MRI evaluation of anterior knee pain: predicting response to nonoperative treatment.

Published

Journal Article

OBJECTIVE: Tibial tubercle lateral deviation and patellofemoral chondromalacia are associated with anterior knee pain (AKP). We hypothesized that increased tibial tubercle lateral deviation and patellofemoral chondromalacia on magnetic resonance imaging correlates with the presence of AKP and with failure of nonoperative management. MATERIALS AND METHODS: In this retrospective comparative study, a blinded musculoskeletal radiologist measured tibial tubercle lateral deviation relative to the trochlear groove in 15 controls, 15 physical therapy responders with AKP, and 15 physical therapy nonresponders with AKP. Patellar and trochlear cartilage was assessed for signal abnormality, irregularity, and defects. RESULTS: The mean tibial tubercle lateral deviation in controls, physical therapy responders, and physical therapy nonresponders were 9.32 +/- 0.68, 13.01 +/- 0.82, and 16.07 +/- 1.16 mm, respectively (data are mean +/- standard deviation). The correlation coefficients for tubercle deviation, chondromalacia patellae, and trochlear chondromalacia were 0.51 (P < 0.01), 0.44 (P < 0.01), and 0.28 (P < 0.05), respectively. On analysis of variance, tubercle deviation and chondromalacia patellae contributed significantly to prediction of AKP and response to physical therapy. The presence of chondromalacia patellae and a tubercle deviation greater than 14.6 mm is 100% specific and 67% sensitive with a positive predictive value of 100% and negative predictive value of 75% for failure of nonoperative management. CONCLUSION: Subjects with AKP have more laterally positioned tibial tubercles and are more likely to have patellar chondromalacia. Patients with AKP, chondromalacia patellae, and a tubercle deviation greater than 14.6 mm are unlikely to respond to nonoperative treatment. Knowledge of tibial tubercle lateralization and presence of chondromalacia patellae may assist clinicians in determining patient prognosis and selecting treatment options.

Full Text

Duke Authors

Cited Authors

  • Wittstein, JR; O'Brien, SD; Vinson, EN; Garrett, WE

Published Date

  • September 2009

Published In

Volume / Issue

  • 38 / 9

Start / End Page

  • 895 - 901

PubMed ID

  • 19381628

Pubmed Central ID

  • 19381628

Electronic International Standard Serial Number (EISSN)

  • 1432-2161

Digital Object Identifier (DOI)

  • 10.1007/s00256-009-0698-6

Language

  • eng

Conference Location

  • Germany