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Patellofemoral Pathologies

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A Case-Based Approach to Knee Pain

Abstract

In this chapter, patellofemoral pathologies are discussed. Topics covered include pathology, clinical presentation, physical examination, diagnostic studies, treatment and return to activities for patellofemoral pathologies are discussed in turn. Patellofemoral joint pain is very common, particularly in young, active individuals and an understanding of its pathology and various characteristics is necessary for anyone seeking to evaluate or treat knee pain.

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References

  1. Loudon JK. Biomechanics and pathomechanics of the patellofemoral joint. Int J Sports Phys Ther. 2016;11(6):820.

    Google Scholar 

  2. Huberti HH, Hayes WC. Patellofemoral contact pressures. The influence of Q-angle and tendofemoral contact. J Bone Jt Surg Ser A. 1984;66(5):715–24. https://doi.org/10.2106/00004623-198466050-00010.

    Article  CAS  Google Scholar 

  3. Hungerford DS, Barry M. Biomechanics of the patellofemoral joint. Clin Orthop Relat Res. 1979;1(144):9–15. https://doi.org/10.1097/00003086-197910000-00003.

    Article  Google Scholar 

  4. Dye SF. The pathophysiology of patellofemoral pain: a tissue homeostasis perspective. Clin Orthop Relat Res. 2005;436:100–10. https://doi.org/10.1097/01.blo.0000172303.74414.7d.

    Article  Google Scholar 

  5. Thomeé R, Augustsson J, Karlsson J. Patellofemoral pain syndrome. A review of current issues. Sports Med. 1999;28(4):245–62. https://doi.org/10.2165/00007256-199928040-00003.

    Article  Google Scholar 

  6. Witvrouw E, Callaghan MJ, Stefanik JJ, et al. Patellofemoral pain: consensus statement from the third international Patellofemoral Pain Research Retreat held in Vancouver, September 2013. Br J Sports Med. 2014;48(6):411–4. https://doi.org/10.1136/bjsports-2014-093450.

    Article  Google Scholar 

  7. Bolgla LA, Malone TR, Umberger BR, Uhl TL. Hip strength and hip and knee kinematics during stair descent in females with and without patellofemoral pain syndrome. J Orthop Sports Phys Ther. 2008;38(1):12–8. https://doi.org/10.2519/jospt.2008.2462.

    Article  Google Scholar 

  8. Robinson RL, Nee RJ. Analysis of hip strength in females seeking physical therapy treatment for unilateral patellofemoral pain syndrome. J Orthop Sports Phys Ther. 2007;37(5):232–8. https://doi.org/10.2519/jospt.2007.2439.

    Article  Google Scholar 

  9. Dierks TA, Manal KT, Hamill J, Davis IS. Proximal and distal influences on hip and knee kinematics in runners with patellofemoral pain during a prolonged run. J Orthop Sports Phys Ther. 2008;38(8):448–56. https://doi.org/10.2519/jospt.2008.2490.

    Article  Google Scholar 

  10. Willson JD, Binder-Macleod S, Davis IS. Lower extremity jumping mechanics of female athletes with and without patellofemoral pain before and after exertion. Am J Sports Med. 2008;36(8):1587–96. https://doi.org/10.1177/0363546508315592.

    Article  Google Scholar 

  11. Tiberio D. The effect of excessive subtalar joint pronation on patellofemoral mechanics: a theoretical model. J Orthop Sport Phys Ther. 1987;9(4):160–5. https://doi.org/10.2519/jospt.1987.9.4.160.

    Article  CAS  Google Scholar 

  12. Thijs Y, Van Tiggelen D, Roosen P, De Clercq D, Witvrouw E. A prospective study on gait-related intrinsic risk factors for patellofemoral pain. Clin J Sport Med. 2007;17(6):437–45. https://doi.org/10.1097/JSM.0b013e31815ac44f.

    Article  Google Scholar 

  13. Dehaven KE, Lintner DM. Athletic injuries: comparison by age, sport, and gender. Am J Sports Med. 1986;14(3):218–24. https://doi.org/10.1177/036354658601400307.

    Article  CAS  Google Scholar 

  14. Boling M, Padua D, Marshall S, Guskiewicz K, Pyne S, Beutler A. Gender differences in the incidence and prevalence of patellofemoral pain syndrome. Scand J Med Sci Sports. 2010;20(5):725–30. https://doi.org/10.1111/j.1600-0838.2009.00996.x.

    Article  CAS  Google Scholar 

  15. Crossley KM, Stefanik JJ, Selfe J, et al. 2016 Patellofemoral pain consensus statement from the fourth international Patellofemoral Pain Research Retreat, Manchester. Part 1: terminology, definitions, clinical examination, natural history, patellofemoral osteoarthritis and patient-reported outcome measures. Br J Sports Med. 2016;50(14):844–52. https://doi.org/10.1136/bjsports-2016-096384.

    Article  Google Scholar 

  16. Dixit S, DiFiori JP, Burton M, Mines B. Management of patellofemoral pain syndrome. Am Fam Physician. 2007;75(2):194–202.

    Google Scholar 

  17. Earl JE, Vetter CS. Patellofemoral pain. Phys Med Rehabil Clin N Am. 2007;18(3):439–58. https://doi.org/10.1016/j.pmr.2007.05.004.

    Article  Google Scholar 

  18. Collins NJ, Barton CJ, Van Middelkoop M, et al. 2018 Consensus statement on exercise therapy and physical interventions (orthoses, taping and manual therapy) to treat patellofemoral pain: recommendations from the fifth international Patellofemoral Pain Research Retreat, Gold Coast, Australia, 2017. Br J Sports Med. 2018;52(18):1170–8. https://doi.org/10.1136/bjsports-2018-099397.

    Article  Google Scholar 

  19. Heintjes EM, Berger M, Bierma-Zeinstra SMA, Bernsen RMD, Verhaar JAN, Koes BW. Pharmacotherapy for patellofemoral pain syndrome. Cochrane Database Syst Rev. 2004;3(3):CD003470. https://doi.org/10.1002/14651858.CD003470.pub2.

    Article  Google Scholar 

  20. Kurut Aysin I, Askin A, Dirim Mete B, Guvendi E, Aysin M, Kocyigit H. Investigation of the relationship between anterior knee pain and chondromalacia patellae and patellofemoral malalignment. Eur J Med. 2018;50(1):28. https://doi.org/10.5152/eurasianjmed.2018.17277.

    Article  Google Scholar 

  21. Habusta SF, Coffey R, Ponnarasu S, et al. Chondromalacia patella. Treasure Island: StatPearls Publishing; 2021.

    Google Scholar 

  22. Lack S, Barton C, Vicenzino B, Morrissey D. Outcome predictors for conservative patellofemoral pain management: a systematic review and meta-analysis. Sports Med. 2014;44(12):1703–16. https://doi.org/10.1007/s40279-014-0231-5.

    Article  Google Scholar 

  23. Figueroa D, Figueroa F, Calvo R. Patellar tendinopathy: diagnosis and treatment. J Am Acad Orthop Surg. 2016;24(12):e184–92. https://doi.org/10.5435/JAAOS-D-15-00703.

    Article  Google Scholar 

  24. Almekinders LC, Temple JD. Etiology, diagnosis, and treatment of tendonitis: an analysis of the literature. Med Sci Sports Exerc. 1998;30(8):1183–90. https://doi.org/10.1097/00005768-199808000-00001.

    Article  CAS  Google Scholar 

  25. Astrom M, Rausing A. Chronic Achilles tendinopathy: a survey of surgical and histopathologic findings. Clin Orthop Relat Res. 1995;316(1):151–64. https://doi.org/10.1097/00003086-199507000-00021.

    Article  Google Scholar 

  26. Fu SC, Wang W, Pau HM, Wong YP, Chan KM, Rolf CG. Increased expression of transforming growth factor-β1 in patellar tendinosis. Clin Orthop Relat Res. 2002;400:174–83. https://doi.org/10.1097/00003086-200207000-00022.

    Article  Google Scholar 

  27. Blazina ME, Kerlan RK, Jobe FW, Carter VS, Carlson GJ. Jumper’s knee. Orthop Clin North Am. 1973;4(3):665–78. https://doi.org/10.1016/S0030-5898(20)32343-9.

    Article  CAS  Google Scholar 

  28. Cook JL, Khan KM, Kiss ZS, Purdam CR, Griffiths L. Reproducibility and clinical utility of tendon palpation to detect patellar tendinopathy in young basketball players. Br J Sports Med. 2001;35(1):65–9. https://doi.org/10.1136/bjsm.35.1.65.

    Article  CAS  Google Scholar 

  29. Black J, Cook J, Kiss ZS, Smith M. Intertester reliability of sonography in patellar tendinopathy. J Ultrasound Med. 2004;23(5):671–5. https://doi.org/10.7863/jum.2004.23.5.671.

    Article  Google Scholar 

  30. El-Khoury GY, Wira RL, Berbaum KS, Pope TL, Monu JUV. MR imaging of patellar tendinitis. Radiology. 1992;184(3):849–54. https://doi.org/10.1148/radiology.184.3.1509078.

    Article  CAS  Google Scholar 

  31. Cannell LJ, Taunton JE, Clement DB, Smith C, Khan KM. A randomised clinical trial of the efficacy of drop squats or leg extension/leg curl exercises to treat clinically diagnosed jumper’s knee in athletes: pilot study. Br J Sports Med. 2001;35(1):60–4. https://doi.org/10.1136/bjsm.35.1.60.

    Article  CAS  Google Scholar 

  32. Lavagnino M, Arnoczky SP, Dodds J, Elvin N. Infrapatellar straps decrease patellar tendon strain at the site of the jumper’s knee lesion: a computational analysis based on radiographic measurements. Sports Health. 2011;3(3):296–302. https://doi.org/10.1177/1941738111403108.

    Article  Google Scholar 

  33. Morath O, Beck M, Taeymans J, Hirschmüller A. Sclerotherapy and prolotherapy for chronic patellar tendinopathies—a promising therapy with limited available evidence, a systematic review. J Exp Orthop. 2020;7(1):89. https://doi.org/10.1186/s40634-020-00303-0.

    Article  Google Scholar 

  34. Gurney B, Wascher D, Eaton L, Benesh E, Lucak J. The effect of skin thickness and time in the absorption of dexamethasone in human tendons using iontophoresis. J Orthop Sports Phys Ther. 2008;38(5):238–45. https://doi.org/10.2519/jospt.2008.2648.

    Article  Google Scholar 

  35. Vulpiani MC, Vetrano M, Savoia V, Di Pangrazio E, Trischitta D, Ferretti A. Jumper’s knee treatment with extracorporeal shock wave therapy: a long-term follow-up observational study. J Sports Med Phys Fitness. 2007;47(3):323.

    CAS  Google Scholar 

  36. Chen SK, Lu CC, Chou PH, Guo LY, Wu WL. Patellar tendon ruptures in weight lifters after local steroid injections. Arch Orthop Trauma Surg. 2009;129(3):369–72. https://doi.org/10.1007/s00402-008-0655-1.

    Article  Google Scholar 

  37. Coleman BD, Khan KM, Kiss ZS, Bartlett J, Young DA, Wark JD. Open and arthroscopic patellar tenotomy for chronic patellar tendinopathy. A retrospective outcome study. Am J Sports Med. 2000;28(2):183–90. https://doi.org/10.1177/03635465000280020801.

    Article  CAS  Google Scholar 

  38. Lankhorst NE, Damen J, Oei EH, et al. Incidence, prevalence, natural course and prognosis of patellofemoral osteoarthritis: the Cohort Hip and Cohort Knee study. Osteoarthr Cartil. 2017;25(5):647–53. https://doi.org/10.1016/j.joca.2016.12.006.

    Article  CAS  Google Scholar 

  39. Kim YM, Joo YB. Patellofemoral osteoarthritis. Knee Surg Relat Res. 2012;24(4):193. https://doi.org/10.5792/ksrr.2012.24.4.193.

    Article  Google Scholar 

  40. Creamer P, Lethbridge-Cejku M, Hochberg MC. Where does it hurt? Pain localization in osteoarthritis of the knee. Osteoarthr Cartil. 1998;6(5):318–23. https://doi.org/10.1053/joca.1998.0130.

    Article  CAS  Google Scholar 

  41. Wood LRJ, Peat G, Thomas E, Duncan R. Knee osteoarthritis in community-dwelling older adults: are there characteristic patterns of pain location? Osteoarthr Cartil. 2007;15(6):615–23. https://doi.org/10.1016/j.joca.2006.12.001.

    Article  CAS  Google Scholar 

  42. McAlindon TE, Bannuru RR, Sullivan MC, et al. OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthr Cartil. 2014;22(3):363–88. https://doi.org/10.1016/j.joca.2014.01.003.

    Article  CAS  Google Scholar 

  43. Khodaee M. Common superficial bursitis. Am Fam Physician. 2017;95(4):224–31.

    Google Scholar 

  44. Baumbach SF, Lobo CM, Badyine I, Mutschler W, Kanz KG. Prepatellar and olecranon bursitis: literature review and development of a treatment algorithm. Arch Orthop Trauma Surg. 2014;134(3):359–70. https://doi.org/10.1007/s00402-013-1882-7.

    Article  Google Scholar 

  45. Myllymäki T, Tikkakoski T, Typpö T, Kivimäki J, Suramo I. Carpet-layer’s knee: an ultrasonographic study. Acta Radiol. 1993;34(5):496–9. https://doi.org/10.3109/02841859309175392.

    Article  Google Scholar 

  46. Porter WL, Mayton AG, Moore SM. Pressure distribution on the anatomic landmarks of the knee and the effect of kneepads. Appl Ergon. 2010;42(1):106–13. https://doi.org/10.1016/j.apergo.2010.05.007.

    Article  Google Scholar 

  47. Wilson-MacDonald J. Management and outcome of infective prepatellar bursitis. Postgrad Med J. 1987;63(744):851–3. https://doi.org/10.1136/pgmj.63.744.851.

    Article  CAS  Google Scholar 

  48. Huang YC, Yeh WL. Endoscopic treatment of prepatellar bursitis. Int Orthop. 2011;35(3):355–8. https://doi.org/10.1007/s00264-010-1033-5.

    Article  Google Scholar 

  49. Bin CJ, Chen D, Xiao YP, Chang JZ, Li T. Efficacy and experience of arthroscopic lateral patella retinaculum releasing through/outside synovial membrane for the treatment of lateral patellar compression syndrome. BMC Musculoskelet Disord. 2020;21(1):108. https://doi.org/10.1186/s12891-020-3130-y.

    Article  Google Scholar 

  50. Migliorini F, LĂĽring C, Eschweiler J, et al. Isolated arthroscopic lateral retinacular release for lateral patellar compression syndrome. Life. 2021;11(4):295. https://doi.org/10.3390/life11040295.

    Article  Google Scholar 

  51. Saper MG, Shneider DA. Diagnosis and treatment of lateral patellar compression syndrome. Arthrosc Tech. 2014;3(5):e633–8. https://doi.org/10.1016/j.eats.2014.07.004.

    Article  Google Scholar 

  52. Hamawandi SA. Use of hyaluronic acid injection after arthroscopic release in lateral patellar compression syndrome with degenerative cartilage changes: randomized control trial. BMC Musculoskelet Disord. 2021;22(1):24. https://doi.org/10.1186/s12891-020-03876-0.

    Article  CAS  Google Scholar 

  53. Yang Y-P, Ling Y-D, Pang C-N, et al. Novel method for diagnosing lateral patellar compression syndrome using X-ray: a retrospective case-control study. Ann Transl Med. 2021;9(6):445. https://doi.org/10.21037/atm-20-6410.

    Article  Google Scholar 

  54. Hamawandi SA, Amin HI, Al-Humairi AK. Open versus arthroscopic release for lateral patellar compression syndrome: a randomized-controlled trial. Arch Orthop Trauma Surg. 2021;2021:878. https://doi.org/10.1007/s00402-021-03878-0.

    Article  Google Scholar 

  55. Fithian DC, Paxton EW, Lou SM, et al. Epidemiology and natural history of acute patellar dislocation. Am J Sports Med. 2004;32(5):1114–21. https://doi.org/10.1177/0363546503260788.

    Article  Google Scholar 

  56. Waterman BR, Belmont PJ, Owens BD. Patellar dislocation in the United States: role of sex, age, race, and athletic participation. J Knee Surg. 2011;25(1):51–8. https://doi.org/10.1055/s-0031-1286199.

    Article  Google Scholar 

  57. Laidlaw M, Diduch D. Current concepts in the management of patellar instability. Indian J Orthop. 2017;51(5):493–504. https://doi.org/10.4103/ortho.IJOrtho_164_17.

    Article  Google Scholar 

  58. Camarda L, D’Arienzo A, Morello S, Guarneri M, Balistreri F, D’Arienzo M. Bilateral ruptures of the extensor mechanism of the knee: a systematic review. J Orthop. 2017;14(4):445–53. https://doi.org/10.1016/j.jor.2017.07.008.

    Article  Google Scholar 

  59. Yousef MAA. Combined avulsion fracture of the tibial tubercle and patellar tendon rupture in pediatric population: case series and review of literature. Eur J Orthop Surg Traumatol. 2018;28(2):317–23. https://doi.org/10.1007/s00590-017-2048-z.

    Article  Google Scholar 

  60. Lu M, Johar S, Veenema K, Goldblatt J. Patellar tendon rupture with underlying systemic lupus erythematosus: a case report. J Emerg Med. 2012;43(1):e35–8. https://doi.org/10.1016/j.jemermed.2009.08.054.

    Article  Google Scholar 

  61. Hsu H, Siwiec RM. Patellar tendon rupture. Treasure Island: StatPearls Publishing; 2021.

    Google Scholar 

  62. Weppe F, Demey G, Fary C, Neyret P. Fractures of the patella. In: Bentley G, editor. European surgical orthopaedics and traumatology. Berlin: Springer; 2014. https://doi.org/10.1007/978-3-642-34746-7_230.

    Chapter  Google Scholar 

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Varlotta, C., O’Connor, I. (2022). Patellofemoral Pathologies. In: Leong, M., Cooper, G., Herrera, J.E., Murphy, P. (eds) A Case-Based Approach to Knee Pain. Springer, Cham. https://doi.org/10.1007/978-3-031-15356-3_5

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