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470 - THE RELATION OF THREE-DIMENSIONAL PATELLOFEMORAL ALIGNMENT AND MORPHOLOGY TO KNEE PAIN: DATA FROM THE MULTICENTER OSTEOARTHRITIS STUDY
Abstract   Peer reviewed

470 - THE RELATION OF THREE-DIMENSIONAL PATELLOFEMORAL ALIGNMENT AND MORPHOLOGY TO KNEE PAIN: DATA FROM THE MULTICENTER OSTEOARTHRITIS STUDY

Johannes M. Sieberer, Brooke McGinley, Armita Manafzadeh, John A. Lynch, James Torner, Neil Segal, Cora E. Lewis, John P. Fulkerson, David Felson and Joshua Stefanik
Osteoarthritis and cartilage, Vol.34(Supplement), pp.S330-S331
04/2026
DOI: 10.1016/j.joca.2026.01.469

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Abstract

Purpose (the aim of the study): Pain is multi-factorial and risk factors for knee pain are poorly understood. However, it is generally understood that abnormalities in joint morphology and alignment can increase stress across localized joint regions and could be a risk factor for pain. Imaging biomarkers are therefore needed to identify individuals that may be at risk for developing pain so early interventions can target these individuals. The objective of this cross-sectional study is to determine the association of three-dimensional (3D) alignment and morphologic features of the patellofemoral joint to knee pain. Methods: Data from the NIH-funded Multicenter Osteoarthritis Study (MOST) participants aged 45 to 60 years with no or mild osteoarthritis were included. Supine high-resolution knee CTs were segmented to create 3D models of the knee joint. From these models we assessed six measures of patellofemoral alignment and morphology: tibial tubercle to trochlear groove distance (TT-TG), tibiofemoral rotation, patellar tilt (PTA), patellar height, entry point to trochlear groove angle (EP-TG), and entry point to transition point angle (EP-TP) (see Figure 1 and 2). Three different domains of knee pain were assessed: location of knee pain, frequent knee pain (yes/no), and pain with stairs (at least mild vs. no pain). Location of knee pain was divided into: isolated anterior knee pain, anterior plus other knee pain, and only other knee pain. Logistic regression with generalized estimating equations (GEE) were used to evaluate the relation of each feature to knee pain, adjusting for age, sex, and BMI. Association is given as odds ratio (OR) increase per standard deviation of the feature. Results: A total of 410 knees (53% female; mean age: 53.1±4.5 years and BMI 28.3±5.1 kg/m2) were included. Frequent knee pain and pain with stairs was present in 26.3 and 53.6%, respectively. Isolated anterior knee pain, anterior plus other knee pain, only other knee pain, and no knee pain was in present in 16.3, 26.6, 26.8, and 30.2% of knees, respectively. Participants had primarily no to mild osteoarthritis (KL 0: 280 (68.5%), KL 1: 87 (21.3%), and KL≥2: 43 (10.2%)). TT-TG was associated with frequent knee pain and other knee pain; patellar height with isolated anterior knee pain; external tibiofemoral rotation with frequent knee pain; EP-TG with other knee pain; EP-TP with pain with stairs and only other knee pain. Detailed OR and their confidence interval can be found in Table 1. Conclusions: 3D structural features of patellofemoral alignment and morphology were associated with different domains of knee pain. No metric was consistently related to all domains.

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