This study investigated the association between patellar morphometric parameters and the presence of chondromalacia patella and meniscopathy using MRI-based assessments. Our key findings include: a significantly greater Q angle in individuals with chondromalacia compared to healthy controls, larger patellar diameters (transverse and A–P) in patients with meniscopathy, and a higher prevalence of type I and II patellae in the meniscopathy group. These results suggest that specific anatomical features of the patella may contribute to the development or susceptibility to common knee joint disorders. To our knowledge, this is one of the few studies to examine these associations using a comprehensive MRI-based morphometric approach with a three-group comparison design.
The knee joint is a critical component of lower extremity stability, offering a wide range of motion but remaining highly susceptible to mechanical stress. The heightened risk of wear and injury during both daily and athletic activities underscores its significance in musculoskeletal health [15]. The anatomical structure of the knee predisposes it to external trauma, with the menisci being among the most frequently injured components. Evidence suggests that lateral meniscus injuries are more common in acute trauma cases, whereas medial meniscus injuries are more frequent in degenerative conditions [16]. Although our retrospective analysis could not definitively distinguish between traumatic and degenerative origins, the higher mean age of patients in the meniscopathy group (34.96 ± 11.58) implies a potential link to degenerative processes, likely reflecting cumulative mechanical stress over time.
Our findings align with existing literature, which indicates that the prevalence of cartilage degeneration increases with age—reaching up to 94% in individuals over 50 years [17]. Notably, a greater prevalence of patellar chondromalacia was observed in females, consistent with prior studies highlighting the increased vulnerability of middle-aged women to this condition [18].
Furthermore, meniscus pathology was more prevalent among male participants (56.40%). This observation supports literature suggesting that men are more prone to meniscal injuries due to greater participation in high-impact sports and occupations involving repetitive knee loading [19]. Additionally, sex-based anatomical and hormonal differences such as increased muscle mass, joint stiffness, and variations in ligamentous laxity may contribute to this trend [20]. While this study did not assess activity level or occupational data, future research should address these variables to validate the association more comprehensively.
Previous large-scale studies have emphasized the predominance of medial meniscus degeneration with advancing age, particularly in populations exposed to high occupational loads or reduced lower limb strength [21]. Our results support this age-related trend and further reveal a higher prevalence of meniscopathy in males. This finding aligns with Adams et al.‘s (2021) meta-analysis reporting a greater incidence of traumatic meniscal lesions in men [22]. Unlike earlier research, our study also suggests that meniscopathy may be associated with larger patellar diameters, a novel anatomical feature warranting further longitudinal investigation. Although our findings indicate that patients with meniscopathy had larger patellae, this observation may be partially influenced by factors such as age, body mass index (BMI), or physical activity level, which are known to affect joint morphology. In our analysis, age and BMI were comparable between groups (p > 0.05), suggesting that these variables were not major contributors to the observed differences. Although not directly measured, variations in physical activity levels may be considered as potential contributors to patellar development. While Oeding et al. (2024) emphasized joint alignment, tibial slope, and intercondylar notch width as contributors to meniscal pathology [23], our results introduce patellar morphology as an additional biomechanical factor. We propose that certain patellar configurations may increase intra-articular stress by altering load distribution within the knee joint. Such morphological variations could contribute to abnormal focal loading, potentially accelerating cartilage wear and joint degeneration.
Sex-related differences in the prevalence of chondromalacia and meniscopathy deserve further attention. The greater occurrence of chondromalacia in females may be explained by several interrelated factors. Anatomically, women typically exhibit a larger Q angle due to wider pelvic structure, which may alter patellofemoral tracking and increase stress on the patellar cartilage. Hormonally, estrogen influences collagen synthesis and cartilage metabolism, possibly reducing cartilage resilience, especially during hormonal fluctuations [24, 25].
In contrast, the higher prevalence of meniscopathy in males may reflect greater participation in high-impact sports or labor-intensive activities. Additionally, higher mechanical loading and muscle strength in men could lead to localized compressive forces on the meniscus during repetitive actions such as squatting or pivoting. These biomechanical and behavioral differences may help explain the sex-specific trends identified in this study and are consistent with existing epidemiological data [26, 27].
Patellar dimensions are known to vary with demographic factors such as age and sex [28]. In our study, patients with meniscopathy exhibited larger patellar sizes across all measured dimensions compared to those with chondromalacia and healthy controls. This observation raises two possibilities: either meniscal pathology contributes to increased patellar dimensions, or individuals with larger patellae are more susceptible to meniscal injury. Alternatively, both conditions may arise from shared underlying risk factors such as lower limb alignment or skeletal morphology, which have been linked to both patellar shape and meniscal integrity. While the correlation between anterior–posterior patellar diameter and severity of meniscopathy was statistically weak (r = 0.278), it may represent a minor yet relevant anatomical factor when considered alongside other risk factors. Differences in sex distribution among groups may have also influenced the observed variations in patellar diameter.
The Q angle, a key biomechanical measure, was significantly higher in individuals with patellar chondromalacia (11.08 ± 2.40) compared to those with meniscopathy and healthy controls. This supports the hypothesis that patellar pathologies may affect Q angle and, in turn, knee joint mechanics. Notably, previous studies have shown that even small increases in Q angle especially values exceeding 15° in females and 10–12° in males can alter patellofemoral tracking and increase lateral stress on the cartilage, suggesting that the observed difference may have biomechanical and clinical relevance [29]. In contrast, meniscus pathology did not appear to significantly affect the Q angle [30]. Although these morphometric differences were statistically significant, effect size estimates (η²) suggested small to moderate magnitudes. Thus, while patellar morphology may influence knee joint pathology, its clinical importance should be interpreted within the multifactorial context of age, sex, biomechanics, and activity level.
Lastly, our study examined the association between patellar type and knee pathology. While no significant link was found between type III patella and chondromalacia, individuals with type I and II patellae showed a higher prevalence of meniscopathy. This supports prior suggestions that certain patellar configurations may affect intra-articular load distribution and increase the risk of meniscal degeneration, particularly given the literature connecting Wiberg types I and II with anterior knee pain and patellofemoral disorders [31, 32].
Study limitations
This study has several limitations. First, its retrospective design hinders the ability to establish causal relationships. Future prospective studies are needed to provide more reliable and interpretable results. Second, the relatively small sample size limits the generalizability of the findings; larger, multicenter studies are recommended to enhance external validity.
Additionally, important confounding factors such as physical activity level, body mass index (BMI), history of previous knee injuries, and occupational loading were not assessed due to the retrospective nature of the study. These variables are known to influence both patellar morphology and the development of knee joint pathologies, and their omission may have affected the observed associations. Moreover, this study did not include intra- and inter- observer reliability assessments for morphometric measurements, which limits the ability to fully confirm the reproducibility of the measurement methods. Future research should incorporate these parameters and reliability testing to allow for a more comprehensive, accurate, and methodologically rigorous analysis.
Another notable limitation is the unequal sex distribution across the study groups specifically, a predominance of females in the chondromalacia group and males in the meniscopathy group. Given the anatomical and biomechanical differences between sexes (e.g., Q angle, patellar dimensions), this imbalance may have confounded the morphometric comparisons. Although subgroup or adjusted analyses could not be performed due to limited sample size, this factor should be taken into account when interpreting the results.
Finally, the study is subject to inherent limitations associated with retrospective data collection, including potential selection and diagnostic biases. Although recall bias was minimized by relying on archived MRI scans and electronic health records, the study’s dependence on available imaging and documentation may have introduced unintentional selection bias. Furthermore, while all radiological assessments were performed according to standardized criteria and confirmed by experienced musculoskeletal radiologists, inter-observer variability and diagnostic bias cannot be entirely ruled out. These factors should be acknowledged when evaluating the robustness of the findings.
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