Jae Ni Jang1, SoYoon Park1, Sukhee Park1, Yumin Song1, Jae Won Kim2, Keum Nae Kang3, Young Uk Kim1

1Department of Anesthesiology and Pain Medicine, Catholic Kwandong University, College of Medicine, International ST. Mary`s Hospital, Incheon, Republic of Korea
2Catholic Kwandong University, College of Medicine, Incheon, Republic of Korea
3Department of Anesthesiology and Pain Medicine, National Police Hospital, Seoul, Republic of Korea

Keywords: Diagnosis, hypertrophy, magnetic resonance imaging, patellofemoral pain syndrome, quadriceps muscle


Objectives: In this study, we aimed to provide a more valuable diagnostic parameter and more equivocal assessment of the diagnostic potential of patellofemoral pain syndrome (PFPS) by comparing the quadriceps tendon cross-sectional area (QTCSA) with the quadriceps tendon thickness (QTT), a traditional measure of quadriceps tendon hypertrophy.

Patients and methods: Between March 2014 and August 2020, a total of 30 patients with PFPS (16 males, 14 females; mean age, 30.4±11.2 years; range, 16 to 49 years) and 30 healthy individuals (19 males, 11 females; mean age: 30.8±13.8 years; range, 17 to 62 years) who underwent knee magnetic resonance imaging (MRI) were retrospectively analyzed. T1-weighted turbo spin-echo transverse MRI scans were obtained. The QTCSA was measured on the axial angled phases of the images by drawing outlines, and the QTT was measured at the most hypertrophied quadriceps tendon.

Results: The mean QTT and QTCSA in the patients with PFPS (6.33±0.80 mm and 155.77±36.60 mm2, respectively) were significantly higher than those in the control group (5.77±0.36 mm and 111.90±24.10 mm2, respectively; p<0.001, for both). The receiver operating characteristic curve was used to confirm the sensitivities and specificities for both the QTT and QTCSA as predictors of PFPS. The optimal diagnostic cut-off value for QTT was 5.98 mm, with a sensitivity of 66.7%, a specificity of 70.0%, and an area under the curve (AUC) of 0.75 (range, 0.62 to 0.88). The optimal diagnostic cut-off value for QTCSA was 121.04 mm2, with a sensitivity of 73.3%, a specificity of 70.0%, and an AUC of 0.83 (range, 0.74 to 0.93).

Conclusion: Based on our study results, the QTCSA seems to be a more reliable diagnostic indicator for PFPS than QTT.

Citation: Jang JN, Park S, Park S, Song Y, Kim JW, Kang KN, et al. Magnetic resonance imaging for assessment of the quadriceps tendon cross-sectional area as an adjunctive diagnostic parameter in patients with patellofemoral pain syndrome. Jt Dis Relat Surg 2023;34(3):565-570.

Ethics Committee Approval

The study protocol was approved by Institutional Review Board of the Catholic Kwandong University College of Medicine, Republic of Korea (date: 22.12.2020, no: IS20RISI0081). The study was conducted in accordance with the principles of the Declaration of Helsinki.

Author Contributions

Researched the data, designed the analysis, and wrote the manuscript: J.N.; Analyzed data, reviewed, and edited the manuscript: S.Y.P., S.P.; Helped with data curation and interpretation: Y.S., J.W.K.; Performed statistical analysis: K.N.K.; Supervised and managed the research and critically reviewed and edited the manuscript, takes full responsibility for the work, the study design, access to data, and the decision to submit and publish the manuscript: Y.U.K.

Conflict of Interest

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Financial Disclosure

The authors received no financial support for the research and/or authorship of this article.


We express our sincere gratitude to the "International St. Mary's Hospital” for their support in conducting our research.

Data Sharing Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.