Patellar maltracking is prevalent among patellofemoral pain subjects with patella alta: An upright, weightbearing MRI study

Authors

  • Saikat Pal,

    Corresponding author
    1. Department of Bioengineering, Stanford University James H. Clark Center, Room S-331, 318 Campus Drive, Stanford, California
    • Department of Bioengineering, Stanford University James H. Clark Center, Room S-331, 318 Campus Drive, Stanford, California. T: 303-217-3953; F: 650-723-8544
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  • Thor F. Besier,

    1. Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
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  • Gary S. Beaupre,

    1. Bone & Joint Rehabilitation R&D Center, VA Palo Alto Health Care System, Palo Alto, California
    2. Mechanical Engineering Department, Stanford University, Stanford, California
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  • Michael Fredericson,

    1. Department of Orthopaedic Surgery, Stanford University, Stanford, California
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  • Scott L. Delp,

    1. Department of Bioengineering, Stanford University James H. Clark Center, Room S-331, 318 Campus Drive, Stanford, California
    2. Mechanical Engineering Department, Stanford University, Stanford, California
    3. Department of Orthopaedic Surgery, Stanford University, Stanford, California
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  • Garry E. Gold

    1. Department of Bioengineering, Stanford University James H. Clark Center, Room S-331, 318 Campus Drive, Stanford, California
    2. Department of Orthopaedic Surgery, Stanford University, Stanford, California
    3. Department of Radiology, Stanford University, Stanford, California
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Abstract

The purpose of this study is to determine if patellar maltracking is more prevalent among patellofemoral (PF) pain subjects with patella alta compared to subjects with normal patella height. We imaged 37 PF pain and 15 pain free subjects in an open-configuration magnetic resonance imaging scanner while they stood in a weightbearing posture. We measured patella height using the Caton–Deschamps, Blackburne–Peel, Insall–Salvati, Modified Insall–Salvati, and Patellotrochlear indices, and classified the subjects into patella alta and normal patella height groups. We measured patella tilt and bisect offset from oblique-axial plane images, and classified the subjects into maltracking and normal tracking groups. Patellar maltracking was more prevalent among PF pain subjects with patella alta compared to PF pain subjects with normal patella height (two-tailed Fisher's exact test, p < 0.050). Using the Caton–Deschamps index, 67% (8/12) of PF pain subjects with patella alta were maltrackers, whereas only 16% (4/25) of PF pain subjects with normal patella height were maltrackers. Patellofemoral pain subjects classified as maltrackers displayed a greater patella height compared to the pain free and PF pain subjects classified as normal trackers (two-tailed unpaired t-tests with Bonferroni correction, p < 0.017). This study adds to our understanding of PF pain in two ways—(1) we demonstrate that patellar maltracking is more prevalent in PF pain subjects with patella alta compared to subjects with normal patella height; and (2) we show greater patella height in PF pain subjects compared to pain free subjects using four indices commonly used in clinics. © 2012 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 31: 448–457, 2013

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