PATELLOFEMORAL PAIN Flashcards
characteristic signs & symptoms
pain arising from the front of the knee (insidious onset) Ø peripatellar or retropatellar pain
- can be medial, lateral or infrapatellar
- can be localised, or non-specific / vague
PFP - 2
aggravated by activities that load the PFJ
… knee flexion in WB - running, stairs, hills, squatting, sitting
may report PFJ crepitus, or episodes of giving way (subluxation, quads pain inhibition)
- MULTIFACTORIAL & heterogeneous
DIAGNOSIS OF PFP
is pain around or behind the patella, which is aggravated by at least one activity that loads the patellofemoral joint during weight bearing on a flexed knee (eg, squatting, stair ambulation, jogging/ running, hopping/jumping).
Additional criteria (not essential):
A. Crepitus or grinding sensation emanating from the patellofe-
moral joint during knee flexion movements
B. Tenderness on patellar facet palpation
C. Small effusion
D. Pain on sitting, rising on sitting, or straightening the knee
following sitting
Potential sources of PFP
- local structures
ligament, meniscus, tendons, articular cartilage, medial/lateral retinaculumn, subchondral bone, synovium, fat pad
Potential sources of PFP
- referred
-Differential diagnosis is essential to identify knee pain arising from sources distant to the knee -Most common referral sources are hip joint and lumbar spine
PFP in adolescents may reduce physical activity
- Age 14.6 ± 1.1: no difference in physical activity level (met equivalents: 42 vs. 45)
- Age 16.9 (95% CI 16.3 to 17.2): moderate to heavy physical activity for at least 5 hours/week in 23% (vs. 36% of controls)
- Age 25.8 ± 7.4 years: significantly lower weekly physical activity vs. controls (344 vs. 536 mins/week)
…may have implications for general & mental health, as well as cartilage health
PFP is persistent
longer leave with PFP > poorer outcome/more likely to have persisitent
pain of potentially debilitating nature > unfavourable outcome in future
baseline pFP >2 months was the most consistent predictor of poor outcome over 12 months
PFP is persistent 2
baseline PFP duration >12 months of greater pain severity (AKPS) were predictive of greater pain severity at follow-ip
xrays showed warly signs of radiographic OA
The knee and OA continuum
AIM:
Describe the prevalence of radiographic PFJ OA in young to middle-aged adults with chronic PFP
Explore clinical factors associated with radiographic PFJ OA severity
OA grades 0 - 1
grade 0: no OA
grade 1: doubtful - possible osteophytic lipping, doubtful JSN (EA large osteophytes, marked JSN, severe sclerosis, definite bony contour deformityRLY OA)
OA grades 2-4
grade 2: mild OA - definite osteophytes, possible JSN
grade 3: moderate - moderate multiple osteophytes, definite JSN, some sclerosis, possible bone contour deformity
grade 4:large osteophytes, marked JSN, severe sclerosis, definite bony contour deformity
grades 2-4 radiographic OA
radiographs
PFP OA isn’t associated with aging 26 - 50 yrs old no OA - 33% early OA - 42% OA - 25%
Clinical diagnosis of OA (without investigations):
aged 45 years or over, and
activity-related joint pain, and
either no morning joint-related stiffness, or morning stiffness that lasts no longer than 30 minutes
PFP across lifespan
need to intervene early in the disease process
PF OA
signs of degenerative joint disease
e. g. radiographic joint space narrowing, osteophytes
- first and most common knee joint compartment affected by OA
