1. 1. MYSTERY OF KNEE PAIN: Black Hole Of Orthopedics: Patellofemoral Joint Dr.Sandeep Agrawal Consultant Orthopedic Surgeon MS,DNB Agrasen Hospital Gondia Maharashtra India drsandeep123@gmail.com
2. 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. 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. 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. 5 Patellofemoral Pain:Black Hole:
6. 6. 6 Theories:
7. 7. 7 Sources of Pain:
8. 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. 9. Common Causes of Patellofemoral Pain 2. Structural damage patella arthritis, stress fracture, direct traumatic injury
10. 10. Common Causes of Patellofemoral Pain 3. Congenital dysplasia patella alta(high patella), facet or trochlear dysplasia
11. 11. Common Causes of Patellofemoral Pain 4. Malalignment tilted patella, intoeing rotation of the legs(persistent femoral anteversion) knock knee (excessive valgus deformity)
12. 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. 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. 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. 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. 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. 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. 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
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