Imaging

In many scenarios, imaging such as x-ray and magnetic resonance imaging (MRI) can be useful to diagnose or assess a condition, or ruling out other serious pathologies. However, what does imaging tell us about patellofemoral pain? Should we request MRIs and X-rays for every patient with patellofemoral pain?

In this section, you will find information about the role of imaging in patellofemoral pain. Let’s find out more?

In the 20th century, it was believed that patellofemoral pain was caused by abnormalities of the patellofemoral joint. In 1999, Kannus and colleagues1 conducted a study using MRI to investigate this assumption. Interestingly, they found that patellofemoral pain was not necessarily related with cartilage defects.

Due to the technological development, today it is possible to detect even very small cartilage defects with the use of high-resolution MRI. Based on this rationale, in 2016, Van der Heijden and colleagues2 investigated if structural abnormalities of the patellofemoral joint was associated with patellofemoral pain. Similarly to Kannus 20 years ago, they concluded that structural abnormalities of the patellofemoral joint on MRI are not associated with patellofemoral pain. Additionally, the same structural abnormalities of the patellofemoral joint have been observed both in people with patellofemoral pain and in asymptomatic people.2,3,4

A recent study also indicated that imaging findings do not appear to be related to symptoms in people with patellofemoral pain.5 According to Collins and colleagues,5 pain on prolonged sitting, a common symptom in people with patellofemoral pain, is not associated with patellofemoral alignment, morphology, or structural MRI features of the patellofemoral joint.

It is important to emphasize that scans can be costly for the individual or for the health system. In addition, the evidence cited above reinforces that, except to rule out an important red flag or a differential diagnosis, imaging may not assist health professionals to reach a diagnosis or to treat patellofemoral pain more properly.

Watch the video below with Dr. Erin Macri, answering the most common questions about this topic [COMING SOON]:

Now that you have reviewed everything about imaging in patellofemoral pain, test your knowledge by taking the quiz below.

References

  1. Kannus et al. 1999. An outcome study of chronic patellofemoral pain syndrome. Seven-year follow-up of patients in a randomized, controlled trial.
  2. Van Der Heijden et al. 2016. Structural abnormalities on magnetic resonance imaging in patients with patellofemoral pain: A cross-sectional case-control study. 
  3. Van Der Heijden et al. 2016. No difference on quantitative magnetic resonance imaging in patellofemoral cartilage composition between patients with patellofemoral pain and healthy controls. 
  4. Drew et al. 2016. Which patellofemoral joint imaging features are associated with patellofemoral pain? Systematic review and meta-analysis.
  5. Collins et al. 2021. Patellofemoral alignment, morphology and structural features are not related to sitting pain in individuals with patellofemoral pain.