Combining advanced computational and imaging techniques as a quantitative tool to estimate patellofemoral joint stress during downhill gait: A feasibility study

Background: The onset and progression of patellofemoral osteoarthritis (OA) has been linked to alterations in cartilage stress—a potential precursor to pain and subsequent cartilage degradation. A lack in quantitative tools for objectively evaluating patellofemoral joint contact stress limits our understanding of pathomechanics associated with OA. Research question: Could computational modeling and biplane fluoroscopy techniques be used to discriminate in-vivo, subject-specific patellofemoral stress profiles in individuals with and without patellofemoral OA? Methods: The current study employed a discrete element modeling framework driven by in-vivo, subject-specific kinematics during downhill gait to discriminate unique patellofemoral stress profiles in individuals with patellofemoral OA (n = 5) as compared to older individuals without OA (n = 6). All participants underwent biplane fluoroscopy kinematic tracking while walking on a declined instrumented treadmill. Subject-specific kinematics were combined with high resolution geometrical models to estimate patellofemoral joint contact stress during 0%, 25 %, 50 %, 75 % and 100 % of the loading response phase of downhill gait. Results: Individuals with patellofemoral OA demonstrated earlier increases in patellofemoral stress in the lateral patellofemoral compartment during loading response as compared to OA-free controls (P = 0.021). Overall, both groups exhibited increased patellofemoral contact stress early in the loading response phase of gait as compared to the end of loading response. Results from this study show increased stress profiles in individuals with patellofemoral OA, indicating increasing joint loading in early phases of gait. Significance: This modeling framework—combining arthrokinematics with discrete element models—can objectively estimate changes in patellofemoral joint stress, with potential applications to evaluate outcomes from various treatment programs, including surgical and non-surgical rehabilitation treatments.