Comparative Analysis of Diagnostic Imaging Modalities for Anatomical Instability in Patellofemoral Pain Disorders: a Systematic Review

Sandhya Nagolu 1 * , Lavanya Prathap 2, Jeyakumar Sankarasubbu 3, Subhadradevi Velichety 4, Jyothinath Kothapalli 5
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1 Department of Anatomy (Research Scholarship), Saveetha Medical College, Saveetha Institute of Medical and Technical Sciences (SIMATS), Chennai, India
2 Department of Anatomy, Saveetha Medical College, Saveetha Medical College, Saveetha Institute of Medical and Technical Sciences, SIMATS, Chennai, India
3 School of Health Sciences, Garden City University, Bangalore, India
4 Department of Anatomy, Apollo Institute of Medical Sciences& Research, Chittoor, India
5 Department of Anatomy, S V Medical College, Tirupathi, Andhra Pradesh, India
* Corresponding Author
J CLIN MED KAZ, Volume 22, Issue 4, pp. 54-61. https://doi.org/10.23950/jcmk/16587
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Author Contributions: Conceptualization, N. S.; methodology, L. P., S. D. V.; validation, J. S., J. K. and L. P.; formal analysis, N. S.; resources, N. S.; data curation, N. S. and J. K.; writing – original draft preparation, N. S., J. K. and J. S.; writing – review and editing, L. P., S. D. V.; visualization, N. S.; supervision, J. K., J. S.; project administration, L. P. All authors have read and agreed to the published version of the manuscript.

Data availability statement: The authors are available and ready to supply the data upon any request through the corresponding author.

ABSTRACT

Patellofemoral pain disorders (PFPD) are characterized by pain around or behind the patella, commonly aggravated by activities such as squatting, running, or stair climbing. Accurate diagnosis of anatomical instability is essential in managing PFPD. This systematic review evaluates the diagnostic accuracy and clinical utility of various imaging modalities—X-ray, magnetic resonance imaging (MRI), and computed tomography (CT)—in detecting key anatomical risk factors associated with patellofemoral instability, including trochlear dysplasia, patellar height, tibial tubercle–trochlear groove (TT-TG) distance, and medial patellofemoral ligament (MPFL) integrity. 
A comprehensive literature search was conducted in accordance with PRISMA guidelines across databases including PubMed, Scopus, ScienceDirect, Google Scholar, and the Cochrane Library, focusing on studies published from 2013 to 2023. Only comparative studies assessing imaging modalities in PFPD were included, while case reports and non-English articles were excluded. Two reviewers independently screened articles, extracted data, and evaluated study quality using the QUADAS-2 tool. A qualitative synthesis was conducted due to the heterogeneity of study designs. 
Results show that MRI and CT are superior to X-ray for evaluating trochlear dysplasia and patellar height, with MRI demonstrating high sensitivity (90–97%) and specificity (93–98%). CT is the gold standard for assessing TT-TG distance (sensitivity 95–98%, specificity 93–96%), while MRI is preferred for evaluating MPFL integrity, showing near-perfect diagnostic accuracy. 
The review underscores the need for standardized imaging protocols and diagnostic criteria to improve comparability and reliability across studies. Future research should investigate the role of dynamic imaging techniques, larger study populations, and cost-effectiveness to refine and optimize diagnostic strategies for PFPD.
Keywords: Patellofemoral pain or patellar instability, Imaging, Anatomical instability, Radiographic imaging, Sensitivity, Specificity

CITATION

Nagolu S, Prathap L, Sankarasubbu J, Velichety S, Kothapalli J. Comparative Analysis of Diagnostic Imaging Modalities for Anatomical Instability in Patellofemoral Pain Disorders: a Systematic Review. J CLIN MED KAZ. 2025;22(4):54-61. https://doi.org/10.23950/jcmk/16587

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