MRI Assessment of Patellofemoral Morphology and Chondromalacia Severity in Young Soccer Players: A Case-Control Study

Introduction: Patellofemoral chondromalacia is an important cause of anterior knee symptoms in physically active individuals. Repetitive loading during football may interact with patellofemoral anatomical variations and contribute to cartilage damage. This study investigated the association between MRI-defined patellofemoral chondromalacia, anatomical variations, and demographic characteristics in young footballers. Methods This case-control study included 70 footballers aged 18–30 years with knee pain who underwent MRI between 2024 and 2025. Thirty-five participants with symptomatic anatomical variations constituted the case group, and 35 without anatomical variations constituted the control group. TT–TG distance, Insall–Salvati ratio, lateral trochlear inclination, trochlear facet asymmetry, and trochlear depth were evaluated. Chondromalacia was graded using the Modified Outerbridge system. Data were analyzed using SPSS version 25 with parametric or non-parametric tests as appropriate, and P < 0.05 was considered statistically significant. Results Age and BMI did not differ significantly between groups. TT–TG distance was greater in the anatomical-variation group (11.50 ± 4.71 vs 9.38 ± 3.25 mm; P = 0.032), whereas the Insall–Salvati ratio (0.82 ± 0.10 vs 0.88 ± 0.07; P = 0.003) and trochlear facet asymmetry (0.63 ± 0.14 vs 0.73 ± 0.13; P = 0.002) were both lower. Patella baja occurred in 54.3% of participants with anatomical variations and none of the controls (P < 0.001), and trochlear depth was significantly lower in the variation group (2.73 ± 1.08 vs 3.84 ± 1.53 mm; P < 0.001). Chondromalacia grades differed significantly between groups (P < 0.001), with grade 3–4 disease affecting 65.7% versus 8.6% of the variation and control groups, respectively. Conclusion Patellofemoral anatomical variations were strongly associated with a greater burden and severity of MRI-defined chondromalacia in young footballers, particularly increased TT–TG distance, patella baja, reduced trochlear facet asymmetry, and shallower trochlear depth.