Knee pathology: patella Flashcards
what is patella alta?
a high resting patella
what is patella baja?
a low resting patella
what is chondromalacia patella?
softening and subsequent tearing, fissuring, and erosion of hyaline cartilage on the underside of the patella
who is chondromalacia patella more common in?
young, active individuals, females > males
what are some risk factors for chondromalacia patella?
previous patellar injury, fracture, dislocation
patellar position
Q angle
what is the MOI for chondromalacia patella?
microtrauma
what are the symptoms of chondromalacia patella?
dull, aching retropatellar pain
grinding during loaded knee flexion activities
what are some differential diagnoses for chondromalacia patella?
PFPS, patellar tendinopathy
what is the medical management for chondromalacia patella?
patellar taping
orthotics
exercise (focus on hip and quad strength flexibility)
medications: salicylates (aspirin), NSAIDs
lateral retinacular release
what is the prevalence of patellofemoral pain syndrome (PFPS)?
25% of all anterior knee pain
who most commonly experiences PFPS?
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%
what is the clinical picture for PFPS?
insidious onset
poorly defined pain- retropatellar/peripatellar
worse with limb loading (squatting, stairs, participation in sports, prolonged sitting, walking)
how is PFPS diagnosed?
based on exclusion and clinical picture
what are pathoanatomical features of PFPS?
decreased quadriceps force
weakness of ABD, EXT, and ER
increased frontal plane projection angle (FPPA)
pain sensitization (pressure)
T/F: there are poorer outcomes with longer duration of symptoms, higher baseline pain severity for PFPS
true
what may PFPS be associated with?
central sensitization
what are some differential diagnoses for PFPS?
lumbar radiculopathy
hip OA
peripheral nerve entrapment (femoral nerve)
what is patellar tendinopathy?
anterior knee pain often localized at the inferior pole of patella
what is the common MOI for patellar tendinopathy?
overuse injury of insidious onset, no specific traumatic injury event but gradually increasing tendon pain
who most common has patellar tendinopathy?
15-30 year old, athletes (basketball, volleyball, jumping events, tennis, football)
what are some risk factors for patellar tendinopathy?
intrinsic: gender, BMI, poor patellar tracking
extrinsic: training load, sport specialization
what are common patient complaints with patellar tendinopathy?
jumping, squatting, going down stairs
what does strong evidence link patellar tendinopathy to?
poor DF and rigid supinated foot
what is a differential diagnosis for patellar tendinopathy?
PFPS
what is the pathophysiology of patellar tendinopathy?
inflammation of patellar tendon, due to tension overload
what are some risk factors of patellar tendinopathy?
patellar tendon graft for ACL repair (bone tendon bone)
what is the management for patellar tendinopathy?
PT, rest, avoid high loads to patellar tendon
what is the incidence of osgood schlatters?
adolescent boys (10-15 y/o) and girls (10-13 y/o)
3:1
what is the etiology of osgood schlatters?
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
what are some symptoms of osgood schlatters?
ache and pain at tibial tubercle
enlarged tubercle
swelling
heat and tenderness over area
pain increases by activity that increases tension to tuberosity
how is osgood schlatters diagnosed?
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
what is the medical management of osgood schlatters?
rest from aggravating activities (no immobilization)
NSAIDs, ice
what is the prognosis of osgood schlatters?
resolution of symptoms with decreased activity in 2-3 weeks to 2-3 months
what is sinding-larsen johansson syndrome?
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
how is sinding-larsen johansson syndrome diagnosed?
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
when do we see a camel sign?
patella alta because there is tension in the patellar ligament
