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Thorough work-up, purposeful imaging may help diagnose patellofemoral pain
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SAN DIEGO — A clinician experienced in treating patients with patellofemoral pain encouraged attendees at the Arthroscopy Association of North America 2011 Specialty Day Meeting to take their time diagnosing anyone who presents with the condition.
Donald C. Fithian, MD, of El Cajon, Calif., said that patients may have problems that are multi-factorial or ones due to limb alignment, femoral laxity or patellofemoral instability issues.
“It is wise to approach these patients fairly open-minded,” he said during his presentation. “There is a possibility you may not be able to treat them at all.”
Biomechanical dysfunction is frequently at the root of patellofemoral pain, he explained. “The knee is caught between the hip and ankle, and poor motor control anywhere from the foot up to the trunk can have a very significant effect on loads at the knee.”
Therefore, during the work-up, Fithian encouraged physicians to assess their patients’ walking patterns, jumping/landing skills and proximal hip control. “My suspicion is — and this has never been compared head-to-head — but I suspect if you can address the muscle control issues, you can have a mechanical effect at the knee joint that will be orders of magnitude higher than anything you can accomplish with a surgical realignment procedure.”
Checking for patellofemoral instability and medial collapse were among Fithian’s other recommendations.
Regarding radiographic imaging, he said that physicians should “get a good lateral view.”
“In patellofemoral arthroplasty, 80% or more of patients have trochlear dysplasia, and so it is a very prominent finding you should really look for on your lateral X-rays. And, if you do this, you do not need advanced studies.”
However, according to Fithian, radiographs only indicate that dysplasia exists — not whether it should be treated. Despite recent attention to the use of axial CT or MR imaging of the tibial tuberosity and trochlear groove offset in the knee, these modes are unnecessary for the work-ups Fithian recommends.
“I use imaging studies to look at the soft tissues and cartilage,” he said, noting the anatomic detail from bone scans can help better isolate the source of patellofemoral pain.
Reference:
- Fithian DC. Patellofemoral pain: Clinical approaches to difficult problems. Presented at the Arthroscopy Association of North America 2011 Specialty Day Meeting. Feb. 19, 2011. San Diego.
Disclosure: He has no relevant disclosures.
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