ISSN:1062-8592    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Significant advances have been made in recent years in the understanding of the anatomy and biomechanics of the patellofemoral joint (PFJ). Some of these advances have provided an understanding quite different from what were recently commonly accepted notions. An accurate analysis of the PFJ can be expected to have a considerable impact on the treatment of patellofemoral pain. Controversies persist, nevertheless, and in this article we review some current findings and analyze their clinical implications. As an indication of future directions in PFJ research, we present some new results from our laboratory on the quantitative anatomy of the PFJ, using stereophotogram-metry.

ISSN:1062-8592    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

The material properties of articular cartilage are presented, with particular emphasis on understanding the role of collagen, proteoglycan, and water in providing these mechanical properties. Descriptions of cartilage de-formational behavior and data on its permeability, compressive, tensile, shear, and swelling properties are summarized, as well as a discussion to show why these material characteristics are important for the normal function of the knee. In addition, we provide adescriptiveexplanation of the biphasic theory required to understanding the mechanical behavior of any hydrated soft tissue.

ISSN:1062-8592    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Patients with patellofemoral pain represent a significant challenge to the orthopaedic community. The origin of patellofemoral pain can be directly traced to supraphysiologic mechanical loading and chemical irritation of nerve endings, denoting loss of tissue homeostasis. The persistent biologic cascade of cytokine production can lower the load-acceptance capacity of soft tissues and activate painful osseous remodeling. Activities of daily living can become supraphysiologic loads to sensitized patellofemoral tissues, resulting in chronic reactivation of tissue inflammation. The principles of treatment in most patients with patellofemoral pain consist of protection of sensitive tissues from excessive loading, appropriate antiinflammatory therapy, and nonirritat-ing rehabilitation.

ISSN:1062-8592    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Despite the improvements in accurate and consistent patellofemoral radiographs, sophisticated (and expensive) imaging studies, and arthroscopic diagnostic techniques, patellofemoral disorders remain frequently misunderstood and frustrating to treat for far too many orthopedic surgeons. Diagnostic terms such as “patellar maltracking,” “anterior knee pain syndrome,” and “chondromalacia” continue to appear in the literature without definition and add to the confusion. This article proposes a clinical classification for patellofemoral disorders that should help the comprehension, improve the results of treatment, and best of all, allow comparison of one protocol or outcome study with another. A major feature of this classification is the recognition that a developmental and familial abnormality, patellofemoral dysplasia, is the etiology for most patellofemoral disorders. Equally important is the assignment of chondromalacia patellae to a secondary position, for the most part. Other causes of anterior knee pain and disability are included to complete the classification.

ISSN:1062-8592    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Evaluation and treatment of patellofemoral disorders requires a thorough clinical history and a detailed and meticulous physical examination. This article outlines all the pertinent signs and symptoms that must be sought out by the examiner to accurately diagnose patellofemoral syndromes. A systematic step-by-step approach to the physical examination of the patellofemoral joint is described with accompanying figures.

ISSN:1062-8592    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

A dilemma exists in choosing the imaging study for patellofemoral patients that provides the most definitive information and is most cost effective. Society has asked that practitioners develop and order the most accurate tests for their patients in addition to the ones that are the most cost effective. Formerly, plain radiographs were the only imaging modality at a doctor's disposal, whereas now a wide array of studies is available. The challenge then is to order the least expensive test that will provide the necessary information. Very often this is the plain radiograph; however, some of the more expensive modalities such as magnetic resonance imaging and computed tomography scan can be cost effective when they clearly affect treatment decisions. In this article, we review the currently available patellar imaging techniques, as well as those that may be forthcoming, along with our opinion concerning their place in our armamentarium.

ISSN:1062-8592    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

The majority (≥90%) of patients with patellofemoral disorders can be treated successfully with nonoperative treatment regimens. Nonoperative treatment regimens require a meticulous review of the historical facts, a physical examination that focuses on the precise location of pain, patellofemoral mobility, and alignment and positioning, as well as lower-extremity alignment and foot positioning. Routine radiographs supplemented by special axial views of the patellofemoral joint may be helpful in establishing a diagnosis of patellofemoral dysplasia. Specialized studies, such as computed tomography and magnetic resonance imaging, performed at various degrees of knee flexion may also aid in determining whether there is patellofemoral dysplasia or patellofemoral malpositioning. A well-defined nonoperative treatment regimen designed to correct patellofemoral mechanics (by way of strengthening exercises, bracing, taping, etc.) is of primary importance in the nonoperative treatment regimen. Physical therapy treatment modalities such as ice, heat, ultrasound, Tens units, etc., may also play a role. A trial period of antiinflammatory medication is indicated in almost every case. Counseling in regard to the pain problem is crucial. Consultation with a pain management service and the utilization of other resources available through such a service can be very helpful (support groups and group counseling). Persistence, patience, and perseverance will ensure success in the vast majority of patients with patellofemoral pain or patellofemoral disorders.

ISSN:1062-8592    

出版商:OVID    

年代:1994

数据来源: OVID

ISSN:1062-8592    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

A review of distal realignment procedures for patellofemoral disorders is presented, with the pertinent anatomy, biomechanics, and a historical review of these procedures. These procedures can be divided into two basic types—the soft-tissue procedures, which are most useful in the skeletally immature, and the tibial tubercle transfer procedures. In the mature individual, the tibial tubercle procedures can be used to address malalignment of the extensor mechanism, patellofemoral incongruence, patellar articular degeneration, or a combination. A specific approach to this treatment, based on the specific pathology found by clinical, radiographic, and arthroscopic studies, is detailed.

ISSN:1062-8592    

出版商:OVID    

年代:1994

数据来源: OVID