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The Patella pp 127–141Cite as

Conservative Care of Patellofemoral Pain

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Abstract

Anterior knee pain is a common complaint of patients presenting to a general orthopedic or orthopedic sports medicine practice. Appropriate treatment of this problem begins with a careful and complete initial evaluation, involving a thorough history, a physical examination, and proper radiologic examinations. After a correct and specific diagnosis is made,1,2 conservative treatment with a patient active rehabilitation program may be pre-scribed. In this chapter, we will review our approach to patients with patellofemoral symptoms and discuss our philosophy of conservative treatment.

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References

References

  1. Merchant A: Classification of patellofemoral disorders. Arthroscopy 1988; 4: 235–240.

    Article  PubMed  CAS  Google Scholar 

  2. Jacobson K, Flandry F: Diagnosis of anterior knee pain. Clin Sports Med 1989; 8: 179–195.

    PubMed  CAS  Google Scholar 

  3. Tindel N, Nisonson B: The plica syndrome. Orthop Clin North Am 1992; 23: 613–618.

    PubMed  CAS  Google Scholar 

  4. Aglietti P, Buzzi R, D’Andria S, et al.: Patellofemoral problems after intra-articular anterior cruciate reconstruction. Clin Orthop 1993; 288: 195–204.

    PubMed  Google Scholar 

  5. Fulkerson J, Shea K: Current concepts review. Disorders of patellofemoral alignment. J Bone Joint Surg Am 1990; 72A: 1424–1429.

    PubMed  CAS  Google Scholar 

  6. Beckman M, Craig R, Lehman R: Rehabilitation of patellofemoral disfunction in the athlete. Clin Sports Med 1989; 8: 841–860.

    PubMed  CAS  Google Scholar 

  7. Cox J: Patellofemoral problems in runners. Clin Sports Med 1985; 4: 699–715.

    PubMed  CAS  Google Scholar 

  8. Aglietti P, Insall J, Cerulli G: Patellar pain and incongruence. I: Measurements of incongruence. Clin Orthop 1983; 176: 217–224.

    PubMed  Google Scholar 

  9. Horton M, Hall T: Quadriceps femoris muscle angle: Normal values and relationships with gender and selected skeletal measures. Phys Ther 1989; 69: 897–901.

    PubMed  CAS  Google Scholar 

  10. Kettlekamp D: Current concepts review. Management of patellar malalignment. J Bone Joint Surg Am 1981; 63A: 1344–1348.

    Google Scholar 

  11. Fulkerson J: Awareness of the retinaculum in evaluating patellofemoral pain. Am J Sports Med 1982; 10: 147–149.

    Article  PubMed  CAS  Google Scholar 

  12. Fulkerson J: Evaluation of the peripatellar soft tissues and retinaculum in patients with patellofemoral pain. Clin Sports Med 1989; 8: 197–202.

    PubMed  CAS  Google Scholar 

  13. Kolowich P, Paulos L, Rosenberg T, et al.: Lateral release of the patella: Indications and contraindications. Am J Sports Med 1990, 18: 359–365.

    Article  PubMed  CAS  Google Scholar 

  14. Hungerford D, Barry M: Biomechanics of the patellofemoral joint. Clin Orthop 1979; 144: 9–15.

    PubMed  Google Scholar 

  15. Rosenberg T, Paulos L, Parker R, et al.: The 45° posteroanterior flexion weight-bearing radiograph of the knee. J Bone Joint Surg Am 1988; 70A: 1479–1483.

    PubMed  CAS  Google Scholar 

  16. Blackburne J, Peel T: A new method of measuring patellar height. J Bone Joint Surg Br 1977; 59B: 241–242.

    PubMed  CAS  Google Scholar 

  17. Merchant A, Mercer R, Jacobsen R, et al.: Roentgenographs analysis of patellofemoral congruence. J Bone Joint Surg Am 1974; 56A: 1391–1396.

    PubMed  CAS  Google Scholar 

  18. Laurin C, Dussault R, Levesque H: The tangential x-ray investigation of the patellofemoral joint. Clin Orthop 1979; 144: 16–26.

    PubMed  Google Scholar 

  19. Dowd G, Bentley G: Radiographic assessment in patellar instability and chondromalacia patellae. J Bone Joint Surg Br 1986; 68B: 297–300.

    PubMed  CAS  Google Scholar 

  20. Schutzer S, Ramsby G, Fulkerson J: Computed tomographic classification of patellofemoral pain patients. Orthop Clin North Am 1986; 17: 235–248.

    PubMed  CAS  Google Scholar 

  21. Ghelman B, Hodge J: Imaging of the patellofemoral joint. Orthop Clin North Am 1992; 23: 532–543.

    Google Scholar 

  22. Dye S, Boll D: Radionuclide imaging of the patellofemoral joint in young adults with anterior knee pain. Orthop Clin North Am 1986; 17: 249–261.

    PubMed  CAS  Google Scholar 

  23. McCauley T, Kier R, Lynch K, et al.: Chon-dromalacia patellae: Diagnosis with MR imaging. AJR 1992; 158: 101–105.

    PubMed  CAS  Google Scholar 

  24. Sandow M, Goodfellow J: The natural history of anterior knee pain in adolescents. J Bone Joint Surg Br 1985; 67B: 36–38.

    PubMed  CAS  Google Scholar 

  25. Casscells S: The arthroscope in the diagnosis of disorders of the patellofemoral joint. Clin Orthop 1979; 144: 45–50.

    PubMed  Google Scholar 

  26. Fu F, Maday M: Arthroscopic lateral release and the lateral patellar compression syndrome. Orthop Clin North Am 1992; 23: 601–612.

    PubMed  CAS  Google Scholar 

  27. Greenfield M, Scott W: Arthroscopic evaluation and treatment of the patellofemoral joint. Orthop Clin North Am 1992; 23: 587–600.

    PubMed  CAS  Google Scholar 

  28. Ceder L, Larson R: Z-plasty lateral retinacular release for the treatment of patellar compression syndrome. Clin Orthop 1979; 144: 110–113.

    PubMed  Google Scholar 

  29. Dandy D, Griffiths D: Lateral release for recurrent dislocation of the patella. J Bone Joint Surg Br 1989; 71B: 121–125.

    PubMed  CAS  Google Scholar 

  30. Zappala F, Taffel C, Scuderi G: Rehabilitation of patellofemoral joint disorders. Orthop Clin North Am 1992; 23: 555–566.

    PubMed  CAS  Google Scholar 

  31. McConnell J: The management of chondromalacia patella: A long term solution. Aust J Physiother 1986; 32: 215–223.

    Google Scholar 

  32. Shelton G: Conservative management of patellofemoral dysfunction. Prim Care 1992; 19: 331–350.

    PubMed  CAS  Google Scholar 

  33. Insall J: “Chondromalacia patellae”: Patellar malalignment syndrome. Orthop Clin North Am 1979;10:117–127.

    Google Scholar 

  34. Muller E: Influence of training and of inactivity on muscle strength. Arch Phys Med Rehabil 1970; 51: 449–462.

    PubMed  CAS  Google Scholar 

  35. Henry J: Conservative treatment of patellofemoral subluxation. Clin Sports Med 1989; 8: 261–278.

    PubMed  CAS  Google Scholar 

  36. Chrisman D: The role of articular cartilage in patellofemoral pain. Orthop Clin North Am 1986; 17: 231–234.

    PubMed  CAS  Google Scholar 

  37. Chrisman D, Snook G, Wilson T: The protective effect of aspirin against degeneration of human articular cartilage. Clin Orthop 1972; 84: 193–196.

    Article  PubMed  CAS  Google Scholar 

  38. Steadman J: Nonoperative measures for patellofemoral problems. Am J Sports Med 1979; 7: 374–375.

    Article  PubMed  CAS  Google Scholar 

  39. Cherf J, Paulos L: Bracing for patellar instability. Clin Sports Med 1990; 9: 813–821.

    PubMed  CAS  Google Scholar 

  40. Palumbo P: Dynamic patellar brace: A new orthosis in the management of patellofemoral disorders. Am J Sports Med 1981; 9: 45–49.

    Article  PubMed  Google Scholar 

  41. Villar R: Patellofemoral pain and the infrapatellar brace. Am J Sports Med 1985; 13: 313–315.

    Article  PubMed  CAS  Google Scholar 

  42. Hanten W, Schulthies S: Exercise effect on electromyographic activity of the vastus medialis oblique and vastus lateralis muscles. Phys Ther 1990; 70: 561–565.

    PubMed  CAS  Google Scholar 

  43. Ingersoll C, Knight K: Patellar location changes following EMG biofeedback of progressive resistive exercises. Med Sci Sports Exerc 1991; 23: 1122–1127.

    PubMed  CAS  Google Scholar 

  44. Soderberg G, Minor S, Arnold K, et al.: Electromyographic analysis of knee exercises in healthy subjects and in patients with knee pathologies. Phys Ther 1987; 67: 1691–1696.

    PubMed  CAS  Google Scholar 

  45. Ericson M, Nisell R: Patellofemoral joint forces during ergometric cycling. Phys Ther 1987; 67: 1365–1369.

    PubMed  CAS  Google Scholar 

  46. DeHaven K, Dolan W, Mayer P: Chondromalacia patellae in athletes: Clinical presentation and conservative management. Am J Sports Med 1979; 7: 5–11.

    Article  PubMed  CAS  Google Scholar 

  47. Fulkerson J: The etiology of patellofemoral pain in young, active patients. Clin Orthop 1983; 179: 129–133.

    PubMed  Google Scholar 

  48. Malek M, Mangine R: Patellofemoral pain syndromes: A comprehensive and conservative approach. J Orthop Sports Phys Ther 1981; 2: 108–116.

    PubMed  CAS  Google Scholar 

Suggested Readings

  • Bentley G, Dowd G: Current concepts of etiology and treatment of chondromalacia patellae. Clin Orthop 1984; 189: 209–228.

    PubMed  Google Scholar 

  • Bigos S, McBride G: The isolated lateral retinacular release in the treatment of patellofemoral disorders. Clin Orthop 1984; 186: 75–80.

    PubMed  Google Scholar 

  • Bose K, Kanagasuntheram R, Osman M: Vastus medialis oblique: An anatomic and physiologic study. Orthopedics 1980; 3: 880–883.

    Google Scholar 

  • Brattstrom H: Patella alta in nondislocating knee joints. Acta Orthop Scand 1970; 41: 578–588.

    Article  PubMed  CAS  Google Scholar 

  • Broom M, Fulkerson J: The plica syndrome: A new prospective. Orthop Clin North Am 1986; 17: 279–281.

    PubMed  CAS  Google Scholar 

  • Chen S, Ramanathan E: The treatment of patellar instability by lateral release. J Bone Joint Surg Br 1984; 66B: 344–348.

    PubMed  CAS  Google Scholar 

  • Crosby E, Insall J: Recurrent dislocation of the patella. J Bone Joint Surg Am 1976; 58A: 9–13.

    PubMed  CAS  Google Scholar 

  • Dandy D: Arthroscopy in the treatment of young patients with anterior knee pain. Orthop Clin North Am 1986; 17: 221–229.

    PubMed  CAS  Google Scholar 

  • Dzioba R: Diagnostic arthroscopy and longitudinal open lateral release. Am J Sports Med 1990; 18: 343–348.

    Article  PubMed  CAS  Google Scholar 

  • Carson W, James S, Larson R, et al.: Patellofemoral disorders: Physical and radiographic evaluation, part I physical examination. Clin Orthop 1984; 185: 165–177.

    PubMed  Google Scholar 

  • Carson W, James S, Larson R, et al.: Patellofemoral disorders: Physical and radiographic evaluation, part II radiographic examination. Clin Orthop 1984; 185: 178–186.

    PubMed  Google Scholar 

  • Fisher R: Conservative treatment of patellofemoral pain. Orthop Clin North Am 1986; 17: 269–272.

    PubMed  CAS  Google Scholar 

  • Fulkerson JP, Hungerford DS: Disorders of the Patello-Femoral Joint, ed. 2. Baltimore, Williams & Wilkiens Co., 1990.

    Google Scholar 

  • Goodfellow J, Hungerford D, Zindel M: Patellofemoral joint mechanics and pathology. Functional anatomy of the patellofemoral joint. J Bone Joint Surg Br 1976; 58B: 287–290.

    PubMed  CAS  Google Scholar 

  • Goodfellow J, Hungerford D, Woods C: Patellofemoral joint mechanics and pathology. Chon-dromalacia patellae. J Bone Joint Surg Br 1976; 58B: 291–299.

    PubMed  CAS  Google Scholar 

  • Grana W, Kriegshauser L: Scientific basis of extensor mechanism disorders. Clin Sports Med 1985; 4: 247–257.

    PubMed  CAS  Google Scholar 

  • Grood E, Suntay W, Noyes F, et al.: Biomechanics of the knee-extension exercise. J Bone Joint Surg Am 1984; 66A: 725–734.

    PubMed  CAS  Google Scholar 

  • Hallisey M, Doherty N, Bennett W, et al.: Anatomy of the junction of the vastus lateralis tendon and the patella. J Bone Joint Surg Am 1987; 69A: 545–549.

    PubMed  CAS  Google Scholar 

  • Hardaker W, Whipple T, Bassett F: Diagnosis and treatment of the plica syndrome of the knee. J Bone Joint Surg Am 1980; 62A: 221–225.

    PubMed  CAS  Google Scholar 

  • Hayes C, Sawyer R, Conway W: Patellar cartilage lesions: In vitro detection and staging with MR imaging and pathologic correlation. Radiology 1990; 176: 479–483.

    PubMed  CAS  Google Scholar 

  • Henry J, Goletz T, Williamson B: Lateral retinacular release in patellofemoral subluxation. Am J Sports Med 1986; 14: 121–129.

    Article  PubMed  CAS  Google Scholar 

  • Hungerford D, Lennox D: Rehabilitation of the knee and disorders of the patellofemoral joint: Relevant biomechanics. Orthop Clin North Am 1983; 14: 397–402.

    PubMed  CAS  Google Scholar 

  • Hughston J: Subluxation of the patella. J Bone Joint Surg Am 1968; 50A: 1003–1026.

    PubMed  CAS  Google Scholar 

  • Insall J: Patellar pain. J Bone Joint Surg Am 1982; 64A.:147–151.

    Google Scholar 

  • Insall J, Aglietti P, Tria A: Patellar pain and incongruence. II. Clinical application. Clin Orthop 1983; 176: 225–232.

    PubMed  Google Scholar 

  • Insall J, Salvati E: Patella position in the normal knee joint. Radiology 1971; 101: 101–104.

    PubMed  CAS  Google Scholar 

  • KauferH: Patellar biomechanics. Clin Orthop 1979; 144: 51–54.

    Google Scholar 

  • Lancourt J, Cristini J: Patella alta and patella infera. J Bone Joint Surg Am 1975; 57A: 1112–1115.

    PubMed  CAS  Google Scholar 

  • Larsen E, Lauridsen F: Conservative treatment of patellar dislocations. Clin Orthop 1982, 171: 131–136.

    PubMed  Google Scholar 

  • Lieb F, Perry J: Quadriceps function. J Bone Joint Surg Am 1968; 50A: 1535–1548.

    PubMed  CAS  Google Scholar 

  • Macdonald D, Hutton J, Kelly I: Maximal isometric patellofemoral contact force in patients with anterior knee pain. J Bone Joint Surg Br 1989; 71B: 296–299.

    PubMed  CAS  Google Scholar 

  • Maquet P: Mechanics and osteoarthritis of the patellofemoral joint. Clin Orthop 1979; 144: 70–73.

    PubMed  Google Scholar 

  • Mariani P, Caruso I: An electromyographic investigation of subluxation of the patella. J Bone Joint Surg Br 1979; 61B: 169–171.

    PubMed  Google Scholar 

  • Micheli L: Overuse injuries in children’s sports: The growth factor. Orthop Clin North Am 1983; 14: 337–360.

    PubMed  CAS  Google Scholar 

  • Paulos L, Rusch K, Johnson C, et al.: Patellar malalignment. A treatment rationale. Phys Ther 1980; 60: 1624–1632.

    PubMed  CAS  Google Scholar 

  • Patel D: Plica as a cause of anterior knee pain. Orthop Clin North Am 1986; 17: 273–277.

    PubMed  CAS  Google Scholar 

  • Reider B, Marshall J, Koslin B, et al.: The anterior aspect of the knee joint. An anatomical study. J Bone Joint Surg Am 1981; 63A: 351–356.

    PubMed  CAS  Google Scholar 

  • Reider B, Marshall J, Ring B: Patellar tracking. Clin Orthop 1981; 157: 143–148.

    PubMed  Google Scholar 

  • Reider B, Marshall J, Warren R: Clinical characteristics of patellar disorders in young athletes. Am J Sports Med 1981; 9: 270–274.

    Article  PubMed  CAS  Google Scholar 

  • Reynolds L, Levin T, Medeiros J, et al.: EMG activity of the vastus medialis oblique and the vastus lateralis in their role in patellar alignment. Am J Phys Med 1983; 62: 61–70.

    PubMed  CAS  Google Scholar 

  • Seedhom B, Takeda T, Tsubuku M, et al: Mechanical factors and patellofemoral osteoarthrosis. Ann Rheum Dis 1979; 38: 307–316.

    Article  Google Scholar 

  • Terry G: The anatomy of the extensor mechanism. Clin Sports Med 1989; 8: 163–177.

    PubMed  CAS  Google Scholar 

  • Tria A, Palumbo R, Alicea J: Conservative care for patellofemoral pain. Orthop Clin North Am 1992; 23: 545–554.

    PubMed  Google Scholar 

  • Walsh W, Helzer-Julin M: Patellar tracking problems in athletes. Prim Care 1992; 19: 303–330.

    PubMed  CAS  Google Scholar 

  • Woodall W, Welsh J: A biomechanical basis for rehabilitation programs involving the patellofemoral joint. J Orthop Sports Phys Ther 1990; 11: 535–542.

    PubMed  CAS  Google Scholar 

  • Yates C: Patellofemoral pain—A prospective study. Orthopedics 1986; 9: 663–667.

    PubMed  CAS  Google Scholar 

  • Yulish B, Montanez J, Goodfellow D, et al.: Chondromalacia patellae: Assessment with MR imaging. Radiology 1987: 164: 763–766.

    PubMed  CAS  Google Scholar 

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Authors
  1. K. Donald Shelbourne
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  2. William S. Adsit
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Editors and Affiliations

  1. Beth Israel Medical Center-North Division, The Insall Scott Kelly Institute for Orthopaedics and Sports Medicine, New York, NY, 10128, USA

    Giles R. Scuderi M.D.

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Shelbourne, K.D., Adsit, W.S. (1995). Conservative Care of Patellofemoral Pain. In: Scuderi, G.R. (eds) The Patella. Springer, New York, NY. https://doi.org/10.1007/978-1-4612-4188-1_7

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  • DOI: https://doi.org/10.1007/978-1-4612-4188-1_7

  • Publisher Name: Springer, New York, NY

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