Lateral displacement, sulcus angle and trochlear angle are associated with early patellofemoral osteoarthritis following anterior cruciate ligament reconstruction

Erin M. Macri; Adam G. Culvenor; Hayden G. Morris; Timothy S. Whitehead; Trevor G. Russell; Karim M. Khan; Kay M. Crossley

doi:10.1007/s00167-017-4571-1

Lateral displacement, sulcus angle and trochlear angle are associated with early patellofemoral osteoarthritis following anterior cruciate ligament reconstruction

Erin M. Macri, Adam G. Culvenor, Hayden G. Morris, Timothy S. Whitehead, Trevor G. Russell, Karim M. Khan, Kay M. Crossley^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

26 Citations (Scopus)

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Abstract

Purpose: Patellofemoral osteoarthritis (PFOA) occurs in approximately half of anterior cruciate ligament (ACL)-injured knees within 10–15 years of trauma. Risk factors for post-traumatic PFOA are poorly understood. Patellofemoral alignment and trochlear morphology may be associated with PFOA following ACL reconstruction (ACLR), and understanding these relationships, particularly early in the post-surgical time period, may guide effective early intervention strategies. In this study, patellofemoral alignment and trochlear morphology were investigated in relation to radiographic features of early PFOA 1-year post-ACLR. Methods: Participants (aged 18–50 years) had undergone ACLR approximately 1 year prior to being assessed. Early PFOA was defined as presence of a definite patellofemoral osteophyte on lateral or skyline radiograph. Sagittal and axial plane alignment and trochlear morphology were estimated using MRI. Using logistic regression, the relationship between alignment or morphology and presence of osteophytes was evaluated. Results: Of 111 participants [age 30 ± 8.5; 41 (37%) women], 19 (17%) had definite osteophytes, only two of whom had had patellofemoral chondral lesions noted intra-operatively. One measure of patellar alignment (bisect offset OR 1.1 [95% confidence interval 1.0, 1.2]) and two measures of trochlear morphology (sulcus angle OR 1.1 [1.0, 1.2], trochlear angle OR 1.2 [1.0, 1.5]) were associated with patellofemoral osteophytes. Conclusions: Patellofemoral malalignment and/or altered trochlear morphology were associated with PFOA 1 year following ACLR compared to individuals post-ACLR without these features. Clarifying the role of alignment and morphology in post-traumatic PFOA may contribute to improving early intervention strategies aimed at secondary prevention. Level of evidence: IV.

Original language	English
Pages (from-to)	2622-2629
Number of pages	8
Journal	Knee Surgery, Sports Traumatology, Arthroscopy
Volume	26
Issue number	9
DOIs	https://doi.org/10.1007/s00167-017-4571-1
Publication status	Published - 1 Sept 2018
Externally published	Yes

Bibliographical note

Funding Information:
Acknowledgements We gratefully acknowledge support for this work, including funding from the Queensland Orthopaedic Physiotherapy Network, a University of Melbourne Research Collaboration grant and a University of British Columbia research grant. E. Macri received funding support from the Australian Endeavour Award Research Fellowship and Vanier Canada Graduate Scholarship (CIHR). A. Culvenor received funding from the European Union Seventh Framework Programme (Grant Agreement Number 607510).

Funding Information:
Funding This work was supported by the Queensland Orthopaedic Physiotherapy Network, a University of Melbourne Research Collaboration grant and a University of British Columbia research grant. E. Macri received funding support from the Australian Endeavour Award Research Fellowship and Vanier Canada Graduate Scholarship (CIHR). A. Culvenor received funding from the European Union Seventh Framework Programme (Grant Agreement Number 607510). Dr. Whitehead reports personal fees from a Smith and Nephew Clinical Fellowship and personal fees from Smith and Nephew speaking engagement, outside the submitted work. Dr. Morris reports personal fees from Oceania Orthopaedics Clinical Fellowship, outside the submitted work.

Publisher Copyright:
© 2017, European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA).

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Lateral displacement, sulcus angle and trochlear angle are associated with early patellofemoral osteoarthritis following anterior cruciate ligament reconstructionFinal published version, 587 KBLicence: CC BY

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Macri, E. M., Culvenor, A. G., Morris, H. G., Whitehead, T. S., Russell, T. G., Khan, K. M., & Crossley, K. M. (2018). Lateral displacement, sulcus angle and trochlear angle are associated with early patellofemoral osteoarthritis following anterior cruciate ligament reconstruction. Knee Surgery, Sports Traumatology, Arthroscopy, 26(9), 2622-2629. https://doi.org/10.1007/s00167-017-4571-1

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abstract = "Purpose: Patellofemoral osteoarthritis (PFOA) occurs in approximately half of anterior cruciate ligament (ACL)-injured knees within 10–15 years of trauma. Risk factors for post-traumatic PFOA are poorly understood. Patellofemoral alignment and trochlear morphology may be associated with PFOA following ACL reconstruction (ACLR), and understanding these relationships, particularly early in the post-surgical time period, may guide effective early intervention strategies. In this study, patellofemoral alignment and trochlear morphology were investigated in relation to radiographic features of early PFOA 1-year post-ACLR. Methods: Participants (aged 18–50 years) had undergone ACLR approximately 1 year prior to being assessed. Early PFOA was defined as presence of a definite patellofemoral osteophyte on lateral or skyline radiograph. Sagittal and axial plane alignment and trochlear morphology were estimated using MRI. Using logistic regression, the relationship between alignment or morphology and presence of osteophytes was evaluated. Results: Of 111 participants [age 30 ± 8.5; 41 (37%) women], 19 (17%) had definite osteophytes, only two of whom had had patellofemoral chondral lesions noted intra-operatively. One measure of patellar alignment (bisect offset OR 1.1 [95% confidence interval 1.0, 1.2]) and two measures of trochlear morphology (sulcus angle OR 1.1 [1.0, 1.2], trochlear angle OR 1.2 [1.0, 1.5]) were associated with patellofemoral osteophytes. Conclusions: Patellofemoral malalignment and/or altered trochlear morphology were associated with PFOA 1 year following ACLR compared to individuals post-ACLR without these features. Clarifying the role of alignment and morphology in post-traumatic PFOA may contribute to improving early intervention strategies aimed at secondary prevention. Level of evidence: IV.",

author = "Macri, {Erin M.} and Culvenor, {Adam G.} and Morris, {Hayden G.} and Whitehead, {Timothy S.} and Russell, {Trevor G.} and Khan, {Karim M.} and Crossley, {Kay M.}",

note = "Funding Information: Acknowledgements We gratefully acknowledge support for this work, including funding from the Queensland Orthopaedic Physiotherapy Network, a University of Melbourne Research Collaboration grant and a University of British Columbia research grant. E. Macri received funding support from the Australian Endeavour Award Research Fellowship and Vanier Canada Graduate Scholarship (CIHR). A. Culvenor received funding from the European Union Seventh Framework Programme (Grant Agreement Number 607510). Funding Information: Funding This work was supported by the Queensland Orthopaedic Physiotherapy Network, a University of Melbourne Research Collaboration grant and a University of British Columbia research grant. E. Macri received funding support from the Australian Endeavour Award Research Fellowship and Vanier Canada Graduate Scholarship (CIHR). A. Culvenor received funding from the European Union Seventh Framework Programme (Grant Agreement Number 607510). Dr. Whitehead reports personal fees from a Smith and Nephew Clinical Fellowship and personal fees from Smith and Nephew speaking engagement, outside the submitted work. Dr. Morris reports personal fees from Oceania Orthopaedics Clinical Fellowship, outside the submitted work. Publisher Copyright: {\textcopyright} 2017, European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA).",

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doi = "10.1007/s00167-017-4571-1",

language = "English",

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Macri, EM, Culvenor, AG, Morris, HG, Whitehead, TS, Russell, TG, Khan, KM & Crossley, KM 2018, 'Lateral displacement, sulcus angle and trochlear angle are associated with early patellofemoral osteoarthritis following anterior cruciate ligament reconstruction', Knee Surgery, Sports Traumatology, Arthroscopy, vol. 26, no. 9, pp. 2622-2629. https://doi.org/10.1007/s00167-017-4571-1

Lateral displacement, sulcus angle and trochlear angle are associated with early patellofemoral osteoarthritis following anterior cruciate ligament reconstruction. / Macri, Erin M.; Culvenor, Adam G.; Morris, Hayden G. et al.
In: Knee Surgery, Sports Traumatology, Arthroscopy, Vol. 26, No. 9, 01.09.2018, p. 2622-2629.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Lateral displacement, sulcus angle and trochlear angle are associated with early patellofemoral osteoarthritis following anterior cruciate ligament reconstruction

AU - Macri, Erin M.

AU - Culvenor, Adam G.

AU - Morris, Hayden G.

AU - Whitehead, Timothy S.

AU - Russell, Trevor G.

AU - Khan, Karim M.

AU - Crossley, Kay M.

N1 - Funding Information: Acknowledgements We gratefully acknowledge support for this work, including funding from the Queensland Orthopaedic Physiotherapy Network, a University of Melbourne Research Collaboration grant and a University of British Columbia research grant. E. Macri received funding support from the Australian Endeavour Award Research Fellowship and Vanier Canada Graduate Scholarship (CIHR). A. Culvenor received funding from the European Union Seventh Framework Programme (Grant Agreement Number 607510). Funding Information: Funding This work was supported by the Queensland Orthopaedic Physiotherapy Network, a University of Melbourne Research Collaboration grant and a University of British Columbia research grant. E. Macri received funding support from the Australian Endeavour Award Research Fellowship and Vanier Canada Graduate Scholarship (CIHR). A. Culvenor received funding from the European Union Seventh Framework Programme (Grant Agreement Number 607510). Dr. Whitehead reports personal fees from a Smith and Nephew Clinical Fellowship and personal fees from Smith and Nephew speaking engagement, outside the submitted work. Dr. Morris reports personal fees from Oceania Orthopaedics Clinical Fellowship, outside the submitted work. Publisher Copyright: © 2017, European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA).

PY - 2018/9/1

Y1 - 2018/9/1

N2 - Purpose: Patellofemoral osteoarthritis (PFOA) occurs in approximately half of anterior cruciate ligament (ACL)-injured knees within 10–15 years of trauma. Risk factors for post-traumatic PFOA are poorly understood. Patellofemoral alignment and trochlear morphology may be associated with PFOA following ACL reconstruction (ACLR), and understanding these relationships, particularly early in the post-surgical time period, may guide effective early intervention strategies. In this study, patellofemoral alignment and trochlear morphology were investigated in relation to radiographic features of early PFOA 1-year post-ACLR. Methods: Participants (aged 18–50 years) had undergone ACLR approximately 1 year prior to being assessed. Early PFOA was defined as presence of a definite patellofemoral osteophyte on lateral or skyline radiograph. Sagittal and axial plane alignment and trochlear morphology were estimated using MRI. Using logistic regression, the relationship between alignment or morphology and presence of osteophytes was evaluated. Results: Of 111 participants [age 30 ± 8.5; 41 (37%) women], 19 (17%) had definite osteophytes, only two of whom had had patellofemoral chondral lesions noted intra-operatively. One measure of patellar alignment (bisect offset OR 1.1 [95% confidence interval 1.0, 1.2]) and two measures of trochlear morphology (sulcus angle OR 1.1 [1.0, 1.2], trochlear angle OR 1.2 [1.0, 1.5]) were associated with patellofemoral osteophytes. Conclusions: Patellofemoral malalignment and/or altered trochlear morphology were associated with PFOA 1 year following ACLR compared to individuals post-ACLR without these features. Clarifying the role of alignment and morphology in post-traumatic PFOA may contribute to improving early intervention strategies aimed at secondary prevention. Level of evidence: IV.

AB - Purpose: Patellofemoral osteoarthritis (PFOA) occurs in approximately half of anterior cruciate ligament (ACL)-injured knees within 10–15 years of trauma. Risk factors for post-traumatic PFOA are poorly understood. Patellofemoral alignment and trochlear morphology may be associated with PFOA following ACL reconstruction (ACLR), and understanding these relationships, particularly early in the post-surgical time period, may guide effective early intervention strategies. In this study, patellofemoral alignment and trochlear morphology were investigated in relation to radiographic features of early PFOA 1-year post-ACLR. Methods: Participants (aged 18–50 years) had undergone ACLR approximately 1 year prior to being assessed. Early PFOA was defined as presence of a definite patellofemoral osteophyte on lateral or skyline radiograph. Sagittal and axial plane alignment and trochlear morphology were estimated using MRI. Using logistic regression, the relationship between alignment or morphology and presence of osteophytes was evaluated. Results: Of 111 participants [age 30 ± 8.5; 41 (37%) women], 19 (17%) had definite osteophytes, only two of whom had had patellofemoral chondral lesions noted intra-operatively. One measure of patellar alignment (bisect offset OR 1.1 [95% confidence interval 1.0, 1.2]) and two measures of trochlear morphology (sulcus angle OR 1.1 [1.0, 1.2], trochlear angle OR 1.2 [1.0, 1.5]) were associated with patellofemoral osteophytes. Conclusions: Patellofemoral malalignment and/or altered trochlear morphology were associated with PFOA 1 year following ACLR compared to individuals post-ACLR without these features. Clarifying the role of alignment and morphology in post-traumatic PFOA may contribute to improving early intervention strategies aimed at secondary prevention. Level of evidence: IV.

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JO - Knee Surgery, Sports Traumatology, Arthroscopy

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ER -

Lateral displacement, sulcus angle and trochlear angle are associated with early patellofemoral osteoarthritis following anterior cruciate ligament reconstruction

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