Elsevier

The Knee

Volume 12, Issue 5, October 2005, Pages 362-365
The Knee

Is anterior knee pain a predisposing factor to patellofemoral osteoarthritis?

https://doi.org/10.1016/j.knee.2004.12.006Get rights and content

Abstract

Adolescent anterior knee pain has traditionally been described as running a benign and self-limiting course. Studies more recently have questioned this supposition. This study aimed to assess how many patients who had undergone patellofemoral arthroplasty for isolated patellofemoral arthritis had previously suffered from adolescent anterior knee pain, knee instability and trauma. This group was then compared to a control group of medial unicompartmental arthroplasty patients. Both groups were surveyed by postal questionnaire, with a >75% response rate from each group. 22% of the patellofemoral arthroplasty group described adolescent or early adulthood anterior knee pain as compared to 6% in the medial unicompartmental arthroplasty group (p<0.001). Patients in the patellofemoral group had also suffered significantly more patellofemoral instability and trauma than the medial unicompartmental group (p<0.001 and p=0.02, respectively).

A significant number of patients with patellofemoral arthritis have described preceding anterior knee pain in their adolescence and early adult years, raising the question as to whether anterior knee pain may be one of the contributing factors to patellofemoral osteoarthritis in later years.

Introduction

Adolescent anterior knee pain has traditionally been considered a benign self-limiting disease with no long-term sequelae [1]. Few studies have charted the natural history of idiopathic anterior knee pain, but Nimon et al. [2] in a 20 year follow up study have shown one in four patients continuing to have significant symptoms over this period of time. They were however unable to identify any factors predicting those patients in whom symptoms would persist. Stathopulu and Baildam in a shorter follow up of 22 anterior knee pain patients between 4 and 18 years after their initial presentation found 91% still having knee pain of varying frequency and intensity although 45% were later diagnosed with other arthritic conditions [3]. These studies may suggest that anterior knee pain main not be the benign entity that it is traditionally considered.

In middle aged and elderly patients with anterior knee pain, patellofemoral arthritis is a relatively commonly encountered problem, with 13.6% women and 15.4% of men greater than 60 years of age having radiological evidence of isolated patellofemoral arthritis [4], [5]. As yet, no causal link has been identified between idiopathic adolescent anterior knee pain and patellofemoral osteoarthritis. The aim of this study was to examine this possible link by means of a comparative study of two patients groups, one who had undergone patellofemoral arthroplasty for isolated patellofemoral arthritis, and a control group who had undergone medial unicompartmental arthroplasty for isolated medial compartment arthritis. Both groups were surveyed as to whether they had suffered with anterior knee pain, knee injury and patellar instability.

Section snippets

Patients and methods

150 patients who had undergone isolated patellofemoral arthroplasty were identified from the Bristol Knee Arthroplasty Database. The criteria for the operation included severe patellofemoral osteoarthritis and an absence of changes in the tibiofemoral compartment. These patients were assessed for precipitating factors and particularly for a history of anterior knee pain. Each patient was sent a postal questionnaire relating to their past experiences of patellofemoral problems. The questionnaire

Results

Almost 80% of both groups returned their questionnaire. The demographic data for the two groups were similar (Table 1). Mean age at operation was similar for both groups. The number of patellofemoral arthroplasty patients who had suffered with adolescent anterior knee pain (22%) was much higher than in the medial unicompartmental arthroplasty group (6%). This difference was statistically significant (p<0.001).

Patients who underwent isolated patellofemoral replacement recalled suffering from

Discussion

A significant number of patients who have isolated patellofemoral arthritis suffered with anterior knee pain in their adolescent or early adult life and many report having symptoms 20 years prior to their arthroplasty thus suggesting that the problem has been more or less continuous throughout their life and that adolescent anterior knee pain or “chondromalacia patellae” may have lead to isolated patellofemoral osteoarthritis. Ficat has described in his classification of chondromalacia patellae

Acknowledgements

We would like to thank Sue Miller for her help in running the Bristol knee database and sending out the questionnaires and Dr. Paul Ewings for providing statistical expertise.

References (7)

  • A.J. Price et al.

    Chronic traumatic anterior knee pain

    Injury

    (2000)
  • J.N. Insall

    Surgery of the knee

    (1984)
  • G. Nimon et al.

    Natural history of anterior knee pain: a 14–20 year follow-up of nonoperative treatment

    J. Pediatr. Orthop.

    (1998)
There are more references available in the full text version of this article.

Cited by (166)

  • Exploring overweight and obesity beyond body mass index: A body composition analysis in people with and without patellofemoral pain

    2023, Journal of Sport and Health Science
    Citation Excerpt :

    Nevertheless, this finding is particularly important because increased body fat may be related not only to increased loads in patellofemoral joint74 but also to systemic changes (e.g., adipokines produced by adipose tissue may impact the patella cartilage metabolism and contribute to cartilage degradation).9,75 PFP has been suggested as a precursor to patellofemoral osteoarthritis,22–25 and obesity seems to have an impact on the pathogenesis of patellofemoral osteoarthritis.7 Therefore, increased body fat could indicate that women with PFP may be at greater risk of developing osteoarthritis than men.76

View all citing articles on Scopus
View full text