Prevalence of Patellofemoral Joint Osteoarthritis After Anterior Cruciate Ligament Injury and Associated Risk Factors: A Systematic Review

J Orthop Translat. 2019 Aug 6;22:14-25. doi: 10.1016/ eCollection 2020 May.


Background: The prevalence of patellofemoral joint (PFJ) osteoarthritis (OA) after anterior cruciate ligament (ACL) injury was inconsistently reported in the literature. This review summarises the reported prevalence of PFJ OA and risk factors of PFJ OA after ACL injury.

Methods: PubMed, Embase, WoS, and MEDLINE (OVID) were searched up to 1 March 2019. A modified version of the Coleman methodology score was used to assess the methodological quality of the included studies. Prevalence of PFJ OA was pooled depended on different interventions in ACL injured populations.

Results: Thirty-eight studies were included. Five different radiographic classification methods were used: the Kellgren and Lawrence Grade 2, IKDC Grade B, Fairbank Grade 1, joint space narrowing of Grade 2 based on OARSI, and Ahlbäck Grade 1. One included study used MRI Osteoarthritis Knee Score to evaluate PFJ degenerative changes. The overall prevalence of PFJ OA after ACL injury in included studies varied between 4.5% and 80%. The large variation of PFJ OA prevalence is mainly because of different follow-up period and surgical techniques. The pooled data showed that bone-patellar tendon-bone graft, single-bundle ACL reconstruction (ACLR), and delayed ACLR are likely associated with PFJ degenerative changes after ACL injury. ACLR, delayed ACLR, body mass index (BMI), meniscectomy, patellofemoral chondral lesions, age at surgery, and TFJ OA were identified in the literature inducing PFJ OA after ACL injury.

Conclusions: Large variations of PFJ OA after ACL injury are associated with different follow-up period and surgical techniques. ACL reconstructed population with bone-patellar tendon-bone graft, single-bundle reconstruction, and delayed operation time has a high prevalence of PFJ OA.

The translational potential of this article: This review focuses more on the effect of surgical technique factors on the degenerative changes on PFJ. The results reveal that BPTB, single-bundle reconstruction, and delayed ACLR are more likely associated with PFJ degenerative changes after ACL injury. These findings imply that awareness of PFJ problems after surgical intervention will remind of surgeons taking PFJ into consideration in operations, which is likely to reduce the incidences of anterior knee pain, patellar maltracking, and over-constrained patella in the early stage after surgery.

Keywords: ACL, Anterior Cruciate Ligament; ACLR, Anterior Cruciate Ligament Reconstruction; Anterior cruciate ligament injury; BPTB, Bone-Patellar Tendon-Bone; CI, Confidence Interval; CMS, Coleman methodology score; HS, Hamstring; IKDC, International Knee Documentation Committee; JSN, Joint Space Narrowing; KL, Kellgren and Lawrence; MOAKS, MRI Osteoarthritis Knee Score; OA, Osteoarthritis; OARSI, Osteoarthritis Research Society International; ORs, odd ratios; PFJ, Patellofemoral Joint; Patellofemoral joint osteoarthritis; Prevalence; Risk factors; TFJ, Tibiofemoral Joint.

Publication types

  • Review