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J Knee Surg 2016; 29(03): 248-253
DOI: 10.1055/s-0035-1554921
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Incidence and Risk Factors for Chronic Anterior Knee Pain

Nicholas Kusnezov
1   Department of Orthopaedic Surgery and Rehabilitation, William Beaumont Army Medical Center, El Paso, Texas
,
Nathaniel Watts
1   Department of Orthopaedic Surgery and Rehabilitation, William Beaumont Army Medical Center, El Paso, Texas
,
Philip J. Belmont Jr.
1   Department of Orthopaedic Surgery and Rehabilitation, William Beaumont Army Medical Center, El Paso, Texas
,
Justin D. Orr
1   Department of Orthopaedic Surgery and Rehabilitation, William Beaumont Army Medical Center, El Paso, Texas
,
Brian Waterman
1   Department of Orthopaedic Surgery and Rehabilitation, William Beaumont Army Medical Center, El Paso, Texas
› Author Affiliations
Further Information

Publication History

14 December 2014

22 April 2015

Publication Date:
10 July 2015 (online)

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Abstract

Chronic anterior knee pain is a common clinical entity, more so in the active individual. The incidence and risk factors, however remain unexplored. We investigated the correlation of demographic and occupational risk factors as well as the incidence of chronic anterior knee pain in an active military population. We performed a retrospective review of all U. S. Military active duty service members with the diagnosis of chondromalacia patellae, representative of the clinical syndrome of chronic anterior knee pain, between 2006 and 2012 using the Defense Medical Epidemiology Database. The demographic and occupation risk factors were categorized and the subgroup and overall incidence rates were determined via multivariable analysis. A total of 42,040 cases of chondromalacia patellae were identified in an at-risk population of 9,723,449, corresponding to an incidence rate of 4.32 cases per 1,000 person-years. Increasing chronological age, female sex, Black race, junior enlisted rank, and primary ground forces (Marines and Army) significantly correlated with an increased risk for chronic anterior knee pain. This study is the first report of incidence and risk factors for chondromalacia patellae in a large athletic population. We determined that sex, age, race, branch of service, and rank all correlated with the incidence of chondromalacia patellae in an active population.

Keywords

chondromalacia patellae - chronic anterior knee pain - anterior knee pain - active - incidence - risk factor
 

  • References

  • 1 Curl WW, Krome J, Gordon ES, Rushing J, Smith BP, Poehling GG. Cartilage injuries: a review of 31,516 knee arthroscopies. Arthroscopy 1997; 13 (4) 456-460
    CrossrefPubMedGoogle Scholar
  • 2 Franzone JM, Vitale MA, Shubin Stein BE, Ahmad CS. Is there an association between chronicity of patellar instability and patellofemoral cartilage lesions? An arthroscopic assessment of chondral injury. J Knee Surg 2012; 25 (5) 411-416
    Article in Thieme ConnectPubMedGoogle Scholar
  • 3 Pascual-Garrido C, Slabaugh MA, L'Heureux DR, Friel NA, Cole BJ. Recommendations and treatment outcomes for patellofemoral articular cartilage defects with autologous chondrocyte implantation: prospective evaluation at average 4-year follow-up. Am J Sports Med 2009; 37 (Suppl. 01) 33S-41S
    CrossrefPubMedGoogle Scholar
  • 4 Widuchowski W, Widuchowski J, Trzaska T. Articular cartilage defects: study of 25,124 knee arthroscopies. Knee 2007; 14 (3) 177-182
    CrossrefPubMedGoogle Scholar
  • 5 Outerbridge RE. The etiology of chondromalacia patellae. J Bone Joint Surg Br 1961; 43-B: 752-757
    CrossrefPubMedGoogle Scholar
  • 6 Wakitani S, Goto T, Pineda SJ , et al. Mesenchymal cell-based repair of large, full-thickness defects of articular cartilage. J Bone Joint Surg Am 1994; 76 (4) 579-592
    CrossrefPubMedGoogle Scholar
  • 7 Harris JD, Brophy RH, Siston RA, Flanigan DC. Treatment of chondral defects in the athlete's knee. Arthroscopy 2010; 26 (6) 841-852
    CrossrefPubMedGoogle Scholar
  • 8 Mouzopoulos G, Borbon C, Siebold R. Patellar chondral defects: a review of a challenging entity. Knee Surg Sports Traumatol Arthrosc 2011; 19 (12) 1990-2001
    CrossrefPubMedGoogle Scholar
  • 9 Buckwalter JA. Articular cartilage: injuries and potential for healing. J Orthop Sports Phys Ther 1998; 28 (4) 192-202
    CrossrefPubMedGoogle Scholar
  • 10 Drawer S, Fuller CW. Propensity for osteoarthritis and lower limb joint pain in retired professional soccer players. Br J Sports Med 2001; 35 (6) 402-408
    CrossrefPubMedGoogle Scholar
  • 11 Holmes Jr SW. Articular cartilage injuries in the athlete's knee: current concepts in diagnosis and treatment. South Med J 2004; 97 (8) 742-747
    CrossrefPubMedGoogle Scholar
  • 12 Mandelbaum BR, Browne JE, Fu F , et al. Articular cartilage lesions of the knee. Am J Sports Med 1998; 26 (6) 853-861
    PubMedGoogle Scholar
  • 13 Roos H. Are there long-term sequelae from soccer?. Clin Sports Med 1998; 17 (4) 819-831 , viii
    CrossrefPubMedGoogle Scholar
  • 14 Kujala UM, Kettunen J, Paananen H , et al. Knee osteoarthritis in former runners, soccer players, weight lifters, and shooters. Arthritis Rheum 1995; 38 (4) 539-546
    CrossrefPubMedGoogle Scholar
  • 15 Piasecki DP, Spindler KP, Warren TA, Andrish JT, Parker RD. Intraarticular injuries associated with anterior cruciate ligament tear: findings at ligament reconstruction in high school and recreational athletes. An analysis of sex-based differences. Am J Sports Med 2003; 31 (4) 601-605
    CrossrefPubMedGoogle Scholar
  • 16 Carnes J, Stannus O, Cicuttini F, Ding C, Jones G. Knee cartilage defects in a sample of older adults: natural history, clinical significance and factors influencing change over 2.9 years. Osteoarthritis Cartilage 2012; 20 (12) 1541-1547
    CrossrefPubMedGoogle Scholar
  • 17 Ding C, Cicuttini F, Scott F, Cooley H, Jones G. Association between age and knee structural change: a cross sectional MRI based study. Ann Rheum Dis 2005; 64 (4) 549-555
    CrossrefPubMedGoogle Scholar
  • 18 Kuikka PI, Pihlajamäki HK, Mattila VM. Knee injuries related to sports in young adult males during military service - incidence and risk factors. Scand J Med Sci Sports 2013; 23 (3) 281-287
    CrossrefPubMedGoogle Scholar
  • 19 Hsiao M, Owens BD, Burks R, Sturdivant RX, Cameron KL. Incidence of acute traumatic patellar dislocation among active-duty United States military service members. Am J Sports Med 2010; 38 (10) 1997-2004
    CrossrefPubMedGoogle Scholar
  • 20 Orr JD, Dawson LK, Garcia EJ, Kirk KL. Incidence of osteochondral lesions of the talus in the United States military. Foot Ankle Int 2011; 32 (10) 948-954
    CrossrefPubMedGoogle Scholar
  • 21 Scher DL, Belmont Jr PJ, Mountcastle S, Owens BD. The incidence of primary hip osteoarthritis in active duty US military servicemembers. Arthritis Rheum 2009; 61 (4) 468-475
    CrossrefPubMedGoogle Scholar
  • 22 Waterman BR, Cameron KL, Hsiao M, Langston JR, Clark NJ, Owens BD. Trends in the diagnosis of SLAP lesions in the US military. Knee Surg Sports Tramatol Arthrosc 2015; 23 (5) 1453-145
    PubMedGoogle Scholar
  • 23 Waterman BR, Liu J, Newcomb R, Schoenfeld AJ, Orr JD, Belmont Jr PJ. Risk factors for chronic exertional compartment syndrome in a physically active military population. Am J Sports Med 2013; 41 (11) 2545-2549
    CrossrefPubMedGoogle Scholar
  • 24 Roach CJ, Haley CA, Cameron KL, Pallis M, Svoboda SJ, Owens BD. The epidemiology of medial collateral ligament sprains in young athletes. Am J Sports Med 2014; 42 (5) 1103-1109
    CrossrefPubMedGoogle Scholar
  • 25 Wolf JM, Mountcastle S, Burks R, Sturdivant RX, Owens BD. Epidemiology of lateral and medial epicondylitis in a military population. Mil Med 2010; 175 (5) 336-339
    CrossrefPubMedGoogle Scholar
  • 26 Flanigan DC, Harris JD, Trinh TQ, Siston RA, Brophy RH. Prevalence of chondral defects in athletes' knees: a systematic review. Med Sci Sports Exerc 2010; 42 (10) 1795-1801
    CrossrefPubMedGoogle Scholar
  • 27 Hjelle K, Solheim E, Strand T, Muri R, Brittberg M. Articular cartilage defects in 1,000 knee arthroscopies. Arthroscopy 2002; 18 (7) 730-734
    CrossrefPubMedGoogle Scholar
  • 28 Lindberg U, Lysholm J, Gillquist J. The correlation between arthroscopic findings and the patellofemoral pain syndrome. Arthroscopy 1986; 2 (2) 103-107
    CrossrefPubMedGoogle Scholar
  • 29 Arøen A, Løken S, Heir S , et al. Articular cartilage lesions in 993 consecutive knee arthroscopies. Am J Sports Med 2004; 32 (1) 211-215
    CrossrefPubMedGoogle Scholar
  • 30 Widuchowski W, Lukasik P, Kwiatkowski G , et al. Isolated full thickness chondral injuries. Prevalance and outcome of treatment. A retrospective study of 5233 knee arthroscopies. Acta Chir Orthop Traumatol Cech 2008; 75 (5) 382-386
    PubMedGoogle Scholar
  • 31 Zelisko JA, Noble HB, Porter M. A comparison of men's and women's professional basketball injuries. Am J Sports Med 1982; 10 (5) 297-299
    CrossrefPubMedGoogle Scholar
  • 32 Griffin LY, Albohm MJ, Arendt EA , et al. Understanding and preventing noncontact anterior cruciate ligament injuries: a review of the Hunt Valley II meeting, January 2005. Am J Sports Med 2006; 34 (9) 1512-1532
    CrossrefPubMedGoogle Scholar
  • 33 Martin JA, Buckwalter JA. Roles of articular cartilage aging and chondrocyte senescence in the pathogenesis of osteoarthritis. Iowa Orthop J 2001; 21: 1-7
    PubMedGoogle Scholar
  • 34 Jones BH, Canham-Chervak M, Canada S, Mitchener TA, Moore S. Medical surveillance of injuries in the U.S. Military descriptive epidemiology and recommendations for improvement. Am J Prev Med 2010; 38 (1, Suppl): S42-S60
    CrossrefPubMedGoogle Scholar