Adolescents and adults with patellofemoral pain exhibit distinct patellar maltracking patterns

Aricia Shen; Barry P Boden; Camila Grant; Victor R Carlson; Katharine E Alter; Frances T Sheehan

doi:10.1016/j.clinbiomech.2021.105481

Adolescents and adults with patellofemoral pain exhibit distinct patellar maltracking patterns

Clin Biomech (Bristol, Avon). 2021 Dec:90:105481. doi: 10.1016/j.clinbiomech.2021.105481. Epub 2021 Sep 10.

Authors

Aricia Shen¹, Barry P Boden², Camila Grant³, Victor R Carlson¹, Katharine E Alter⁴, Frances T Sheehan⁵

Affiliations

¹ Department of Rehabilitation Medicine, NIH, Bethesda, MD, USA.
² The Orthopaedic Center, Rockville, MD, USA. Electronic address: bboden@starpower.net.
³ Department of Rehabilitation Medicine, NIH, Bethesda, MD, USA. Electronic address: camila.grant@nih.gov.
⁴ Department of Rehabilitation Medicine, NIH, Bethesda, MD, USA. Electronic address: kalter@nih.gov.
⁵ Department of Rehabilitation Medicine, NIH, Bethesda, MD, USA. Electronic address: gavellif@cc.nih.gov.

Abstract

Background: Chronic idiopathic patellofemoral pain is associated with patellar maltracking in both adolescents and adults. To accurately target the underlying, patient-specific etiology, it is crucial we understand if age-of-pain-onset influences maltracking.

Methods: Twenty adolescents (13.9 ± 1.4 years) and 20 adults (28.1 ± 4.9 years) female patients with idiopathic patellofemoral pain (age-of-pain-onset: < 14 and > 18 years of age, respectively) formed the patient cohort. Twenty adolescents and 20 adults (matched for gender, age, and body mass index) formed the control cohort. We captured three-dimensional patellofemoral kinematics during knee flexion-extension using dynamic MRI. Patellar maltracking (deviation in patient-specific patellofemoral kinematics, relative to their respective age-controlled mean values) was the primary outcome measure, which was compared between individuals with adolescent-onset and adult-onset patellofemoral pain using ANOVA and discriminant analysis.

Findings: The female adolescent-onset patellofemoral pain cohort demonstrated increased lateral (P = 0.032), superior (P = 0.007), and posterior (P < 0.001) maltracking, with increased patellar flexion (P < 0.001) and medial spin (P = 0.002), relative to the adult-onset patellofemoral pain cohort. Post-hoc analyses revealed increased lateral shift [mean difference ± 95% confidence interval = -2.9 ± 2.1 mm at 10° knee angle], posterior shift [-2.8 ± 2.1 mm, -3.3 ± 2.3 mm & -3.1 ± 2.4 mm at 10°, 20°& 30°], with greater patellar flexion [3.8 ± 2.6 mm & 5.0 ± 2.8 mm, at 20°& 30°] and medial spin [-2.2 ± 1.7 mm & -3.4 ± 2.3 mm at 20°& 30°]. Axial-plane maltracking accurately differentiated the patient age-of-pain-onset (60-75%, P < 0.001).

Interpretation: Age-of-pain-onset influences the maltracking patterns seen in patients with patellofemoral pain; with all, but 1, degree of freedom being unique in the adolescent-onset-patellofemoral pain cohort. Clinical awareness of this distinction is crucial for correctly diagnosing a patient's pain etiology and optimizing interventional strategies.

Keywords: Child; Kinematics; Knee; Magnetic resonance imaging; Patellar maltracking; Patellofemoral pain syndrome; Pediatric; patella.

Publication types

Research Support, N.I.H., Intramural
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Biomechanical Phenomena
Female
Humans
Knee Joint / diagnostic imaging
Patella / diagnostic imaging
Patellofemoral Joint* / diagnostic imaging
Patellofemoral Pain Syndrome* / diagnostic imaging
Range of Motion, Articular

Abstract

Publication types

MeSH terms

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