on both sides as patellofemoral OA worsened.

Conclusion

Varus knee malalignment was induced by patellofemoral OA, especially at the lateral facet. Patellar tilt and the TT–TG distance are considered critical factors for the severity of patellofemoral OA. Understanding the critical factors for patellofemoral OA in varus knees such as the TT–TG distance and patellar will facilitate the prevention of patellofemoral OA using procedures such as high tibial osteotomy and total knee arthroplasty to correct knee malalignment.

Level of evidence

Retrospective cohort study, Level III.

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
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Beck P, Brown NAT, Greis PE, Burks RT (2007) Patellofemoral contact pressures and lateral patellar translation after medial patellofemoral ligament reconstruction. Am J Sports Med 35:1557–1563

    Article  PubMed  Google Scholar 

  2. Biedert RM, Warnke K (2001) Correlation between the Q angle and the patella position: a clinical and axial computed tomography evaluation. Arch Orthop Trauma Surg 121:346–349

    Article  PubMed  CAS  Google Scholar 

  3. Boyd AD, Ewald FC, Thomas WH, Poss R, Sledge CB (1993) Long-term complications after total knee arthroplasty with or without resurfacing of the patella. J Bone Joint Surg Am 75:674–681

    PubMed  Google Scholar 

  4. Cahue S, Dunlop D, Hayes K, Song J, Torres L, Sharma L (2004) Varus–valgus alignment in the progression of patellofemoral osteoarthritis. Arthritis Rheum 50:2184–2190

    Article  PubMed  Google Scholar 

  5. Caton JH, Dejour D (2010) Tibial tubercle osteotomy in patello-femoral instability and in patellar height abnormality. Int Orthop 34:305–309

    Article  PubMed  PubMed Central  Google Scholar 

  6. Delgado-Martínez AD, Rodríguez-Merchán EC, Ballesteros R, Luna JD (2000) Reproducibility of patellofemoral CT scan measurements. Int Orthop 24:5–8

    Article  PubMed  PubMed Central  Google Scholar 

  7. Dejour H, Walch G, Nove-Josserand L, Guier C (1994) Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc 2:19–26

    Article  PubMed  CAS  Google Scholar 

  8. Diederichs G, Köhlitz T, Kornaropoulos E, Heller MO, Vollnberg B, Scheffler S (2013) Magnetic resonance imaging analysis of rotational alignment in patients with patellar dislocations. Am J Sports Med 41:51–57

    Article  PubMed  Google Scholar 

  9. Drexler M, Dwyer T, Dolkart O, Goldstein Y, Steinberg EL, Chakravertty R, Cameron JC (2013) Tibial rotational osteotomy and distal tuberosity transfer for patella subluxation secondary to excessive external tibial torsion: surgical technique and clinical outcome. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-013-2561-5

    Google Scholar 

  10. Elahi S, Cahue S, Felson DT, Engelman L, Sharma L (2000) The association between varus–valgus alignment and patellofemoral osteoarthritis. Arthritis Rheum 43:1874–1880

    Article  PubMed  CAS  Google Scholar 

  11. Fabbriciani C, Panni AS, Delcogliano A (1992) Role of arthroscopic lateral release in the treatment of patellofemoral disorders. Arthroscopy 8:531–536

    Article  PubMed  CAS  Google Scholar 

  12. Feinleib M, Kannel WB, Garrison RJ, McNamara PM, Castelli WP (1975) The Framingham offspring study. Design and preliminary data. Prev Med 4:518–525

    Article  PubMed  CAS  Google Scholar 

  13. Felson DT, Nevitt MC (2004) Epidemiologic studies for osteoarthritis: new versus conventional study design approaches. Rheum Dis Clin North Am 30:783–797

    Article  PubMed  Google Scholar 

  14. Fulkerson JP, Schutzer SF, Ramsby GR (1987) Computerized tomography of the patellofemoral joint before and after lateral release or realignment. Arthroscopy 3:19–24

    Article  PubMed  CAS  Google Scholar 

  15. Grelsamer RP, Dejour D, Gould J (2008) The pathophysiology of patellofemoral arthritis. Orthop Clin North Am 39:269–274

    Article  PubMed  Google Scholar 

  16. Gross KD, Niu J, Stefanik JJ, Guermazi A, Roemer FW, Sharma L, Nevitt MC, Segal NA, Lewis CE, Felson DT (2012) Breaking the law of valgus: the surprising and unexplained prevalence of medial patellofemoral cartilage damage. Ann Rheum Dis 71:1827–1832

    Article  PubMed  PubMed Central  Google Scholar 

  17. Huberti HH, Hayes WC (1984) Patellofemoral contact pressures. The influence of q-angle and tendofemoral contact. J Bone Joint Surg Am 66:715–724

    PubMed  CAS  Google Scholar 

  18. Iwano T, Kurosawa H, Tokuyama H, Hoshikawa Y (1990) Roentgenographic and clinical findings of patellofemoral osteoarthrosis: with special reference to its relationship to femorotibial osteoarthrosis and etiologic factors. Clin Orthop Relat Res 252:190–197

    PubMed  Google Scholar 

  19. Izadpanah K, Weitzel E, Vicari M, Hennig J, Weigel M, Südkamp NP, Niemeyer P (2013) Influence of knee flexion angle and weight bearing on the tibial tuberosity–trochlear groove (TTTG) distance for evaluation of patellofemoral alignment. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-013-2537-5

    PubMed  Google Scholar 

  20. Karlson EW, Sanchez-Guerrero J, Wright EA, Lew RA, Daltroy LH, Katz JN, Liang MH (1995) A connective tissue disease screening questionnaire for population studies. Ann Epidemiol 5:297–302

    Article  PubMed  CAS  Google Scholar 

  21. Lin YF, Jan MH, Lin DH, Cheng CK (2008) Different effects of femoral and tibial rotation on the different measurements of patella tilting: an axial computed tomography study. J Orthop Surg Res 3:5

    Article  PubMed  PubMed Central  Google Scholar 

  22. McAlindon T, Zhang Y, Hannan M, Naimark A, Weissman B, Castelli W, Felson D (1996) Are risk factors for patellofemoral and tibiofemoral knee osteoarthritis different? J Rheumatol 23:332–337

    PubMed  CAS  Google Scholar 

  23. McWalter EJ, Cibere J, MacIntyre NJ, Nicolaou S, Schulzer M, Wilson DR (2007) Relationship between varus–valgus alignment and patellar kinematics in individuals with knee osteoarthritis. J Bone Joint Surg Am 89:2723–2731

    Article  PubMed  Google Scholar 

  24. Meding JB, Fish MD, Berend ME, Ritter MA, Keating EM (2008) Predicting patellar failure after total knee arthroplasty. Clin Orthop Relat Res 466:2769–2774

    Article  PubMed  PubMed Central  Google Scholar 

  25. Panni AS, Cerciello S, Maffulli N, Di Cesare M, Servien E, Neyret P (2011) Patellar shape can be a predisposing factor in patellar instability. Knee Surg Sports Traumatol Arthrosc 19:663–670

    Article  PubMed  Google Scholar 

  26. Powers CM (2003) The influence of altered lower-extremity kinematics on patellofemoral joint dysfunction: a theoretical perspective. J Orthop Sports Phys Ther 33:639–646

    Article  PubMed  Google Scholar 

  27. Rolston L, Bresch J, Engh G, Franz A, Kreuzer S, Nadaud M, Puri L, Wood D (2007) Bicompartmental knee arthroplasty: a bone-sparing, ligament-sparing, and minimally invasive alternative for active patients. Orthopedics 30:70–73

    PubMed  Google Scholar 

  28. Sharma L, Song J, Felson DT, Cahue S, Shamiyeh E, Dunlop DD (2001) The role of knee alignment in disease progression and functional decline in knee osteoarthritis. JAMA 286:188–195

    Article  PubMed  CAS  Google Scholar 

  29. Stoffel K, Willers C, Korshid O, Kuster M (2007) Patellofemoral contact pressure following high tibial osteotomy: a cadaveric study. Knee Surg Sports Traumatol Arthrosc 15:1094–1100

    Article  PubMed  Google Scholar 

  30. Tetsworth K, Paley D (1994) Malalignment and degenerative arthropathy. Orthop Clin North Am 25:367–377

    PubMed  CAS  Google Scholar 

  31. Yagi T, Sasaki T (1986) Tibial torsion in patients with medial-type osteoarthritic knee. Clin Orthop Relat Res 213:177–182

    PubMed  Google Scholar 

Download references

Conflict of interest

The authors declare that they have no competing interests.

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Osaka, Japan

    Shuhei Otsuki, Mikio Nakajima, Yoshinori Okamoto, Shuhei Oda, Yoshiaki Hoshiyama, Go Iida & Masashi Neo

Authors
  1. Shuhei Otsuki
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mikio Nakajima
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yoshinori Okamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Shuhei Oda
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yoshiaki Hoshiyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Go Iida
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Masashi Neo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shuhei Otsuki.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Otsuki, S., Nakajima, M., Okamoto, Y. et al. Correlation between varus knee malalignment and patellofemoral osteoarthritis. Knee Surg Sports Traumatol Arthrosc 24, 176–181 (2016). https://doi.org/10.1007/s00167-014-3360-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-014-3360-3

Keywords

Search

Navigation