Prevalence of lateral patellofemoral maltracking and associated complications in patients with Osgood Schlatter disease

Abstract

Objective To evaluate adults with history of Osgood Schlatter disease (OSD) for imaging features of lateral patellofemoral maltracking. Methods In a span of four years, 10,181 unique non-contrast knee MRIs were performed on patients aged 20–50. Patients with acute trauma, prior surgery, and synovial pathologies were excluded. 171 exams had imaging findings of OSD, and an age-matched control group of 342 patients without OSD was randomly selected. Two radiologists retrospectively reviewed MRIs for features of lateral patellofemoral maltracking. Maltracking was defined as edema in superolateral Hoffa’s fat or a tibial tuberosity-trochlear groove (TT-TG) distance ≥20 mm with either patellar tilt/translation. Binomial logistic regression identified predictors of maltracking in OSD. Optimal TT-TG distance to indicate maltracking was determined by receiver operating characteristic curve. Results 59% (101/171) of the knees with OSD showed findings of maltracking, with patella alta, trochlear dysplasia, and quadriceps tendinosis as significant predictors of maltracking (p < 0.001). Patellofemoral chondrosis was present in 63% (107/171), with maltracking contributing to higher grade chondrosis more so than increasing age (OR 8.4 versus 1.07). 13 mm was the optimal cut-off TT-TG distance to indicate maltracking (sensitivity 83%, specificity 80%). The prevalence of maltracking in the control group was 15% (p < 0.001 compared with the OSD group). Conclusion Adults with sequelae of OSD are at high risk of maltracking and are likely to develop patellofemoral chondrosis. A lower threshold for identifying maltracking patients, including a lower cut-off TT-TG distance can help identify those at risk. Radiologists should maintain a high index of suspicion for maltracking in adults with OSD to guide clinical intervention.