International Orthopaedics

, Volume 8, Issue 3, pp 189–194 | Cite as

Osteotomy of the patella in the patellofemoral pain syndrome

The significance of increased intraosseous pressure during sustained knee flexion
  • Niels Hejgaard
  • Carl C. Arnoldi
Article

Summary

In 40 patients with patellofemoral pain, intra-osseous pressure measurements were recorded under anaesthesia with the knee first in extension and then in flexion prior to performing a longitudinal osteotomy of the patella. There was a statistically significant increase of pressure in painful knees compared with normal knees (29 mm Hg. vs 15 mm Hg.), and a marked increase when compared during sustained flexion (97 mm Hg. vs 60 mm Hg.). However wide variability of individual results made the diagnostic value of a single pressure measurement unreliable.

A clinical test, based on reproduction of the characteristic pain by sustained knee flexion, proved to be reliable in predicting a good response to operation.

The effect of the operation was encouraging, with significant relief of pain as measured by a visual analogue scale.

Key words

Patellofemoral pain Osteotomy Intraosseus pressure 

Résumé

Chez 40 malades présentant un syndrome douloureux rotulien, on a pratiqué sous anesthésie une mesure de la pression intra-osseuse sur le genou en extension, puis en flexion; ceci avant de réaliser une ostéotomie longitudinale de la rotule. On a trouvé une augmentation significative de la pression au niveau des genoux douloureux comparativement aux genoux normaux (29 mm Hg contre 15 mm Hg) et une augmentation notable lorsqu'on la compare après une flexion prolongée (97 mm Hg contre 60 mm Hg). Cependant l'existence d'importantes variantions individuelles ne permet pas d'accorder une valeur diagnostique à une measure de pression isolée.

A l'inverse, un test clinique, basé sur le déclenchement de la douleur caractéristique par la flexion prolongée du genou, permet de prédire avec certitude le bon résultat de l'opération.

Ces résultats sont encourageants puisqu'ils comportent une importante amélioration des douleurs que l'on peut mesurer grâce à une abaque.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Arnoldi CC, Linderholm H, Müssbichler H (1972) Venous engorgement and intraosseous hypertension in osteoarthritis of the hip. J Bone Joint Surg [Br] 54: 409–421Google Scholar
  2. 2.
    Arnoldi CC, Lemperg RK, Linderholm H (1971) Immediate effect of osteotomy on the intramedullary pressure of the femoral head and neck in patients with degenerative osteoarthritis. Acta Orthop Scand 42: 357–365Google Scholar
  3. 3.
    Arnoldi CC, Lemperg RK, Linderholm H (1975) Intraosseous hypertension and pain in the knee. J Bone Joint Surg [Br] 57: 360–363Google Scholar
  4. 4.
    Arnoldi CC, Reimann I, Mortensen S, Christensen SB, Kristoffersen J, Sønnichsen HV, Smith M (1980) The effect of joint position on juxta-articular bone marrow pressure. Relation to intra-articular pressure and joint effusion — An experimental study on horses. Acta Orthop Scand 51: 893–897Google Scholar
  5. 5.
    Azuma H (1964) Intraosseous pressure as a measure of hemodynamic changes in bone marrow. Angiology 15: 396–406Google Scholar
  6. 6.
    Björkström S, Goldie IF, Wetterqvist H (1980) Intramedullary pressure of the patella in chondromalacia. Arch Orthop Trauma Surg 97: 81–85Google Scholar
  7. 7.
    Bünger C, Harving S, Bünger EH (1982) Intraosseous pressure in the patella in relation to simulated joint effusion and knee position. An experimental study in puppies. Acta Orthop Scand 53: 745–751Google Scholar
  8. 8.
    Deliss L (1977) Coronal patellar osteotomy: Preliminary report of its use in chondromalacia patellae. Proc Roy Soc Med 70: 257–259Google Scholar
  9. 9.
    Goldie I, Wetterqvist H (1974) Pletysmographic and intramedullary pressure measurements before and after tibial osteotomy for osteoarthritis of the knee. Acta Orthop Belg 40: 285–293Google Scholar
  10. 10.
    Henche HR, Künzi HU, Morscher E (1981) The areas of contact pressure in the patello-femoral joint. Int Orthop 4: 279–281Google Scholar
  11. 11.
    Insall J (1982) Current concepts review. Patellar pain. J Bone Joint Surg [Am] 64: 147–152Google Scholar
  12. 12.
    Jayson MIV, Dixon AStJ (1970) Intra-articular pressure in rheumatoid arthritis of the knee. III. Pressure changes during joint use. Ann Rheum Dis 29: 401–408Google Scholar
  13. 13.
    Krebs B, Paulsen PK, Lucht U, Djurhuus JC (1982) Influence of the hip joint position on the intraosseous pressures in the juxta-articular bones. An experimental investigation in dogs. Eur Surg Res 14: 440–446Google Scholar
  14. 14.
    Lemperg RK, Arnoldi CC (1978) The significance of intraosseous pressure in normal and diseased states with special references to the intraosseous engorgement-pain syndrome. Clin Orthop 136: 143–156Google Scholar
  15. 15.
    Morscher E (1978) Osteotomy of the patella in chondromalacia. Preliminary report. Arch Orthop Trauma Surg 92: 139–147Google Scholar
  16. 16.
    Perrild C, Hejgaard N, Rosenklint A (1982) Chondromalacia patellae. A radiographic study of the femoropatellar joint. Acta Orthop Scand 53: 131–134Google Scholar
  17. 17.
    Scott J, Huskisson EC (1976) Graphic representation of pain. Pain 2: 175–184Google Scholar

Copyright information

© Springer-Verlag 1984

Authors and Affiliations

  • Niels Hejgaard
    • 1
  • Carl C. Arnoldi
    • 1
  1. 1.Department of Orthopaedic Surgery, RigshospitaletUniversity of CopenhagenDenmark

Personalised recommendations