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chapter 11: Articular Cartilage Lesions in Patellofemoral Pain Patients

CLINICAL FEATURES‑CHONDROMALACIA RELATED TO MALALIGNMENT

As already noted, chondromalacia may cause no problems whatsoever in some patients. Consequently, it behooves the clinician to identify the cause or causes of pain by careful clinical evaluation.

Often, the patient will describe rather nonspecific pain around the anterior knee, and clinical evaluation will reveal a subluxation‑instability syndrome, a tilt‑compression syndrome, or a combination of the two. The majority of patients will fall into one of these categories. Nonetheless, there is an occasional patient who may enter the office with complaints of anterior knee pain that can be localized only to the patellar articular surface and attributed to articular cartilage breakdown.

Trauma and Infrapatellar Contracture

Some patients will give a history of trauma causing the onset of this pain. The infrapatellar contracture syndrome described by Paulos and Rosenberg (78) following cruciate ligament surgery can also cause isolated patellar arthrosis. On clinical examination, such patients will often have pain on compression of the patella. The clinician should demonstrate that pain may be reproduced only by maneuvers that accentuate loading of the patella in varying degrees of flexion. The clinical history may be similar to that in the patient with malalignment and retinacular pain, that is, discomfort with activities, difficulty with stairs, sharp or aching pain in the anterior knee, limitation of physical activities, crepitation, and/or difficulty squatting. The physical examination, however, will be different in most patients with articular versus retinacular pain. The careful clinician will develop a clear picture of pain localization, either in the patella itself, or in the surrounding retinacular structures, including the patellar tendon. Sometimes both will be present, particularly if a tilt compression syndrome has progressed from initial retinacular strain and fibroneuropathy to central lateral facet breakdown and progressive arthrosis.

 

        

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