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Mystery of Knee pain Black Hole of Orthopedics- Patellofemoral joint dr.sandeep c agrawal agrasen hospital gondia india


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Knee Pain. Patellofemoral pain syndrome,Chondromalacia patellae,Iliotibial Band fRICTION Syndrome,Patella Alta,Patellofemoral Arthritis, Patellar Tilt,Patellar Displacement,Anterior Knee Pain,Lateral Retinaculum,VMO Dysplasia.Excessive Lateral Patellar Pressure Syndrome,Patella Malalignment,Patellar Instabilty,Patella Maltracking,Patella Subluxation,Patella Dislocation,Synovial Plica,Tendinitis,Jumpers Knee,Congruence Angle,Malalignment of Extensor Mechanism,Patella Arthritis,Patella Fracture. Mystery of knee pain black hole of orthopedics- patellofemoral joint dr.sandeep c agrawal agrasen hospital gondia india

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Mystery of Knee pain Black Hole of Orthopedics- Patellofemoral joint dr.sandeep c agrawal agrasen hospital gondia india

  1. 1. MYSTERY OF KNEE PAIN: Black Hole Of Orthopedics: Patellofemoral Joint Dr.Sandeep Agrawal Consultant Orthopedic Surgeon MS,DNB Agrasen Hospital Gondia Maharashtra India
  2. 2. Patella contact area • At full extension, the distal portion of the patella is in contact with the superior portion of the trochlea • As knee flexion, the contact area moves proximately • Contact area increases from 0.8 cm2 at knee full extension to 4 cm2 at 90º of flexion (Hehne, 1990)
  3. 3. Patella contact area Goodfellow J, Hungerford DS, Zindel M. Patellofemoral joint mechanics and pathology J Bone Joint Surg (Br) 1976; 58-B: 287-290 20° 45° 90° 135°
  4. 4. • Lateral tilt and displacement of patella: considered characteristic features of patellofemoral pain syndrome • Suggested that : abnormal patellar tilt and displacement …detected best with the knee near full extension, before the patella becomes engaged in the trochlear groove. which requires CT or MRI Patellofemoral Disorders
  5. 5. 5 Patellofemoral Pain:Black Hole:
  6. 6. 6 Theories:
  7. 7. 7 Sources of Pain:
  8. 8. Common Causes of Patellofemoral Pain 1. Muscular • Excessive muscle tightness (inflexibility), rapid teenage growth or poor conditioning • Fatigue or tearing(strain) of quadriceps or hamstring muscles , • Muscular strength imbalances, • Overuse/disuse : bending overuse, too aggressive in starting a fitness program runners and athletes that over train
  9. 9. Common Causes of Patellofemoral Pain 2. Structural damage patella arthritis, stress fracture, direct traumatic injury
  10. 10. Common Causes of Patellofemoral Pain 3. Congenital dysplasia patella alta(high patella), facet or trochlear dysplasia
  11. 11. Common Causes of Patellofemoral Pain 4. Malalignment tilted patella, intoeing rotation of the legs(persistent femoral anteversion) knock knee (excessive valgus deformity)
  12. 12. Common Causes of Patellofemoral Pain 5. Instability of the patella : Maltracking with subluxation(partial) or complete dislocation of the knee cap: Damaged or stretched ligament support Acute dislocation After repair
  13. 13. Common Causes of Patellofemoral Pain 6. Inflammatory : Bursitis,Tendinitis Jumper’s knee: Patella tendinitis results from excessive overload or overuse of the extensor mechanism of the knee 7. Synovial plica
  14. 14. Radiographic Measures in Subjects Who Are Asymptomatic and Subjects With Patellofemoral Pain Syndrome CORR (414) 2003,p172 lateral patellar angle congruence angle Caton’s ratio B/A 35° knee flexion unloaded or loaded
  15. 15. There is no significant abnormal patellar alignment detectable in subjects with patellofemoral pain syndrome at 35° knee flexion It is possible that the patellar malpositioning in subjects with patellofemoral pain syndrome is too subtle to be measured at one static imaging angle
  16. 16. Lateral tubercle deviation Tibial tubercle lateralization greater than 10 mm and a lateral patellofemoral angle less than 8° were predictive of anterior knee pain with a specificity of 95% and a sensitivity of 64% Arthroscopy June 2006 • Volume 22 • Number 6
  17. 17. Patellofemoral Pain Syndrome • Overuse ???? • Neurogenic factors ??? • To think of anterior knee pain or patellar instability as somehow being necessarily tied to PFM [patellofemoral malalignment] is an oversimplification that has positively stultified progress toward better diagnosis and treatment
  18. 18. Patellofemoral Pain Syndrome • Malalignment of the extensor mechanism :probably has a role in the multifactorial pathogenesis of patellofemoral pain and altered patellofemoral biomechanics. • Contribution of extensor mechanism malalignment to patellofemoral pain and altered biomechanics may change on the basis of the frequency and magnitude of physiological weight-bearing and non-weight- bearing loading conditions
  19. 19. 19 Message:
  20. 20. Qualities of A Doctor
  21. 21. 21 THANK YOU