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Imaging in Patellofemoral Pain

  • Vivek Kalia
  • Douglas N. Mintz
Chapter

Abstract

Anatomic function of the patellofemoral compartment requires congruency and synergy of its osseous and soft tissue components. At different degrees of flexion, various components provide the main stabilizing force protecting against lateral patellar maltracking. Knowing the anatomy allows for a better understanding of patterns of injury seen on imaging (e.g., lateral trochlear bone contusion seen with transient lateral patellar dislocations). Anatomic variants can predispose to particular pathologies and outcomes, and some of these variants can be associated with pain (e.g., trochlear dysplasia), while others are typically not (e.g., bipartite patella).

When imaging the patellofemoral joint, a radiographic series is the best initial examination to evaluate the osseous structures and their relationships and to form an impression of what soft tissue injuries may be present given secondary findings. Axial radiographic views allow for evaluation of patellar alignment, position, and joint space, while MRI offers excellent visualization of soft tissue and cartilage.

Specific causes of patellofemoral pain can be broadly split into three categories: (1) acute trauma, (2) overuse injuries ± anatomic issues, and (3) arthritis, all of which can be evaluated with imaging. Some causes of patellofemoral pain, such as fat pad impingement syndrome, patellofemoral overload syndrome, and chondral/osteochondral abnormalities, are best imaged with MRI. Others, such as patellofemoral osteoarthritis and chronic overuse injuries like Osgood-Schlatter syndrome and Sinding-Larsen-Johansson syndrome, are evaluated on radiographs. Advanced cartilage imaging techniques such as T1 rho mapping, T2 mapping, and dGEMRIC (delayed gadolinium-enhanced magnetic resonance imaging of cartilage) can evaluate cartilage ultrastructure.

Keywords

Patellofemoral pain Anterior knee pain Patellofemoral joint replacement MRI CT X-ray Cartilage imaging 

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Vivek Kalia
    • 1
  • Douglas N. Mintz
    • 1
  1. 1.Hospital for Special SurgeryNew YorkUSA

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