Patients with unilateral patellofemoral pain have altered bone turnover in the painful knee compared to the pain-free knee at rest and after acute knee loading

Objective: The objective of this study was to investigate subchondral bone turnover at rest and after acute loading using Fluorine-18-labeled sodium fluoride (Na[18F]F) Positron Emission Tomography (PET), in patients with unilateral PFP. Design: Twenty-seven patients with unilateral PFP were recruit...

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Main Authors: Rudi Hansen, Bryan Haddock, René B. Svensson, Markus Nowak Lonsdale, Lisbeth Marner, Lene Rørdam, Inge Lise Rasmussen, Christoffer Brushøj, S. Peter Magnusson, Marius Henriksen, Christian Couppé
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Language:English
Published: Elsevier 2025-06-01
Series:Osteoarthritis and Cartilage Open
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Online Access:http://www.sciencedirect.com/science/article/pii/S2665913125000196
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author Rudi Hansen
Bryan Haddock
René B. Svensson
Markus Nowak Lonsdale
Lisbeth Marner
Lene Rørdam
Inge Lise Rasmussen
Christoffer Brushøj
S. Peter Magnusson
Marius Henriksen
Christian Couppé
author_facet Rudi Hansen
Bryan Haddock
René B. Svensson
Markus Nowak Lonsdale
Lisbeth Marner
Lene Rørdam
Inge Lise Rasmussen
Christoffer Brushøj
S. Peter Magnusson
Marius Henriksen
Christian Couppé
author_sort Rudi Hansen
collection DOAJ
description Objective: The objective of this study was to investigate subchondral bone turnover at rest and after acute loading using Fluorine-18-labeled sodium fluoride (Na[18F]F) Positron Emission Tomography (PET), in patients with unilateral PFP. Design: Twenty-seven patients with unilateral PFP were recruited from the Institute of Sports Medicine Copenhagen. Participants underwent Na[18F]F-PET imaging before and after a bout of single-leg squats. Bone turnover measures, including mean and maximal standardized uptake value (SUVmean and SUVmax), rate of bone perfusion (K1), rate of tracer uptake into bone (Ki), and extraction fraction of tracer absorbed into bone mineral were assessed for patella and trochlea. Results: At rest, the painful knees showed lower SUVmax, K1, and Ki compared to the pain-free knees in the superficial part of the patella. No significant differences were found in the profound part of the patella or trochlea at rest. Following knee loading, the acute increases in SUVmean, SUVmax, Ki and blood flow were reduced in the superficial patella of the painful knees compared to the pain-free knees. In the trochlea, painful knees showed larger increases in SUVmean and Ki in the lateral part, whereas the medial part showed greater increases in K1, Ki, and a larger decrease in extraction fraction after loading. Conclusion: Patella displayed decreased bone metabolism at rest and reduced response to loading in the painful versus pain-free knees. Trochlea in the painful knees showed significantly larger increases in subchondral bone metabolism following knee loading compared to the pain-free knees. These novel findings highlight potential differences in bone turnover between the patellar and trochlear regions.
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spelling doaj-art-b08ab731a19e48b6855ab52ae3128c2f2025-08-20T02:32:54ZengElsevierOsteoarthritis and Cartilage Open2665-91312025-06-017210058310.1016/j.ocarto.2025.100583Patients with unilateral patellofemoral pain have altered bone turnover in the painful knee compared to the pain-free knee at rest and after acute knee loadingRudi Hansen0Bryan Haddock1René B. Svensson2Markus Nowak Lonsdale3Lisbeth Marner4Lene Rørdam5Inge Lise Rasmussen6Christoffer Brushøj7S. Peter Magnusson8Marius Henriksen9Christian Couppé10Department of Physical and Occupational Therapy, Copenhagen University Hospital Bispebjerg Frederiksberg, Copenhagen, Denmark; Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital Bispebjerg Frederiksberg, Copenhagen, Denmark; Corresponding author. Department of Physical and Occupational Therapy, Copenhagen University Hospital Bispebjerg Frederiksberg, Nielsine Nielsensvej 10, DK-2400 Copenhagen, Denmark.Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen University Hospital, DenmarkInstitute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital Bispebjerg Frederiksberg, Copenhagen, DenmarkDepartment of Clinical Physiology & Nuclear Medicine, Copenhagen University Hospital Bispebjerg Frederiksberg, Copenhagen, DenmarkDepartment of Clinical Physiology & Nuclear Medicine, Copenhagen University Hospital Bispebjerg Frederiksberg, Copenhagen, DenmarkDepartment of Clinical Physiology & Nuclear Medicine, Copenhagen University Hospital Bispebjerg Frederiksberg, Copenhagen, DenmarkDepartment of Clinical Physiology & Nuclear Medicine, Copenhagen University Hospital Bispebjerg Frederiksberg, Copenhagen, DenmarkInstitute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital Bispebjerg Frederiksberg, Copenhagen, DenmarkDepartment of Physical and Occupational Therapy, Copenhagen University Hospital Bispebjerg Frederiksberg, Copenhagen, Denmark; Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital Bispebjerg Frederiksberg, Copenhagen, DenmarkThe Parker Institute, Copenhagen University Hospital Bispebjerg Frederiksberg, Copenhagen, DenmarkDepartment of Physical and Occupational Therapy, Copenhagen University Hospital Bispebjerg Frederiksberg, Copenhagen, Denmark; Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital Bispebjerg Frederiksberg, Copenhagen, DenmarkObjective: The objective of this study was to investigate subchondral bone turnover at rest and after acute loading using Fluorine-18-labeled sodium fluoride (Na[18F]F) Positron Emission Tomography (PET), in patients with unilateral PFP. Design: Twenty-seven patients with unilateral PFP were recruited from the Institute of Sports Medicine Copenhagen. Participants underwent Na[18F]F-PET imaging before and after a bout of single-leg squats. Bone turnover measures, including mean and maximal standardized uptake value (SUVmean and SUVmax), rate of bone perfusion (K1), rate of tracer uptake into bone (Ki), and extraction fraction of tracer absorbed into bone mineral were assessed for patella and trochlea. Results: At rest, the painful knees showed lower SUVmax, K1, and Ki compared to the pain-free knees in the superficial part of the patella. No significant differences were found in the profound part of the patella or trochlea at rest. Following knee loading, the acute increases in SUVmean, SUVmax, Ki and blood flow were reduced in the superficial patella of the painful knees compared to the pain-free knees. In the trochlea, painful knees showed larger increases in SUVmean and Ki in the lateral part, whereas the medial part showed greater increases in K1, Ki, and a larger decrease in extraction fraction after loading. Conclusion: Patella displayed decreased bone metabolism at rest and reduced response to loading in the painful versus pain-free knees. Trochlea in the painful knees showed significantly larger increases in subchondral bone metabolism following knee loading compared to the pain-free knees. These novel findings highlight potential differences in bone turnover between the patellar and trochlear regions.http://www.sciencedirect.com/science/article/pii/S2665913125000196Patellofemoral painPFPBone turnoverBone perfusionBone metabolismPositron Emission Tomography
spellingShingle Rudi Hansen
Bryan Haddock
René B. Svensson
Markus Nowak Lonsdale
Lisbeth Marner
Lene Rørdam
Inge Lise Rasmussen
Christoffer Brushøj
S. Peter Magnusson
Marius Henriksen
Christian Couppé
Patients with unilateral patellofemoral pain have altered bone turnover in the painful knee compared to the pain-free knee at rest and after acute knee loading
Osteoarthritis and Cartilage Open
Patellofemoral pain
PFP
Bone turnover
Bone perfusion
Bone metabolism
Positron Emission Tomography
title Patients with unilateral patellofemoral pain have altered bone turnover in the painful knee compared to the pain-free knee at rest and after acute knee loading
title_full Patients with unilateral patellofemoral pain have altered bone turnover in the painful knee compared to the pain-free knee at rest and after acute knee loading
title_fullStr Patients with unilateral patellofemoral pain have altered bone turnover in the painful knee compared to the pain-free knee at rest and after acute knee loading
title_full_unstemmed Patients with unilateral patellofemoral pain have altered bone turnover in the painful knee compared to the pain-free knee at rest and after acute knee loading
title_short Patients with unilateral patellofemoral pain have altered bone turnover in the painful knee compared to the pain-free knee at rest and after acute knee loading
title_sort patients with unilateral patellofemoral pain have altered bone turnover in the painful knee compared to the pain free knee at rest and after acute knee loading
topic Patellofemoral pain
PFP
Bone turnover
Bone perfusion
Bone metabolism
Positron Emission Tomography
url http://www.sciencedirect.com/science/article/pii/S2665913125000196
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