Purpose
To perform patellofemoral joint (PFJ) geometric measurements on knee magnetic resonance
imaging scans and determine their relations with chondral lesions in a multicenter
cohort using deep learning.
Methods
The sagittal tibial tubercle–trochlear groove (sTTTG) distance, tibial tubercle–trochlear
groove distance, trochlear sulcus angle, trochlear depth, Caton-Deschamps Index (CDI),
and flexion angle were measured by use of deep learning–generated segmentations on
a subset of the Osteoarthritis Initiative study with radiologist-graded PFJ cartilage
grades (n = 2,461). Kruskal-Wallis H tests were performed to compare differences in PFJ morphology between subjects without
PFJ osteoarthritis (OA) and those with PFJ OA. PFJ morphology was correlated with
secondary outcomes of mean patellar cartilage thickness and mean patellar cartilage
T2 relaxation time using linear regression models controlling for age, sex, and body
mass index.
Results
A total of 1,626 knees did not have PFJ OA, whereas 835 knees had PFJ OA. Knees without
PFJ OA had an increased (anterior) sTTTG distance (mean ± standard deviation, 11.1
± 12.8 mm) compared with knees with PFJ OA (8.4 ± 12.7 mm) (P < .001), indicating a more posterior tibial tubercle in subjects with PFJ OA. Knees
without PFJ OA had a decreased sulcus angle (127.4° ± 7.1° vs 128.0° ± 8.4°, P = .01) and increased trochlear depth (9.1 ± 1.7 mm vs 9.0 ± 2.0 mm, P = .03) compared with knees with PFJ OA. Decreased patellar cartilage thickness was
associated with decreased trochlear depth (β = 0.12, P = .002) and increased CDI (β = –0.07, P < .001). Increased patellar cartilage T2 relaxation time was correlated with decreased
sTTTG distance (β = –0.08, P = .01), decreased sulcus angle (β = –0.12, P = .04), and decreased CDI (β = –0.12, P < .001).
Conclusions
PFJ OA, patellar cartilage thickness, and patellar cartilage T2 relaxation time were
shown to be associated with the underlying geometries within the PFJ. This large longitudinal
study highlights that a decreased sTTTG distance (i.e., a more posterior tibial tubercle)
is significantly associated with PFJ degenerative cartilage change.
Level of Evidence
Level III, retrospective comparative prognostic trial.
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Article info
Publication history
Published online: December 26, 2022
Accepted:
November 30,
2022
Received:
June 23,
2022
Footnotes
See commentary on page 1502
The authors report the following potential conflicts of interest or sources of funding: D.A.L. receives educational payments from Arthrex, Evolution Surgical, and Vericel, outside the submitted work. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
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© 2022 by the Arthroscopy Association of North America
