An investigation into the patellofemoral joint: improving diagnostics, prognostics and cell-based therapies

Rix, Larissa Dee

Abstract

Abnormalities in the patellofemoral joint (PFJ) may result in a change in the biomechanics of the joint, leading to patellofemoral pain (PFP), patellar instability, chondral lesions, and PFJ osteoarthritis (PFJ OA). This thesis aimed to further understand PFJ pathology, improve diagnosis/treatment, and inform clinical decisions.

Assessment of several patellar alta measurements on magnetic resonance imaging (MRI) showed no correlation between femoral and tibial-based methods, highlighting the need for standardised diagnostic methods. Three-dimensional (3D) gait analysis was assessed as a diagnostic tool for rotational abnormality and may be used alongside computed tomography (CT). A systematic review determined single-photon emission computed tomography (SPECT)/CT for chondral lesion detection to be a valuable diagnostic modality, particularly when MRI cannot be used.

Histological and biochemical assessments of cartilage from total knee replacement (TKR) revealed distinct regional differences in knee cartilage function and gene expression. Thus, caution should be taken when using a ‘one size’ approach to cartilage regeneration therapies.

Synovial fluid (SF) biomarker analyses using enzyme-linked immunosorbent assay (ELISA) demonstrated that lower cartilage oligomeric matrix protein (COMP) concentration and trochlear-treated defects correlated with improved Lysholm scores at 1-year follow-up in PFJ patients from the Autologous Stem Cells, Chondrocytes Or the Two? (ASCOT) trial, leading to optimised patient selection.

A retrospective analysis of PFJ autologous chondrocyte implantation (ACI) outcome identified risk factors to enhance patient selection for the therapy. Younger age, lower body mass index (BMI), and trochlear defects were associated with improved 1-year outcome, while older age and non-smokers correlated with improved long-term results.

Citation

Rix, L. D. (2025). An investigation into the patellofemoral joint: improving diagnostics, prognostics and cell-based therapies. (Thesis). Keele University. https://keele-repository.worktribe.com/output/1279827

• Thesis Type: Thesis
• Online Publication Date: Jun 26, 2025
• Deposit Date: Jun 17, 2025
• Publicly Available Date: Jun 27, 2025
• Public URL: https://keele-repository.worktribe.com/output/1279827
• Award Date: 2025-06