Arthritis Res Ther. 2014 Jan 1;16(1):R1.

Association between individual quadriceps muscle volume/enthesis and patello femoral joint cartilage morphology

Hechmi Toumi1*, Thomas M Best2, Marija Mazor1, Raphael Coursier3, Antonio Pinti1 and Eric Lespessailles1

Corresponding author: Hechmi Toumi

Author Affiliations

1.    EA4708 Orleans University, IPROS, CHRO, 1, rue Porte-Madeleine, BP 2439, 45032 Orleans, cedex 1, France

2.    Division of Sports Medicine, Department of Family Medicine, Sports Health and Performance Institute, The Ohio State University, Columbus, OH 43221, USA

3.    Groupement des Hôpitaux de l’Institut Catholique de Lille (GHICL)/Faculté Libre de Médecine, F-59000 Lille, France

4.    Département de traumatologie-orthopédie France, UCLille, Lille, France



Introduction: The aim of this study was to determine the association between individual quadriceps muscle volumes and the quadriceps enthesis structures and cartilage morphology at the patellofemoral joint (PFJ). The aim of the present study was to investigate the impact of individual quadriceps muscles, and their volume ratios, on the quadriceps tendon enthesis/patella structures and the related association with patellofemoral joint (PFJ). OA. Our hypothesis was that changes in patellofemoral joint morphology would correlate with quadriceps muscle volume. Such information will help to clarify the contribution of each individual muscle to the load transferred to the patella and its association with PFJ OA. Our long-term goal is to utilize such information to determine if targeted interventions aimed at the specific muscles can be utilized to mitigate the disabling features of progressive OA of the PFJ.

Methods: We studied 12 cadavers (age 75 ± 5 years). For both legs, individual quadriceps muscles (vastus lateralis (VL), rectus femoris (RF), vastus intermedialis (VI) and vastus medialis (VM)) were dissected and their volumes measured. Cartilage areas at the PFJ were classified using the International Cartilage Repair Society (ICRS) score. Histological sections were evaluated at the quadriceps tendon enthesis (laterally, centrally and medially). Several variables were calculated on the binary images based on two-dimensional analysis. These were apparent bone area (BA) and apparent trabecular thickness (TH). A Spearman rank test was used to determine the strength of correlation between individual quadriceps muscles volume, the structure of the quadriceps tendon enthesis and the ICRS score.

Results: The thickness of calcified fibrocartilage tissue was significantly greater in the central part of the enthesis than both medially (P = 0.03) and laterally (P = 0.04). Uncalcified fibrocartilage was significantly thicker laterally (P = 0.04) and centrally (P = 0.02) than medially. Muscle volume was highest (P <0.05) for the VL, followed by the VI, VM and RF. There was no association between total and individual muscle volumes and ICRS or BA. However, there was a strong positive correlation (r = 0.81) between the VL/VM volume ratio and BA ratio (bone volume at the lateral part divided by bone volume at the medial part). There was a moderate positive correlation between VL/VM and ICRS (r = 0.65) and between ICRS and BA ratio (lateral/medial; r = 0.74).

Conclusions: Our study demonstrates that ICRS scoring is positively correlated with the BA ratio (lateral/medial) and VL/VM. Although the aim of the study was not to investigate if there was any variance between MRI results and similar data obtained directly from sample tissues, the parallel findings obtained in relation to the correlation between VL/VM ratio and OA suggests that the MRI limitations (evaluation of muscle size using CSA instead of muscle volume and not excluding the fat tissue) have no significant effect on the overall correlation between VL/VM ratio and knee OA. To the best of our knowledge, this is the first study which has measured two independent parameters (individual muscle volume and enthesis structure of each individual muscle) to estimate individual quadriceps muscle contribution to the PFJ.

PMID: 24380386

fig1 toumiFig 1: Gross anatomy of the patella and the femoral quadriceps: posterior views.VM, vastus medialis; VI, vatsus intermedialis; VL, vastus lateralis; and P, patella. Dotted lines correspond to the longitudinal cuts which were then continued through the patella itself dividing the patella into medial, central and lateral parts.

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