ISSN:1062-8592    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

The conceptualization of factors responsible for the etiology of patellofemoral pain are changing. In the recent past, chondromalacia and malalignment were believed to be most important factors relative to the genesis of anterior knee pain symptoms. However, new evidence from Europe and North America indicates other factors may be more important, such as overuse of anatomically normal patellofemoral structures, leading to the possible loss of both osseous and soft tissue homeostasis. The range of painless loading compatible with tissue homeostasis of a joint without causing structural or physiologic injury is termed the “envelope of function.” Restoration of the envelope of function as safely and predictably as possible is viewed as the primary underlying principle of treatment for patients with patellofemoral pain.

ISSN:1062-8592    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Anterior knee pain, like back pain, is a common complaint in modern developed countries. It has attracted and held significant interest among investigators for generations. Yet we might ask ourselves, “Are we truly making progress in explaining anterior knee pain?” Are our discussions constructively seeking consensus or distilling observations into testable hypotheses that can be scrutinized scientifically? It can be argued that in large measure, the causes of anterior knee pain are as elusive today as they have ever been. The author examines some lessons from medical history to illustrate how strikingly similar issues in anterior knee pain are to other challenges medical scientists have faced and overcome. These recurring historical themes offer guides that are useful for approaching any arena of medical inquiry, not just knee pain.

ISSN:1062-8592    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

The authors studied the articular joint surface morphology and osseous anatomy of the patellofemoral joint in the axial plane on cryosections from one cadaveric knee and on magnetic resonance arthrotomograms from 30 patients. The cryosectional analysis revealed intraspecimen differences in the articular joint surface geometry and corresponding subchondral osseous morphology of the patella and of the femoral trochlea. On magnetic resonance arthrotomograms, the median ridge of the articular cartilage surface of the patella was located laterally with respect to the corresponding subchondral osseous contour in 19 knees and was located medially in 7 knees. The deepest portion of the articular cartilage surface of the intercondylar sulcus was located laterally with respect to the corresponding subchondral osseous contour of the femoral trochlea in 4 knees and medially in 17 knees. Despite that there was a considerable discrepancy and morphologic variation in the patellofemoral joint geometry among the patients, the hypothesis that the surface of the articular cartilage and corresponding anatomy of the osseous contours match was refuted by the authors' observations of the patella and of the femoral trochlea. The only consistent finding in the anatomic imaging analysis of the patellofemoral joint in the axial plane was a large intra-and interindividual variation of osseous and articular joint surface morphology. Because the osseous anatomy and corresponding articular joint geometry of the patellofemoral joint did not match, magnetic resonance arthrotomography may offer the knee surgeon and the radiologist an accurate insight into the functional congruence/incongruence of opposing articular cartilage surfaces and contact zones of the patellofemoral joint in the axial plane.

ISSN:1062-8592    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

The authors studied articular surface geometry and osseous anatomy of the patella and of the femoral trochlea in the sagittal plane. They analyzed the patellofemoral joint in the midline sagittal plane on cryosections from a cadaver knee. On magnetic resonance arthrograms, the authors analyzed the patella of 38 patients and the femoral trochlea of 24 patients. The cryosections revealed significant differences in the bony anatomy and corresponding articular surface geometry of the patellofemoral joint in the sagittal plane: The patella exhibited a posteriorly oriented convex articular cartilage surface; the osseous contour of the patella revealed a anteriorly oriented concave “indentation” or “imprint.” On magnetic resonance arthrotomograms, the retropatellar cartilage surface and corresponding osseous contour of the patella did not match in any of the investigated knees. The convex articular cartilage surface of the deepest parts of the intercondylar sulcus and the corresponding deepest osseous contour of the femoral trochlea did not match on sagittal midline magnetic resonance arthrotomograms. Because multiplanar magnetic resonance arthrotomography can distinguish between the joint surface geometry and subchondral osseous morphology of the patellofemoral joint, this imaging modality allows the surgeon and the radiologist to appraise the true articulating joint surfaces and underlying bony architecture of the knee in the sagittal plane. Thus, the authors recommend magnetic resonance arthrotomography in the sagittal plane as an imaging technique of choice in assessing sagittal morphology, congruence, and joint contact zones of the patellofemoral joint.

ISSN:1062-8592    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Different structures of the patellofemoral joint containing nociceptors can be sources of pain. The nociceptive afferent nerve supply of the patellofemoral joint is illustrated by the substance-P and the free nerve endings type IVa. Pain results when structures are irritated, inflamed, damaged, or overused. The underlying pathophysiologic mechanisms causing pain are variable and consist of mechanical, neural, and chemical factors. They can be present in combination and cumulative.

ISSN:1062-8592    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Although malalignment of the patellofemoral joint is widely discussed as a cause of pain, little scientific evidence exists to support this proposition. The current data regarding this important issue is reviewed. Although not much proof exists that malalignment and pain are definitely related, clinical practice empirically shows that treatment can be successful after realignment in some scenarios. This may be because the “measurements” of malalignment that have been studied do not reflect the complex interplay of dynamic and static mechanisms that control the forces around the anterior knee during activity. In the author's opinion, imbalances caused by deficits in ligament stability, muscular power, muscular flexibility, or articular compliance affect clinical symptoms. Such factors are incompletely measured by current methods of measuring “malalignment.”

ISSN:1062-8592    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

The underlying principle of treatment for patients with patellofemoral pain from a tissue homeostasis perspective is to maximize the range of painless loading for a given symptomatic joint (envelope of function) as safely and predictably as possible. Current therapeutic approaches aimed at surgical correction of chondromalacia and malalignment often are neither safe nor predictable. A tissue homeostasis approach involves addressing the pathokinematics—primarily through temporary but scrupulous load restriction, anti-inflammatory therapy, and a gentle painless rehabilitation program. Failing this, a careful and analytical surgical approach may be warranted to include a possible gentle peripatellar synovectomy.

ISSN:1062-8592    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Patellofemoral disorders, especially patellofemoral pain with degenerative arthrosis, are difficult to treat unless the physician understands the importance of a thorough history, physical examination, and radiographic imaging. The presence of patellofemoral arthrosis does not always cause pain and disability. Likewise, patellofemoral pain and disability can exist without arthrosis. Although nonoperative treatment is the mainstay and the most successful of treatment options for patellofemoral pain with arthrosis, surgical treatment often is required. Surgical options include arthroscopic debridement, abrasion arthroplasty/microfracture, cartilage transplantation, tibial tubercle anteriorization (Maquet osteotomy), anteromedial tibial tubercle transfer (Fulkerson), anteroproximal tibial tubercle transfer (DeLee), patellar resurfacing, patellofemoral arthroplasty, total knee replacement, and patellectomy. The authors review operative treatment options for patellofemoral pain with arthrosis with an emphasis on grade III or IV Outerbridge changes, with specific attention to the results that have been presented in the literature.

ISSN:1062-8592    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Patellofemoral disorders continue to present as some of the most common and challenging pathologic conditions of the orthopedic and sports medicine community. Numerous surgical and rehabilitative approaches have been suggested to treat patients with such conditions, but no single approach has been shown to be the most beneficial because of the numerous etiologic factors associated with patellofemoral pain. Rehabilitation programs should be implemented based on a thorough clinical evaluation and continuously modified based on the unique and specific presentation of each patient. Early emphasis is placed on eliminating pain and inflammation. In addition, reestablishing soft tissue and muscular balance is an essential component to patellofemoral rehabilitation programs. As the patient improves, the rehabilitation program is advanced in a progressive and sequential manner to ensure that adequate stress is applied to the injured tissues to facilitate healing while minimizing detrimental loads. This article outlines specific treatment principles commonly associated with nonoperative and postoperative patellofemoral management to restore function as quickly and safely as possible.

ISSN:1062-8592    

出版商:OVID    

年代:2001

数据来源: OVID