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Osteotomy of the patella in the patellofemoral pain syndrome

The significance of increased intraosseous pressure during sustained knee flexion

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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.

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.

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Hejgaard, N., Arnoldi, C.C. Osteotomy of the patella in the patellofemoral pain syndrome. International Orthopaedics 8, 189–194 (1984). https://doi.org/10.1007/BF00269915

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