Skip to main content
SpringerLink
Log in

A Philosophy of the Patellofemoral Joint: A Logical Clinical Approach

  • Chapter
  • First Online:
Anterior Knee Pain and Patellar Instability

Abstract

A philosophy or pathomechanical and pathophysiological theory of the patellofemoral joint is described which leads to a logical etiology-based clinical classification, provides a framework for measurement and analysis of the six anatomic abnormalities that affect the normal function of the patellofemoral joint, and presents a simple and logical approach to treatment, both operative and nonoperative. This theory, based on the careful clinical measurement of these six potential abnormalities, is also able to explain the two major symptoms of patellofemoral disorders, anterior knee pain and patellar instability, using available scientific data.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Aglietti P, Insall JH, Cerulli G. Patellar pain and incongruence. I: measurements of incongruence. Clin Orthop Relat Res. 1983;122:217-224.

    Google Scholar 

  2. Beaconsfield T, Pintore E, Maffulli N, et al. Radiological measurements in patellofemoral disorders. A review. Clin Orthop Relat Res. 1994;308:18-28.

    PubMed  Google Scholar 

  3. Berg EE, Mason SL, Lucas MJ. Patellar height ratios: a comparison of four measurement methods. Am J Sports Med. 1996;24:218-221.

    Article  PubMed  CAS  Google Scholar 

  4. Besier TF, Gold GE, Beaupre GS, et al. A modeling framework to estimate patellofemoral joint cartilage stress in vivo. Med Sci Sports Exerc. 2005;37:1924-1930.

    Article  PubMed  Google Scholar 

  5. Bose K, Kanagasuntheram R, Osman MBH. Vastus medialis oblique: an anatomic and physiologic study. Orthopedics. 1980;3:880-883.

    Google Scholar 

  6. Brattstrom H. Shape of the intercondylar groove normally and in recurrent dislocation of the patella: a clinical and x-ray anatomical investigation. Acta Orthop Scand. 1964;68(suppl):1-147.

    Google Scholar 

  7. Davies AP, Costa ML, Donnell ST, et al. The sulcus angle and malalignment of the extensor mechanism of the knee. J Bone Joint Surg Br. 2000;82:1162-1166.

    Article  PubMed  CAS  Google Scholar 

  8. Dehaven KE, Dolan WA, Mayer PJ. Chondromalacia patellae in athletes. Am J Sports Med. 1979;7:5-11.

    Article  PubMed  CAS  Google Scholar 

  9. Dejour H, Neyret P, Walch G. Factors in patellar instability. In: Aichroth PM, Cannon WD Jr, Patel DV, eds. Knee Surgery: Current Practice. London: Martin Dunitz Limited; 1992.

    Google Scholar 

  10. Dye SF. An evolutionary perspective of the knee. J Bone Joint Surg Am. 1987;69:976-983.

    PubMed  CAS  Google Scholar 

  11. Dye SF. The knee as a biologic transmission with an envelope of function: a theory. Clin Orthop Relat Res. 1996;325: 10-18.

    Article  PubMed  Google Scholar 

  12. Fulkerson JP, Tennet R, Jaivin JS, et al. Histologic evidence of retinacular nerve injury associated with patellofemoral alignment. Clin Orthop Relat Res. 1985;197:196-205.

    PubMed  Google Scholar 

  13. Grelsamer RP, Dubey A, Weinstein CH. Men and women have similar Q angles: a clinical and trigonometric evaluation. J Bone Joint Surg Br. 2005;87:1498-1501.

    PubMed  CAS  Google Scholar 

  14. Hauser EW. Total tendon transplant for slipping patella. Surg Gynecol Obstet. 1938;66:199-203.

    Google Scholar 

  15. Heiple KG, Lovejoy CO. The distal femoral anatomy of Australopithecus. Am J Phys Anthropol. 1971;35:75-84.

    Article  PubMed  CAS  Google Scholar 

  16. Jan MH, Lin DH, Lin JJ, et al. Differences in sonographic characteristics of the vastus medialis obliquus between patients with patellofemoral pain syndrome and healthy adults. Am J Sports Med. 2009;37:1743-1749.

    Article  PubMed  Google Scholar 

  17. Jones RB, Bartlett EC, Vainright JR, et al. CT determination of tibial tubercle lateralization in patients presenting with anterior knee pain. Skeletal Radiol. 1995; 24:505-509.

    Article  PubMed  CAS  Google Scholar 

  18. Kempson GE. Mechanical properties of articular cartilage. In: Freeman MAR, ed. Adult Articular Cartilage. 2nd ed. Kent: Pitman Medical Publishing; 1979.

    Google Scholar 

  19. Lin YF, Lin JJ, Jan MH, et al. Role of the vastus medialis obliquus in repositioning the patella: a dynamic computed tomography study. Am J Sports Med. 2008;36:741-746.

    Article  PubMed  Google Scholar 

  20. Lovejoy CO. The natural history of human gait and posture. Part 3. The knee. Gait Posture. 2007;25:325-341.

    Article  PubMed  Google Scholar 

  21. Lovejoy CO. Personal communication. 2009.

    Google Scholar 

  22. Merchant AC. Classification of patellofemoral disorders. Arthroscopy. 1988;4:235-240.

    Article  PubMed  CAS  Google Scholar 

  23. Merchant AC. Patellofemoral disorders: biomechanics, diagnosis, and non-operative treatment. In: McGinty JB, Casperi RB, Jackson RW, Poehling GG, eds. Operative Arthroscopy. New York: Raven; 1991.

    Google Scholar 

  24. Merchant AC. Patellofemoral joint disorders. In: Chapman MW, ed. Chapman’s Orthopaedic Surgery. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2001.

    Google Scholar 

  25. Merchant AC, Mercer RL. Lateral release of the patella: a preliminary report. Clin Orthop Relat Res. 1974;103:40-45.

    Article  PubMed  Google Scholar 

  26. Merchant AC, Mercer RL, Jacobsen RH, et al. Roen­tgenographic analysis of patellofemoral congruence. J Bone Joint Surg Am. 1974;56:1391-1396.

    PubMed  CAS  Google Scholar 

  27. Metin-Cubuk S, Sindel M, Karaali K, et al. Tibial tubercle position and patellar height as indicators of malalignment in women with anterior knee pain. Clin Anat. 2000;13:199-203.

    Article  PubMed  CAS  Google Scholar 

  28. Miyanishi K, Nagamine R, Murayama S, et al. Tibial tubercle malposition in patellar joint instability: a computed tomography study in full extension and at 30 degree flexion. Acta Orthop Scand. 2000;71:286-291.

    Article  PubMed  CAS  Google Scholar 

  29. Muneta T, Yamamoto H, Ishibashi T, et al. Computerized tomographic analysis of tibial tubercle position in the painful female patellofemoral joint. Am J Sports Med. 1994;22:67-71.

    Article  PubMed  CAS  Google Scholar 

  30. Post WR. Clinical evaluation of patients with patellofemoral disorders. Arthroscopy. 1999;15:841-851.

    Article  PubMed  CAS  Google Scholar 

  31. Senavongse W, Amis AA. The effects of articular, retinacular, or muscular deficiencies on patellofemoral joint stability. J Bone Joint Surg Br. 2005;87:577-582.

    PubMed  CAS  Google Scholar 

  32. Smith RL, Carter DR, Schurman DJ. Pressure and shear differentially alter human articular chondrocyte metabolism. Clin Orthop Relat Res. 2004;427S:S89-S95.

    Google Scholar 

  33. Tsujimoto K, Kurosaka M, Yoshiya S, et al. Radiographic and computed tomographic analysis of the position of the tibial tubercle in recurrent dislocation and subluxation of the patella. Am J Knee Surg. 2000;13:83-88.

    PubMed  CAS  Google Scholar 

  34. Weightman B, Kempson GE. Load carriage. In: Freeman MAR, ed. Adult Articular Cartilage. 2nd ed. Kent: Pitman Medical Publishing; 1979.

    Google Scholar 

  35. Wittstein JR, Bartlett EC, Easterbrook J, et al. Magnetic resonance imaging evaluation of patellofemoral malalignment. Arthroscopy. 2006;22:643-649.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Stanford University School of Medicine, Stanford, CA, USA

    Alan C. Merchant

  2. Department of Orthopedic Surgery, El Camino Hospital, Mountain View, CA, USA

    Alan C. Merchant

Authors
  1. Alan C. Merchant
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alan C. Merchant .

Editor information

Editors and Affiliations

  1. Depto. Cirugia Ortopédica, Hospital Arnau de Vilanova, c/San Clemente 12, Valencia, 46015, Spain

    Vicente Sanchis-Alfonso

Rights and permissions

Reprints and permissions

Copyright information

© 2011 Springer-Verlag London Limited

About this chapter

Cite this chapter

Merchant, A.C. (2011). A Philosophy of the Patellofemoral Joint: A Logical Clinical Approach. In: Sanchis-Alfonso, V. (eds) Anterior Knee Pain and Patellar Instability. Springer, London. https://doi.org/10.1007/978-0-85729-507-1_47

Download citation

  • DOI: https://doi.org/10.1007/978-0-85729-507-1_47

  • Published:

  • Publisher Name: Springer, London

  • Print ISBN: 978-0-85729-506-4

  • Online ISBN: 978-0-85729-507-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation