Association between obesity and magnetic resonance imaging defined patellar tendinopathy in community-based adults: a cross-sectional study

Background: Patellar tendinopathy is a common cause of activity-related anterior knee pain. Evidence is conflicting as to whether obesity is a risk factor for this condition. The aim of this study was to determine the relationship between obesity and prevalence of magnetic resonance imaging (MRI) defined patellar tendinopathy in community-based adults. Methods. 297 participants aged 50-79 years with no history of knee pain or injury were recruited from an existing community-based cohort. Measures of obesity included measured weight and body mass index (BMI), self-reported weight at age of 18-21 years and heaviest lifetime weight. Fat-free mass and fat mass were measured using bioelectrical impedance. Participants underwent MRI of the dominant knee. Patellar tendinopathy was defined on both T1- and T2-weighted images. Results: The prevalence of MRI defined patellar tendinopathy was 28.3 . Current weight (OR per kg = 1.04, 95 CI 1.01-1.06, P = 0.002), BMI (OR per kg/m2= 1.10, 95 CI 1.04-1.17, P = 0.002), heaviest lifetime weight (OR per kg = 1.03, 95 CI 1.01-1.05, P = 0.007) and weight at age of 18-21 years (OR per kg = 1.03, 95 CI 1.00-1.07, P = 0.05) were all positively associated with the prevalence of patellar tendinopathy. Neither fat mass nor fat-free mass was associated with patellar tendinopathy. Conclusion: MRI defined patellar tendinopathy is common in community-based adults and is associated with current and past history of obesity assessed by BMI or body weight, but not fat mass. The findings suggest a mechanical pathogenesis of patellar tendinopathy and patellar tendinopathy may be one mechanism for obesity related anterior knee pain.