Anterior knee pain (original) (raw)
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https://ijshr.com/IJSHR\_Vol.6\_Issue.2\_April2021/IJSHR-Abstract.038.html, 2021
Objectives: The Patellofemoral joint (PFJ) is a complex joint structure with high functional and biomechanical requirements. The purpose of this study is to evaluate cause of patella-femoral joint instability with in-depth evaluation of influence of anatomical risk factors (AF), measurements and anatomical relationships of the patellofemoral joint and various pathologies causing medial patellofemoral ligament (MPFL) injury that contributes to the patellar maltracking using 1.5 Tesla magnetic resonance imaging. Materials and Methods: The present prospective study is carried out at department of radiology, shri M P Shah Medical College, Jamnagar. This is study of total 50 patients carried out in 12-month duration from July 2019 to June 2020, in which 50 patients aged between 8 - 68 years selected as study group presented with complaint symptoms of patellofemoral instability, knee pain and maltracking were examined and identified by an orthopaedic surgeon. Patients with the clinical suspicion of a PFJ maltracking were selected for subsequent MRI examination. Results: The age distribution in our study was in range of 8 years to 68 years with maximum population within 31 to 40 years range, 66 % were male and 34 % female. Their trochlear depth, sulcal angle, trochlear facet asymmetry, lateral inclination angle was found abnormal in 18 cases (36%), 8 (16%) showed patellar alta and 7 (14%) patella baja. Lateralization of patella (> 6 mm) was noted in 18 patients (36%), Medial patellofemoral ligament injuries were seen in 16 (32%) patients on MRI and kissing contusion 10 (20%) patients. A detailed understanding of the anatomy and pathology of the anterior knee compartment is essential for proper imaging interpretation and treatment management. Conclusion: Magnetic resonance (MR) imaging has been established as the method of choice, showing high accuracy in patellofemoral joint abnormalities. The present study aims to explore the role of MR imaging in diagnosing the various disorders located in anterior compartment of knee.
Role of MRI in assessment of patello-femoral derangement in patients with anterior knee pain
The Egyptian Journal of Radiology and Nuclear Medicine, 2016
Objective: To assess the diagnostic accuracy of magnetic resonance imaging (MRI) in evaluating patello-femoral instability as a cause of anterior knee pain (AKP) and its predisposing factors. Methods: 55 knees of 50 adult patients below 40 years complaining of AKP underwent MRI between February 2013 and February 2015. The patients were analyzed prospectively for the presence of bone, hyaline cartilage and soft-tissue abnormalities, as well as anatomic variants that may contribute to patello-femoral maltracking or impingement abnormalities. Our results were compared to those of the arthroscopic and mini open exploration procedures. Results: In the 55 knees analyzed for patello-femoral instability cartilaginous injuries were found in 58%, with an MRI sensitivity of 88%, disruption of the medial patello-femoral ligament (MPFL) in 31% with an MRI sensitivity 84%, joint morphology abnormalities in 74.5% of patients, bone edema in 27% of patients and Hoffa's fat pad edema in 30 patients (55%). MRI had a sensitivity of 84% and accuracy of 81% in determining the injury site and pattern. Conclusion: MRI is reliable imaging modality in identifying the risk factors that may contribute to the development of patello-femoral maltracking or impingement permitting individual tailored treatment.
Magnetic Resonance Imaging Evaluation of Patellofemoral Malalignment
Arthroscopy: The Journal …, 2006
The purpose of this study was to determine the relationship between anterior knee pain secondary to suspected patellofemoral malalignment and tibial tubercle lateralization, patellar tilt, and patellar lateralization on magnetic resonance imaging. Methods: We compared the bony relationships of the knee in patients with anterior knee pain and patients with nonspecific internal derangements of the knee. We measured the lateral deviation of the tibial tubercle and the patella from the trochlea, patellar tilt, and patellar and patellar tendon length. Results: The symptomatic knees of patients with anterior knee pain had significantly (P Յ .01) greater lateralization of the tibial tubercle and lateral patellar tilt than did knees of the control group. Patella alta appears to be more common in subjects with anterior knee pain. Conclusions: Magnetic resonance imaging determination of tibial tubercle lateralization and patellar tilt correlates positively with the clinical diagnosis of anterior knee pain, suggesting that patellofemoral pain is caused by subtle malalignment. Level of Evidence: Level III, development of diagnostic criteria on basis of nonconsecutive patients.
Fluoroscopic Video Imaging as a Clinical Tool for Assessing Patellar Maltracking
Medicine & Science in Sports & Exercise, 2015
One of the most common overuse injuries among runners is patellofemoral pain (PFP). This pathological condition develops from abnormal gliding of the patella, and can ultimately result in increased muscle weakness and compromise knee joint kinetics. A clinical evaluation of patellar instability is the J sign, which is a lateral deviation of the tracking of the patella as the patient approaches full knee extension. The use of kinesiology tape is often recommended for facilitating the muscle healing process and muscle function; however, no accessible clinical tool has been available to quantify levels of lateral deviation utilizing this or any other intervention designed to improve patellar tracking. PURPOSE: To use fluoroscopic video imaging to assess the effectiveness of kinesiology tape in mitigating patellar maltracking in patients affected by PFP. METHODS: Four subjects (1M, 3F) affected by PFP and diagnosed with patellar maltracking participated to this study. The patellofemoral kinematics with and without kinesiology taping were investigated via a quantitative analysis of fluoroscopic video images using a 5mm spherical stereotactic marker to visualize the patellar centroid during isokinetic knee extension from 1.05 to 1.57 rad at 1.05 rad•s-1. A t-test (α=.05) was used to assess percent differences in medial-lateral excursion between conditions. RESULTS: Using our fluoroscopic video imaging technique we were able to track the movement of the patella throughout the knee extension exercise and compare the degree of patellar lateral displacement with and without taping. The application of kinesiology tape reduced the patellar medial-lateral excursion by 30.4±10.7% (mean±SE; p<.01). CONCLUSIONS: The use of fluoroscopy may prove an important quantitative tool for assessing patellar maltracking. This study should be repeated using a much larger sample of patients with varying levels of pain, and other clinical presentations, so that normative scores can be developed, thereby increasing the diagnostic value of this methodology.
Current clinical, radiological and treatment perspectives of patellofemoral pain syndrome
The British journal of radiology, 2018
Anterior knee pain in active young adults is commonly related to patellofemoral pain syndrome, which can be broadly classified into patellar malalignment and patellar maltracking. Imaging is performed to further elucidate the exact malalignment and maltracking abnormalities and exclude other differentials. This article details the role of the stabilizers of the patellofemoral joint, findings on conventional and multimodality imaging aiding in patellofemoral pain syndrome diagnosis and characterization, and current perspectives of various treatment approaches.
Knee Surgery, Sports Traumatology, Arthroscopy, 2016
had normal tracking patterns; 41 (82 %) had increased lateral translation in extension, which we termed the J-sign pattern; 4 (8 %) had persistent lateralization of the patella throughout range of motion; and 1 had increased lateral translation in flexion. In knees with the J-sign pattern, degree of maltracking was graded by severity: J1 (n = 24), J2 (n = 19), and J3 (n = 15). The sensitivities of J-sign grades in predicting patellar instability symptoms were 50 % (J1), 80 % (J2), and 93 % (J3) (p < 0.01). There were significant differences in sensitivity between knees with no J sign or J1 versus J2 or J3 (p = 0.02). Conclusion DKCT showed several patellar maltracking patterns in patients with patellar instability. A J-sign pattern with more than two quadrants of lateral translation correlated with the presence of patellar instability symptoms. Incorporation of this approach of objectively quantifying maltracking patterns is recommended in the evaluation of patellofemoral instability. Level of evidence IV.
Usefulness of magnetic resonance imaging in the evaluation of patellar malalignment
Revista Española de Cirugía Ortopédica y Traumatología (English Edition), 2014
The aim of this study is to evaluate the usefulness of magnetic resonance imaging (MRI) at 20 • of knee flexion in patients with patellofemoral pain syndrome (PFPS) caused by suspected patellofemoral malalignment (PFM). Materials and methods: Fifty MRIs were performed on 25 patients with PFPS secondary to suspected PFM based on clinical examination, and on 25 patients without PFPS (control group). Measurements were made of tibial tuberosity-trochlear groove distance (TTTG) and modified Laurin, Merchant and trochlear angles. The results were analyzed with ANOVA and Fischer's tests. Pearson's correlation coefficients were used to analyze differences between PFPS and control cases. Specificity, sensitivity, positive predictive value and negative predictive value for knee pain were documented. Results: Significant differences were observed between PFPS and control groups in TTTG (11.79 mm vs. 9.35 mm; P = .002), Laurin angle (12.17 • vs. 15.56 • ; P = .05), and trochlear angle (139 • vs. 130.02 • ; P = .049). No differences were found between groups as regards the merchant angle (P = .5). TTTG was 70% predictive of PFPS; however, it was only 53.33% specific, with a sensitivity of 51.61% for PFPS. Laurin angle was 77.78% predictive of PFPS, with a specificity of 92% and a sensitivity of 28%. Trochlear angle was 85.71% predictive of PFPS, with a specificity of 96% and a sensitivity of 24%. Conclusions: MRI can confirm clinically suspected PFPS secondary to malalignment. MRI determination of TTTG, patellar tilt, and trochlear angle correlates positively with clinical diagnosis of PFPS, suggesting that PFPS is caused by subtle malalignment.