Knee pathology: patella

Question 1

what is patella alta?

Answer 1

a high resting patella

Question 2

what is patella baja?

Answer 2

a low resting patella

Question 3

what is chondromalacia patella?

Answer 3

softening and subsequent tearing, fissuring, and erosion of hyaline cartilage on the underside of the patella

Question 4

who is chondromalacia patella more common in?

Answer 4

young, active individuals, females > males

Question 5

what are some risk factors for chondromalacia patella?

Answer 5

previous patellar injury, fracture, dislocation
patellar position
Q angle

Question 6

what is the MOI for chondromalacia patella?

Answer 6

microtrauma

Question 7

what are the symptoms of chondromalacia patella?

Answer 7

dull, aching retropatellar pain
grinding during loaded knee flexion activities

Question 8

what are some differential diagnoses for chondromalacia patella?

Answer 8

PFPS, patellar tendinopathy

Question 9

what is the medical management for chondromalacia patella?

Answer 9

patellar taping
orthotics
exercise (focus on hip and quad strength flexibility)
medications: salicylates (aspirin), NSAIDs
lateral retinacular release

Question 10

what is the prevalence of patellofemoral pain syndrome (PFPS)?

Answer 10

25% of all anterior knee pain

Question 11

who most commonly experiences PFPS?

Answer 11

most common 12-19 years (sports), 50-59 years (clinic)
50% of adolescents -> pain at 2 years
females > males (high school runners)
recurrence rate 70-90%

Question 12

what is the clinical picture for PFPS?

Answer 12

insidious onset
poorly defined pain- retropatellar/peripatellar
worse with limb loading (squatting, stairs, participation in sports, prolonged sitting, walking)

Question 13

how is PFPS diagnosed?

Answer 13

based on exclusion and clinical picture

Question 14

what are pathoanatomical features of PFPS?

Answer 14

decreased quadriceps force
weakness of ABD, EXT, and ER
increased frontal plane projection angle (FPPA)
pain sensitization (pressure)

Question 15

T/F: there are poorer outcomes with longer duration of symptoms, higher baseline pain severity for PFPS

Answer 15

true

Question 16

what may PFPS be associated with?

Answer 16

central sensitization

Question 17

what are some differential diagnoses for PFPS?

Answer 17

lumbar radiculopathy
hip OA
peripheral nerve entrapment (femoral nerve)

Question 18

what is patellar tendinopathy?

Answer 18

anterior knee pain often localized at the inferior pole of patella

Question 19

what is the common MOI for patellar tendinopathy?

Answer 19

overuse injury of insidious onset, no specific traumatic injury event but gradually increasing tendon pain

Question 20

who most common has patellar tendinopathy?

Answer 20

15-30 year old, athletes (basketball, volleyball, jumping events, tennis, football)

Question 21

what are some risk factors for patellar tendinopathy?

Answer 21

intrinsic: gender, BMI, poor patellar tracking
extrinsic: training load, sport specialization

Question 22

what are common patient complaints with patellar tendinopathy?

Answer 22

jumping, squatting, going down stairs

Question 23

what does strong evidence link patellar tendinopathy to?

Answer 23

poor DF and rigid supinated foot

Question 24

what is a differential diagnosis for patellar tendinopathy?

Answer 24

PFPS

Question 25

what is the pathophysiology of patellar tendinopathy?

Answer 25

inflammation of patellar tendon, due to tension overload

Question 26

what are some risk factors of patellar tendinopathy?

Answer 26

patellar tendon graft for ACL repair (bone tendon bone)

Question 27

what is the management for patellar tendinopathy?

Answer 27

PT, rest, avoid high loads to patellar tendon

Question 28

what is the incidence of osgood schlatters?

Answer 28

adolescent boys (10-15 y/o) and girls (10-13 y/o)
3:1

Question 29

what is the etiology of osgood schlatters?

Answer 29

indirect trauma or repetitive stress to the attachment of patellar tendon or tibial tuberosity
force produced by sudden powerful contractions of quads, repeated knee flexion against tight quads

Question 30

what are some symptoms of osgood schlatters?

Answer 30

ache and pain at tibial tubercle
enlarged tubercle
swelling
heat and tenderness over area
pain increases by activity that increases tension to tuberosity

Question 31

how is osgood schlatters diagnosed?

Answer 31

x-rays: may be normal or may be positive for soft tissue swelling and bone fragmentation
may still reach diagnosis via clinical picture if x-ray negative

Question 32

what is the medical management of osgood schlatters?

Answer 32

rest from aggravating activities (no immobilization)
NSAIDs, ice

Question 33

what is the prognosis of osgood schlatters?

Answer 33

resolution of symptoms with decreased activity in 2-3 weeks to 2-3 months

Question 34

what is sinding-larsen johansson syndrome?

Answer 34

overuse injury causing anterior knee pain at inferior patellar pole
common in adolescence
pain at inferior pole
similar pathologies to osgood schaltter
overuse causing traction apophysitis

Question 35

how is sinding-larsen johansson syndrome diagnosed?

Answer 35

x-rays: may be normal or may show spur at inferior patellar pole
MRI: inflammation best on T2 sagittal, bony spur best on T1 sagittal

Question 36

when do we see a camel sign?

Answer 36

patella alta because there is tension in the patellar ligament