chapter 7: nonarthritic anterior knee pain
Nonarthritic Anterior Knee Pain
"If I were a policymaker, interested in saving money for health care over the long haul, 1 would regard it as an act of high prudence to give high priority to a lot more basic research in biologic science."
—Lewis Thomas, The Lives of a Cell
"Man's productivity moves from potentiality to actuality in such a way that everything actualized has potentialities for further actualization."
Patellofemoral arthralgia is a descriptive term that simply means pain originating from the patellofemoral joint. Because patellofemoral pain may occur also as a result of problems in the support structures around the patellofemoral joint, however, the term "anterior knee pain" is more appropriate in order to consider all possibilities in and around the anterior knee. This would seem to be a very simple matter but, in fact, the use of terms that imply understanding of etiology has led to a great deal of confusion in the real understanding of conditions that cause anterior knee pain. In the English literature, "chondromalacia patellae" has been used inappropriately as a synonym for patellofemoral arthralgia, but it has become clear that anterior knee pain may be a soft tissue, retinacular problem in many patients (1 3). The term "chondromalacia" should be restricted to describe morphologic softening of patellar articular cartilage. Using the word chondromalacia has even diverted attention from other sources of patellofemoral pain, providing a seemingly useful, but often inaccurate, "wastebasket" term to describe anterior knee pain. In fact, some authors have gone so far as to describe patients with patellofemoral pain and normal articular cartilage under the rubric of chondromalacia patellae (4). Use of the term "anterior knee pain" will underline the need to search further for a specific cause of pain in each patient (5), remembering that there is not always a correlation between articular cartilage lesions and pain (6).
Inside Chapter 7: