1. MYSTERY OF KNEE PAIN: Black Hole Of Orthopedics:
Patellofemoral Joint Dr.Sandeep Agrawal Consultant Orthopedic
Surgeon MS,DNB Agrasen Hospital Gondia Maharashtra India
[email protected]
2. Patella contact area At full extension, the distal portion
of the patella is in contact with the superior portion of the
trochlea As knee flexion, the contact area moves proximately
Contact area increases from 0.8 cm2 at knee full extension to 4 cm2
at 90 of flexion (Hehne, 1990)
3. Patella contact area Goodfellow J, Hungerford DS, Zindel M.
Patellofemoral joint mechanics and pathology J Bone Joint Surg (Br)
1976; 58-B: 287-290 20 45 90 135
4. Lateral tilt and displacement of patella: considered
characteristic features of patellofemoral pain syndrome Suggested
that : abnormal patellar tilt and displacement detected best with
the knee near full extension, before the patella becomes engaged in
the trochlear groove. which requires CT or MRI Patellofemoral
Disorders
5. 5 Patellofemoral Pain:Black Hole:
6. 6 Theories:
7. 7 Sources of Pain:
8. Common Causes of Patellofemoral Pain 1. Muscular Excessive
muscle tightness (inflexibility), rapid teenage growth or poor
conditioning Fatigue or tearing(strain) of quadriceps or hamstring
muscles , Muscular strength imbalances, Overuse/disuse : bending
overuse, too aggressive in starting a fitness program runners and
athletes that over train
9. Common Causes of Patellofemoral Pain 2. Structural damage
patella arthritis, stress fracture, direct traumatic injury
10. Common Causes of Patellofemoral Pain 3. Congenital
dysplasia patella alta(high patella), facet or trochlear
dysplasia
11. Common Causes of Patellofemoral Pain 4. Malalignment tilted
patella, intoeing rotation of the legs(persistent femoral
anteversion) knock knee (excessive valgus deformity)
12. Common Causes of Patellofemoral Pain 5. Instability of the
patella : Maltracking with subluxation(partial) or complete
dislocation of the knee cap: Damaged or stretched ligament support
Acute dislocation After repair
13. Common Causes of Patellofemoral Pain 6. Inflammatory :
Bursitis,Tendinitis Jumpers knee: Patella tendinitis results from
excessive overload or overuse of the extensor mechanism of the knee
7. Synovial plica
14. Radiographic Measures in Subjects Who Are Asymptomatic and
Subjects With Patellofemoral Pain Syndrome CORR (414) 2003,p172
lateral patellar angle congruence angle Catons ratio B/A 35 knee
flexion unloaded or loaded
15. There is no significant abnormal patellar alignment
detectable in subjects with patellofemoral pain syndrome at 35 knee
flexion It is possible that the patellar malpositioning in subjects
with patellofemoral pain syndrome is too subtle to be measured at
one static imaging angle
16. Lateral tubercle deviation Tibial tubercle lateralization
greater than 10 mm and a lateral patellofemoral angle less than 8
were predictive of anterior knee pain with a specificity of 95% and
a sensitivity of 64% Arthroscopy June 2006 Volume 22 Number 6
17. Patellofemoral Pain Syndrome Overuse ???? Neurogenic
factors ??? To think of anterior knee pain or patellar instability
as somehow being necessarily tied to PFM [patellofemoral
malalignment] is an oversimplification that has positively
stultified progress toward better diagnosis and treatment
18. Patellofemoral Pain Syndrome Malalignment of the extensor
mechanism :probably has a role in the multifactorial pathogenesis
of patellofemoral pain and altered patellofemoral biomechanics.
Contribution of extensor mechanism malalignment to patellofemoral
pain and altered biomechanics may change on the basis of the
frequency and magnitude of physiological weight-bearing and
non-weight- bearing loading conditions