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Abstract Number: 1104

The Association of Demographic, Modifiable, Structural and Biomechanical Risk Factors with Medial and Lateral Patellofemoral Joint Structural Damage On MRI: The Multicenter Osteoarthritis Study

Joshua J. Stefanik1, Ke Wang2, K. Douglas Gross3, Frank Roemer4, John A. Lynch5, Neil Segal6, Cora E. Lewis7, Michael C. Nevitt8, Ali Guermazi9 and David T. Felson10, 1Clinical Epidemiology, Boston University, Boston, MA, 2Biostatistics, Boston University, Boston, MA, 3Physical Therapy, MGH Institute of Health Professions, Boston, MA, 4Klinikum Augsburg, Augsburg, Germany, 5Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA, 6Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA, 7Preventive Medicine, University of Alabama, Birmingham City, Birmingham, AL, 8Epidemiology & Biostatistics, UCSF (University of California, San Francisco), San Francisco, CA, 9Radiology, Boston University, Boston, MA, 10Boston University, Boston, MA

Meeting: 2012 ACR/ARHP Annual Meeting

Keywords: Osteoarthritis

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Session Information

Title: Osteoarthritis - Clinical Aspects

Session Type: Abstract Submissions (ACR)

Background/Purpose: Past investigations into risk factors for patellofemoral joint (PFJ) osteoarthritis (OA) have been limited by the use of radiography, which is insensitive to identify PFJ OA and have focused on only a few risk factors. MRI offers a unique opportunity to directly visualize tissue damage in the PFJ, and risk factors related to medial PFJ damage, which was recently reported as common (Gross, ARD, 2012), can be distinguished from those related to lateral damage. The purpose of this study is to evaluate the association between PFJ structural damage on MRI with a wide spectrum of risk factors including: demographic, modifiable, structural, and biomechanical factors.

Methods: We analyzed data from the baseline exam of MOST, a NIH-funded cohort study of persons aged 50-79 years with or at risk for knee OA. Knees for this study came from persons with x-ray OA in tibiofemoral joint and/or PFJ. Demographic risk factors included age, sex, and race. Modifiable risk factors included BMI, occupational history, quadriceps strength, and hamstring-quadriceps strength ratio. Structural risk factors included Insall-Salvati ratio (measure of patella alta), lateral trochlear inclination (measure of trochlear morphology), and femur length. Biomechanical risk factors included varus and valgus alignment (from long limb x-rays). Cartilage damage and bone marrow lesions (BMLs) were assessed on MRI using the WORMS scale in 4 regions (medial and lateral patella and trochlea). PFJ structural damage was defined in two ways: 1) full-thickness cartilage loss (WORMS 2.5; ³5 on a 0-6 scale) and 2) full-thickness cartilage loss in addition to a BML (³1 on a 0-3 scale). We examined the cross-sectional association between risk factors and PFJ structural damage using logistic regression with GEE to account for the correlation between regions from the same knee. We performed analyses in the PFJ overall (damage in any of the four regions) and for the medial and lateral PFJ separately.

Results: 1268 regions from 317 knees were studied (mean age 63.5 years, mean BMI 30.5 kg/m2, 67% female). Full-thickness cartilage damage was present in any PFJ region, medial, and lateral in 20%, 16%, and 25% of regions, respectively. The hamstring-quadriceps ratio, Insall-Salvati ratio, and lateral trochlear inclination demonstrated the strongest associations with overall and lateral PFJ damage (see table). Females and older subjects were more likely to have medial but not lateral PFJ damage. Femur length was strongly associated with lateral PFJ damage. Similar results were seen for the PFJ damage definition including a BML.

Conclusion: PFJ structural damage is more strongly related to structural and demographic factors than to modifiable ones. Risk factors may be different for medial and lateral PFJ structural damage. Future studies should evaluate risk factors separately for medial and lateral PFJ damage.

Association between demographic, modifiable, structural, and biomechanical risk factors and full-thickness cartilage damage (WORMS 2.5; ³5) in the PFJ

Any PFJ

Medial PFJ

Lateral PFJ

OR (95% CI)

OR (95% CI)

OR (95% CI)

Demographic risk factors

Age (per 10 years)

1.3 (1.1, 1.7)

1.7 (1.2, 2.4)

1.2 (0.8, 1.8)

Sex (Reference=Male)

1.4 (0.9, 2.1)

2.9 (1.5, 5.6)

0.9 (0.5, 1.7)

Race

Other (Reference)

1.0

1.0

1.0

African American

0.9 (0.4, 1.7)

0.6 (0.2, 1.4)

1.1 (0.4,2.9)

Modifiable risk factors

BMI (per 5 units)

1.1 (0.9, 1.3)

1.2 (0.9, 1.5)

1.0 (0.7, 1.3)

Occupational history

No labor (Reference)

1.0

1.0

1.0

Labor

1.0 (0.6, 1.5)

1.2 (0.7, 2.2)

0.8 (0.4, 1.7)

Other

1.0 (0.6, 1.5)

0.7 (0.4, 1.4)

1.3 (0.7, 2.4)

History of knee injury (Reference=none)

0.4 (0.3, 0.7)

0.4 (0.2, 0.7)

0.4 (0.2, 0.9)

History of knee surgery (Reference=none)

0.8 (0.5, 1.5)

1.0 (0.5, 2.2)

0.6 (0.3, 1.5)

Quadriceps strength

Tertile 1 (Weak)

1.5 (1.0, 2.4)

1.4 (0.7, 2.9)

1.9 (0.9, 3.7)

Tertile 2

1.6 (1.0, 2.4)

1.8 (1.0, 3.4)

1.6 (0.8, 3.2)

Tertile 3 (Reference)

1.0

1.0

1.0

Hamstring-quadriceps strength ratio

Tertile 1 (Reference; Low)

1.0

1.0

1.0

Tertile 2

0.8 (0.5, 1.3)

0.8 (0.5, 1.5)

0.8 (0.4, 1.6)

Tertile 3 (High)

1.8 (1.2, 2.6)

1.1 (0.6, 1.9)

2.9 (1.5, 5.6)

Structural risk factors

Insall-Salvati Ratio

Tertile 1 (Reference)

1.0

1.0

1.0

Tertile 2

1.2 (0.8, 1.8)

1.2 (0.7, 2.1)

1.3 (0.7, 2.6)

Tertile 3 (Patella alta)

1.5 (1.0, 2.4)

1.1 (0.6, 2.0)

2.2 (1.1, 4.1)

Lateral trochlear inclination

Tertile 1 (Flat trochlea)

1.0 (0.6, 1.5)

0.7 (0.4, 1.4)

4.4 (2.1, 9.4)

Tertile 2

1.8 (1.1, 2.7)

0.9 (0.5, 1.7)

1.1 (0.5, 2.2)

Tertile 3 (Reference)

1.0

1.0

1.0

Femur length

Tertile 1 (Reference; Short)

1.0

1.0

1.0

Tertile 2

1.3 (0.9, 2.1)

0.8 (0.5, 1.4)

2.5 (1.2, 5.3)

Tertile 3 (Long)

1.3 (0.8, 2.0)

0.6 (0.3, 1.2)

2.8 (1.3, 6.0)

Biomechanical risk factors

Frontal plane knee alignment

Neutral (Reference)

1.0

1.0

1.0

Valgus

1.5 (0.97, 2.4)

1.1 (0.5, 2.4)

2.2 (1.1, 4.3)

Varus

0.9 (0.6, 1.3)

1.3 (0.7, 2.4)

0.6 (0.3, 1.1)


Disclosure:

J. J. Stefanik,
None;

K. Wang,
None;

K. D. Gross,
None;

F. Roemer,

Boston Imaging Core Lab,

1,

National Institute of Health,

5,

Merck Serono,

5;

J. A. Lynch,
None;

N. Segal,
None;

C. E. Lewis,
None;

M. C. Nevitt,
None;

A. Guermazi,

BICL, LLC,

4,

AstraZeneca, Genzyme, Novartis, and MerckSerono,

5;

D. T. Felson,
None.

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