chapter 7: nonarthritic anterior knee pain

Cruciate Ligament Deficiency and Reconstruction

Like a meniscus tear, chronic effusion associated with cruciate ligament deficiency can lead eventually to patellar articular cartilage softening. Quadriceps atrophy in association with ligament insufficiency may also lead to patellar problems, particularly if there is patellar malalignment. Patellar crepitation and pain are common after cruciate ligament reconstruction (27), but may have had origin before reconstruction when patellar articular cartilage had experienced insult from the original injury or instability with effusion. Shino et al (28), however, have shown that immobilization after anterior cruciate ligament (ACL) reconstruction leads to a high incidence of patellofemoral articular degeneration. Early mobilization of the knee following ACL reconstruction, as recommended by Shelbourne (29), is important in minimizing patellofemoral degeneration after ACL reconstruction. Paulos et al (30) pointed out the importance of delaying ACL reconstruction until there is near normal knee motion to help avoid infrapatellar contracture.

The clinician should consider rotatory instability in any patient with giving way of the knee. Sometimes, one must differentiate between cruciate ligament injury and an unstable patella in the acutely injured patient who describes the knee "going out of place." There is no replacement for careful physical examination in making this differentiation.


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