Dottorato in TECNOLOGIE INNOVATIVE NELLE MALATTIE DELLO SCHELETRO,
DELLA CUTE E DEL DISTRETTO ORO-CRANIO-FACCIALE

Titolo della tesi: Patello-Femoral Pain Syndrome: Magnetic Resonance Imaging versus Ultrasound

Background: X-ray and MRI have always been the most common imaging examinations of the knee allowing the characterization of both soft tissue and bone pathology. Today among the various knee pathologies, there is a growing interest in patello-femoral syndrome whose diagnostic-therapeutic procedure is still not universally defined. Magnetic Resonance Imaging (MRI) and Ultrasound (US) in combination with clinical data could contribute to the diagnosis, staging and follow-up of Patello-Femoral Syndrome (PFS), which often overlaps with other pathologies of the knee. Besides common method related limitations, ultrasound (US) investigation could contribute to the diagnosis, staging and follow-up of patello-femoral pathology; however, there are no studies in the literature evaluating its real diagnostic impact in comparison with MRI. Purpose of the study: To evaluate the diagnostic role of MRI and US findings associated with PFS and define the range values of instrumental measurements obtained in pathological cases and healthy controls, the performance of the two methods in comparison, and the correlation with clinical data. Materials and Methods: 100 subjects were examined: 60 patients with a high suspicion of PFS at the clinical evaluation and 40 healthy controls. All measurements obtained by MRI and US examination were correlated with clinical data. A descriptive analysis of all measurements was stratified for pathological cases and healthy controls. A Student’s t-test for continuous variables was used to compare patients to controls and US to MRI. Logistic regression analysis was applied to test the correlation between MRI and US measurements with clinical data Results: Statistical descriptive analysis determined the MRI and US range values of medial patello-femoral distance and the thickness of retinacles and cartilages in pathological cases and healthy controls. In pathological cases, the retinacle results of both increased; the medial appeared to be slightly more increased than the lateral. Furthermore, in some cases, the thickness of the cartilage decreased in both techniques; the medial cartilage was more thinned than the lateral. According to logistic regression analyses, the best diagnostic parameter was the medial patello-femoral distance due to the overlapping results of the US and MRI. Furthermore, all clinical data obtained by different tests showed a good correlation with patello-femoral distance. In particular, the correlation between medial patello-femoral distance and the VAS score is direct and equal to 97–99%, which is statistically significant (p < 0.001), and the correlation with the KOOS score is inverse and equal to 96–98%, which is statistically significant Conclusion: MRI and Ultrasound examination in combination with clinical data demonstrated high-value results in the diagnosis of PFS. Ultrasound examination in combination with clinical parameters demonstrated a diagnostic accuracy value comparable to MRI investigation. In pathological cases medial patello-femoral distances increase proportionally to the severity degree as compared to the healthy controls and as showed by both exams. Keywords: Patello-Femoral Pain Syndrome, Knee ,anterior pain, Ultrasound,MRI.