chapter 11: Articular Cartilage Lesions in Patellofemoral Pain Patients


These are similar to those of other patellofemoral pain problems, but generally more severe, more persistent, and sometimes more disabling. Swelling and stiffness are more common. Pain is referred to the anterior knee, medial or lateral joint line, or anterior tibia. Stair climbing and descending may have become extremely difficult. Giving way while walking is less frequent only because use of the knee has become guarded. Sudden giving way while arising from a chair or descending stairs, associated with sharp pain, is common. It is, however, quite different from the giving way associated with an unstable patella in which there is a sudden movement of the patella. In arthrosis, the issue is pain and sometimes "catching" of irregular joint surfaces.

The gait may have lost its spontaneity and become more cautious or stiff‑legged. Seeing the patient rise slowly with pain from a chair, with the aid of his arms, raises clinical suspicion. Crepitus may be audible. The patella may be chronically tilted with or without subluxation.

Osteophytes may widen all margins and patella magna may become apparent (Fig. 11.46). Transverse passive movement is usually limited. Compression against the sulcus causes acute pain, as does extension against resistance. Crepitus may be easily felt in many cases. Flexion is frequently limited. When tibiofemoral arthrosis is present, extension may also lack 5 to 10 degrees. Quadriceps atrophy is inevitably present and proportional to severity of symptoms and disease. The clinician should always look for pain that evolves from a single prominent osteophyte. Arthroscopic resection of such an osteophyte can give great relief even when there is general radiologic evidence of osteoarthrosis.



Inside Chapter 11: