DOCSLIB.ORG

Anterior Knee Pain

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Anterior Knee Pain Page 1 of 4 Anterior Knee Pain Anterior knee pain is common with a variety of causes.[1] It is important to make a careful assessment of the underlying cause in order to ensure appropriate management and advice, Common causes [2] Patellofemoral pain syndrome (PFPS) PFPS is defined as pain behind or around the patella, caused by stress in the patellofemoral joint. PFPS is common. Symptoms are usually provoked by climbing stairs, squatting, and sitting with flexed knees for long periods of time.[3] PFPS seems to be multifactorial, resulting from a complex interaction between intrinsic anatomy and external training factors.[4] Pain and dysfunction often result from either abnormal forces or prolonged repetitive compressive or shearing forces between the patella and the femur. Patellofemoral pain syndrome (PFPS) is a common cause of knee pain in adolescents and young adults, especially among those who are physically active and regularly participate in sports. Although PFPS most often presents in adolescents and young adults, it can occur at any age. Over half of all cases are bilateral (but one side is often more affected than the other). The potential causes of PFPS remain controversial but include overuse, overloading and misuse of the patellofemoral joint. Underlying causes of PFPS include: Overuse of the knee - eg, in sporting activities. Minor problems in the alignment of the knee. Foot problems - eg, flat feet. Repeated minor injuries to the knee. Joint hypermobility affecting the knee. Reduced muscle strength in the leg. Physiotherapy and foot orthoses are often used in the management of PFPS.[5] Other common causes of anterior knee pain in adolescents These include: Osgood-Schlatter disease See the separate article on Osgood-Schlatter Disease. Sinding-Larsen-Johansson disease - another common cause of anterior knee pain in children and adolescents. It is similar to Osgood-Schlatter disease but occurs at the inferior pole of the patella. Osgood-Schlatter and Sinding-Larsen-Johannson diseases are common causes of anterior knee pain which are aggravated by jumping and kneeling.[6] Chondromalacia patella[7] Softening of the articular cartilage of the patella. This is therefore a pathological diagnosis and confirmation of chondromalacia patella requires MRI or arthroscopy.[8] There is a poor correlation between the degree of anterior knee pain and cartilage damage. It may be associated with patellar misalignment. Page 2 of 4 Bipartite patella This is common in adolescence and may cause pain and tenderness. It is usually asymptomatic but variable in severity and may require surgical treatment.[9] Patellar misalignment Often accompanied by damage to the chondral surface of the patellofemoral joint.[10] It is more common in girls and may cause recurrent dislocation or subluxation of the patella. Hypermobility Causes hyperextension and hyperflexion of the knee. This most often presents around the time of the pubertal growth spurt. Other common causes of anterior knee pain in adults These include: Patellar tendinopathy (jumper's knee) Patellar tendinopathy is a common and painful overuse disorder.[11] Bursitis Prepatellar bursitis (housemaid's knee). Deep infrapatellar bursitis (parson's knee): inflammation is below the patella.[2] Anserine bursitis: often presents with spontaneous medial knee pain with tenderness in the inferomedial aspect of the joint.[12] Isolated patellofemoral arthritis[13] Patellofemoral osteoarthritis is a common form of knee osteoarthritis in middle and older age.[14] Presentation [2] See also the separate article on Knee Assessment. Knee pain is often bilateral but more severe in one knee than the other. Pain may be difficult to localise but is usually anterior or anteromedial. Pain may be aggravated by active and passive movement. Pain may be aggravated by particular activities such as walking, running (especially downhill), stairs (especially going down stairs), squatting and when getting up after prolonged sitting. Associated features may include crepitus, clicking and swelling. Investigations X-rays (skyline views should be included with anteroposterior and lateral knee X-rays). MRI scanning may be useful and give much more detail of soft tissues.[15] Other investigations may be required (eg, joint aspiration, serology, arthroscopy) depending on likely diagnosis. Page 3 of 4 Differential diagnosis Other causes of knee pain,including: Children and adolescents: referred pain from the hip - eg, slipped capital femoral epiphysis and Perthes' disease, osteochondritis dissecans. Adults: trauma - ligamentous sprains (anterior cruciate, medial collateral, lateral collateral); meniscal tear; inflammatory arthropathy (rheumatoid arthritis, reactive arthritis); referred pain from the hip (eg, fracture of the neck of the femur) or sciatica. Older adults: osteoarthritis, gout, pseudogout. Any age: septic arthritis Management The management will depend on the underlying cause. However, conservative treatment is usually effective and most patients will not require surgical intervention.[16] Management includes modification of training, patellar taping/strapping techniques, quadriceps strengthening, non-steroidal anti-inflammatory drugs (NSAIDs) and rest.[17] Referral to a physiotherapist is therefore often appropriate. Modify exercise to eliminate activities which aggravate symptoms. Exercise therapy has been shown to be effective in reducing pain but evidence regarding improvement of function has been conflicting.[18] Patellar taping may be beneficial to reduce pain and improve function.[19] Soft knee braces may also be of benefit. The quadriceps must be strengthened once the pain has subsided. Muscular imbalance may be the cause of the patellar malalignment and building of the appropriate muscles can assist realignment of the patella and reduce or eliminate symptoms with time. Proper footwear is important. Foot orthoses are often effective in decreasing rotational forces in the tibia that affect tracking of the patella during locomotion. Drugs NSAIDs and simple analgesics help to relieve discomfort. However there is only limited evidence for the effectiveness of NSAIDs for short-term pain reduction in PFPS.[20] Surgical Most people achieve results that are acceptable or better with conservative treatment. If conservative measures fail, there are a number of possible surgical procedures depending on the underlying diagnosis: Simply removing damaged cartilage is not enough. The biomechanical problem needs addressing and there are various procedures to aid re-alignment. Surgical intervention usually involves arthroscopic evaluation followed by release of the lateral attachments of the patella. Shaving: with early degenerative changes an option is to shave the damaged cartilage down to the normal cartilage underneath and so smooth the gliding surface. The success of the treatment depends on the severity of the cartilage damage. Tightening of the medial capsule: If the medial capsule is lax, it can be tightened to pull the patella back into correct alignment. Medial shift of the tibial tubercle: moving the insertion of the quadriceps tendon medially at the tibial tubercle allows the quadriceps to pull the patella more directly and decreases the amount of wear on the underside of the patella. Other surgical techniques include partial or complete removal of the patella, or replacement of damaged cartilage by a polyethylene cap prosthesis. Prognosis In younger patients, if appropriate action is taken at an early stage, exercise adjusted accordingly and the quadriceps muscles built up, then the outlook for full functional recovery is very good. In older affected patients, there is often progression to osteoarthritis. Page 4 of 4 Further reading & references Knee pain - assessment; NICE CKS, March 2011 1. Elias DA, White LM; Imaging of patellofemoral disorders. Clin Radiol. 2004 Jul;59(7):543-57. 2. Anterior Knee Pain; Arthritis Research Campaign, October 2004 3. van Dijk CN, van der Tempel WM; Patellofemoral pain syndrome. BMJ. 2008 Oct 24;337:a1948. doi: 10.1136/bmj.a1948. 4. Collado H, Fredericson M; Patellofemoral pain syndrome. Clin Sports Med. 2010 Jul;29(3):379-98. doi: 10.1016/j.csm.2010.03.012. 5. Swart NM, van Linschoten R, Bierma-Zeinstra SM, et al; The additional effect of orthotic devices on exercise therapy for patients with patellofemoral pain syndrome: a systematic review. Br J Sports Med. 2012 Jun;46(8):570-7. doi: 10.1136/bjsm.2010.080218. Epub 2011 Mar 14. 6. Atanda A Jr, Shah SA, O'Brien K; Osteochondrosis: common causes of pain in growing bones. Am Fam Physician. 2011 Feb 1;83(3):285-91. 7. Chondromalacia of the Patella; Wheeless' Textbook of Orthopaedics 8. Pihlajamaki HK, Kuikka PI, Leppanen VV, et al; Reliability of clinical findings and magnetic resonance imaging for the diagnosis of chondromalacia patellae. J Bone Joint Surg Am. 2010 Apr;92(4):927-34. doi: 10.2106/JBJS.H.01527. 9. Atesok K, Doral MN, Lowe J, et al; Symptomatic bipartite patella: treatment alternatives. J Am Acad Orthop Surg. 2008 Aug;16(8):455-61. 10. Gaweda K, Walawski J, Weglowski R, et al; Treatment outcome after patellar re-alignment by one-stage correction of the axis of the knee extensor and mosaicplasty of the patellofemoral joint. Ortop Traumatol Rehabil. 2004 Oct 30;6(5):638-42. 11. Larsson ME, Kall I, Nilsson-Helander K; Treatment of patellar tendinopathy--a systematic review of randomized controlled trials. Knee Surg Sports Traumatol Arthrosc. 2012 Aug;20(8):1632-46. doi: 10.1007/s00167-011-1825-1. Epub 2011 Dec 21. 12. Helfenstein M Jr, Kuromoto J; Anserine syndrome. Rev Bras Reumatol. 2010 May-Jun;50(3):313-27. 13. van Jonbergen HP, Poolman RW, van Kampen A; Isolated patellofemoral osteoarthritis. Acta Orthop. 2010 Apr;81(2):199- 205. doi: 10.3109/17453671003628756. 14. Thomas MJ, Wood L, Selfe J, et al; Anterior knee pain in younger adults as a precursor to subsequent patellofemoral osteoarthritis: a systematic review. BMC Musculoskelet Disord. 2010 Sep 9;11:201. doi: 10.1186/1471-2474-11-201. 15. Mattila VM, Weckstrom M, Leppanen V, et al; Sensitivity of MRI for articular cartilage lesions of the patellae. Scand J Surg. 2012;101(1):56-61. 16. Post WR; Anterior knee pain: diagnosis and treatment.
Load more

Recommended publications
  • Patellofemoral Pain Syndrome and Chondromalacia: the Effect of Ozone on Pain, Function and Quality of Life. a Non-Randomized Control-Trial
    Central JSM Physical Medicine and Rehabilitation Bringing Excellence in Open Access Research Article *Corresponding author Marcos Edgar Fernández-Cuadros, Calle del Ánsar, 44, piso Segundo, CP 28047, Madrid, Spain, Tel: Patellofemoral Pain Syndrome 34-620314558; Email: [email protected]; Submitted: 23 November 2016 and Chondromalacia: The Effect Accepted: 05 December 2016 Published: 06 December 2016 of Ozone on Pain, Function Copyright © 2016 Fernández-Cuadros et al. and Quality of Life. A Non- OPEN ACCESS Keywords Randomized Control-Trial • Patellofemoral pain syndrome • Chondromalacia Marcos Edgar Fernández-Cuadros1,2*, Olga Susana Pérez-Moro1, • Pain and María Jesús Albaladejo-Florin1 • Ozone therapy • Quality of life 1Servicio de Rehabilitación, Hospital Universitario Santa Cristina, Spain 2de Rehabilitación, Fundación, Hospital General Santísima Trinidad, Spain Abstract Objectives: 1) To demonstrate the effectiveness of a treatment protocol with Ozone therapy on pain, function and quality of life in patients with Patellofemoral Pain Syndrome (PFPS) and Chondromalacia; and 2) to apply Ozone as a conservative treatment option with a demonstrable level of scientific evidence. Material and Methods: Prospective quasi-experimental before-after study (non-randomized control-trial) on 41 patients with PFPS and Chondromalacia grade 2 or more, who attended to Santa Cristina’s University Hospital, from January 2012 to November 2016 The protocol consisted of an intra articular infiltration of a medical mixture of Oxygen-Ozone (95% -5%) 20ml, at a 20ug / ml concentration, and a total number of 4 sessions (1 per week). Pain and quality of life were measured by Visual Analogical Scale (VAS) and Western Ontario and Mc Master Universities Index for Osteoarthritis (WOMAC) at the beginning / end of treatment.
    [Show full text]
  • SODIUM HYALURONATE Policy Number: PHARMACY 059.37 T2 Effective Date: April 1, 2018
    UnitedHealthcare® Oxford Clinical Policy SODIUM HYALURONATE Policy Number: PHARMACY 059.37 T2 Effective Date: April 1, 2018 Table of Contents Page Related Policies INSTRUCTIONS FOR USE .......................................... 1 Autologous Chondrocyte Transplantation in the CONDITIONS OF COVERAGE ...................................... 1 Knee BENEFIT CONSIDERATIONS ...................................... 2 Unicondylar Spacer Devices for Treatment of Pain COVERAGE RATIONALE ............................................. 2 or Disability APPLICABLE CODES ................................................. 4 DESCRIPTION OF SERVICES ...................................... 5 CLINICAL EVIDENCE ................................................. 5 U.S. FOOD AND DRUG ADMINISTRATION ................... 10 REFERENCES .......................................................... 12 POLICY HISTORY/REVISION INFORMATION ................ 14 INSTRUCTIONS FOR USE This Clinical Policy provides assistance in interpreting Oxford benefit plans. Unless otherwise stated, Oxford policies do not apply to Medicare Advantage members. Oxford reserves the right, in its sole discretion, to modify its policies as necessary. This Clinical Policy is provided for informational purposes. It does not constitute medical advice. The term Oxford includes Oxford Health Plans, LLC and all of its subsidiaries as appropriate for these policies. When deciding coverage, the member specific benefit plan document must be referenced. The terms of the member specific benefit plan document [e.g.,
    [Show full text]
  • OES Site Color Scheme 1
    Nuisance Problems You will Grow to Love Thomas V Gocke, MS, ATC, PA-C, DFAAPA President & Founder Orthopaedic Educational Services, Inc. Boone, NC [email protected] www.orthoedu.com Orthopaedic Educational Services, Inc. © 2016 Orthopaedic Educational Services, Inc. all rights reserved. Faculty Disclosures • Orthopaedic Educational Services, Inc. Financial Intellectual Property No off label product discussions American Academy of Physician Assistants Financial PA Course Director, PA’s Guide to the MSK Galaxy Urgent Care Association of America Financial Intellectual Property Faculty, MSK Workshops Ferring Pharmaceuticals Consultant Orthopaedic Educational Services, Inc. © 2016 Orthopaedic Educational Services, Inc. all rights reserved. 2 LEARNING GOALS At the end of this sessions you will be able to: • Recognize nuisance conditions in the Upper Extremity • Recognize nuisance conditions in the Lower Extremity • Recognize common Pediatric Musculoskeletal nuisance problems • Recognize Radiographic changes associates with common MSK nuisance problems • Initiate treatment plans for a variety of MSK nuisance conditions Orthopaedic Educational Services, Inc. © 2016 Orthopaedic Educational Services, Inc. all rights reserved. Inflammatory Response Orthopaedic Educational Services, Inc. © 2016 Orthopaedic Educational Services, Inc. all rights reserved. Inflammatory Response* When does the Inflammatory response occur: • occurs when injury/infection triggers a non-specific immune response • causes proliferation of leukocytes and increase in blood flow secondary to trauma • increased blood flow brings polymorph-nuclear leukocytes (which facilitate removal of the injured cells/tissues), macrophages, and plasma proteins to injured tissues *Knight KL, Pain and Pain relief during Cryotherapy: Cryotherapy: Theory, Technique and Physiology, 1st edition, Chattanooga Corporation, Chattanooga, TN 1985, p 127-137 Orthopaedic Educational Services, Inc. © 2016 Orthopaedic Educational Services, Inc.
    [Show full text]
  • The Anatomy of the Deep Infrapatellar Bursa of the Knee Robert F
    0363-5465/98/2626-0129$02.00/0 THE AMERICAN JOURNAL OF SPORTS MEDICINE, Vol. 26, No. 1 © 1998 American Orthopaedic Society for Sports Medicine The Anatomy of the Deep Infrapatellar Bursa of the Knee Robert F. LaPrade,* MD Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota ABSTRACT knee joint, and to define a consistent surgical approach to the deep infrapatellar bursa. Disorders of the deep infrapatellar bursa are important to include in the differential diagnosis of anterior knee pain. Knowledge regarding its anatomic location can MATERIALS AND METHODS aid the clinician in establishing a proper diagnosis. Fifty cadaveric knees were dissected, and the deep infrapa- Thorough dissections of the anterior aspect of the knee of tellar bursa had a consistent anatomic location in all 50 nonpaired cadaveric knees were performed. There were specimens. The deep infrapatellar bursa was located 27 male and 23 female cadaveric knees with 25 right and directly posterior to the distal 38% of the patellar ten- 25 left knees. The average age of the specimens was 71.8 don, just proximal to its insertion on the tibial tubercle. years (range, 42 to 93). After the skin and subcutaneous There was no communication to the knee joint. Its tissues of the anterior aspect of the knee were carefully average width at the most proximal margin of the tibial dissected away, an approach to the deep infrapatellar tubercle was slightly wider than the average distal bursa of the knee was made through medial and lateral width of the patellar tendon. It was found to be partially arthrotomy incisions along the patella, followed by compartmentalized, with a fat pad apron extending transection of the quadriceps tendon from the patella.
    [Show full text]
  • Physical Examination of the Knee: Meniscus, Cartilage, and Patellofemoral Conditions
    Review Article Physical Examination of the Knee: Meniscus, Cartilage, and Patellofemoral Conditions Abstract Robert D. Bronstein, MD The knee is one of the most commonly injured joints in the body. Its Joseph C. Schaffer, MD superficial anatomy enables diagnosis of the injury through a thorough history and physical examination. Examination techniques for the knee described decades ago are still useful, as are more recently developed tests. Proper use of these techniques requires understanding of the anatomy and biomechanical principles of the knee as well as the pathophysiology of the injuries, including tears to the menisci and extensor mechanism, patellofemoral conditions, and osteochondritis dissecans. Nevertheless, the clinical validity and accuracy of the diagnostic tests vary. Advanced imaging studies may be useful adjuncts. ecause of its location and func- We have previously described the Btion, the knee is one of the most ligamentous examination.1 frequently injured joints in the body. Diagnosis of an injury General Examination requires a thorough knowledge of the anatomy and biomechanics of When a patient reports a knee injury, the joint. Many of the tests cur- the clinician should first obtain a rently used to help diagnose the good history. The location of the pain injured structures of the knee and any mechanical symptoms were developed before the avail- should be elicited, along with the ability of advanced imaging. How- mechanism of injury. From these From the Division of Sports Medicine, ever, several of these examinations descriptions, the structures that may Department of Orthopaedics, are as accurate or, in some cases, University of Rochester School of have been stressed or compressed can Medicine and Dentistry, Rochester, more accurate than state-of-the-art be determined and a differential NY.
    [Show full text]
  • Pathophysiology of Anterior Knee Pain
    1 Patellofemoral Online Education Pathophysiology of Anterior Knee Pain Vicente Sanchis-Alfonso, MD, PhD The original publication is available at www.springerlink.com INTRODUCTION Anterior knee pain, diagnosed as Patellofemoral Pain Syndrome (PFPS), is one of the most common musculoskeletal disorders [61]. It is of high socioeconomic relevance as it occurs most frequently in young and active patients. The rate is around 15-33% in active adult population and 21-45% of adolescents [36]. However, in spite of its high incidence and abundance of clinical and basic science research, its pathogenesis is still an enigma (“The Black Hole of Orthopaedics”). The numerous treatment regimes that exist for PFPS highlight the lack of knowledge regarding the etiology of pain. The present review synthesizes our research on pathophysiology [53-62] of anterior knee pain in the young patient. BACKGROUND: CHONDROMALACIA PATELLAE, PATELLOFEMORAL MALALIGMENT, TISSUE HOMEOSTASIS THEORY Until the end of the 1960’s anterior knee pain was attributed to chondromalacia patellae, a concept from the beginnings of the 20th century that, from a clinical point of view, is of no value, and ought to be abandoned, given that it has no diagnostic, therapeutic or prognostic implications. In fact, many authors have failed to find a connection between anterior knee pain and chondromalacia [52, 61]. Currently, however, there is growing evidence that a subgroup of patients with chondral lesions may have a component of their 2 pain related to that lesion due to the overload of the subchondral bone interface which is richly innervated. In the 1970’s anterior knee pain was related to the presence of patellofemoral malaligment (PFM) [14, 24, 26, 40].
    [Show full text]
  • Ambulatory Surgery Job
    Ambulatory Surgery ICD-10-CM 2014: Reference Mapping Card ICD-9-CM ICD-10-CM ICD-9-CM ICD-10-CM 354.0 Carpal tunnel syndrome G56.00 Carpal tunnel 715.94 Osteoarthrosis hand M18.9 Osteoarthritis of first syndrome carpometacarpal joint 366.14 Post subcap senile H25.041 Posterior subcapsular 717.7 Chondromalacia patellae M22.41 Chondromalacia patellae cataract polar age-related right knee cataract, right eye M22.41 Chondromalacia patellae Posterior subcapsular left knee H25.042 polar age-related cataract, left eye 721.0 Cervical spondylosis M47.812 Spondylosis without Posterior subcapsular myelopathy or H25.043 polar age-related radiculopathy, cervical cataract, bilateral region eyes 721.3 Lumbosacral spondylosis M47.817 Spondylosis without Posterior subcapsular myelopathy or radiculopathy, Posterior subcapsular polar age-related cataract is only applicable lumbosacral region to adult patients age 15 - 124 years. 722.52 Lumbar/lumbosacral disc M51.36 Other intervertebral disc 366.15 Cortical senile cataract H25.011 Cortical age-related degeneration degeneration, lumbar cataract, right region eye M51.37 Other intervertebral disc H25.012 Cortical age-related degeneration, cataract, left lumbosacral region eye 723.4 Brachial M54.12 Radiculopathy, cervical H25.013 Cortical age-related neuritis/radiculitis region cataract, bilateral M54.13 Radiculopathy, eyes cervicothoracic region 724.02 Spinal stenosis – lumbar, M48.06 Spinal stenosis, lumbar Cortical age-related cataract is only applicable to adult without neurogenic region patients age 15
    [Show full text]
  • Case Report Septic Infrapatellar Bursitis in an Immunocompromised Female
    Hindawi Case Reports in Orthopedics Volume 2018, Article ID 9086201, 3 pages https://doi.org/10.1155/2018/9086201 Case Report Septic Infrapatellar Bursitis in an Immunocompromised Female Kenneth Herring , Seth Mathern, and Morteza Khodaee 1Department of Family Medicine, University of Colorado School of Medicine, 3055 Roslyn Street, Denver, CO 80238, USA Correspondence should be addressed to Kenneth Herring; [email protected] Received 8 April 2018; Revised 19 April 2018; Accepted 20 April 2018; Published 6 June 2018 Academic Editor: John Nyland Copyright © 2018 Kenneth Herring et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Bursitis is a relatively common occurrence that may be caused by traumatic, inflammatory, or infectious processes. Septic bursitis most commonly affects the olecranon and prepatellar bursae. Staphylococcus aureus accounts for 80% of all septic bursitis, and most cases affect men and are associated with preceding trauma. We present a case of an 86-year-old female with an atypical septic bursitis involving the infrapatellar bursa. Not only are there very few reported cases of septic infrapatellar bursitis, but also this patient’s case is particularly unusual in that she is a female with no preceding trauma who had Pseudomonas aeruginosa on aspirate. The case also highlights the diagnostic workup of septic bursitis through imaging modalities and aspiration. This patient had full resolution of her septic bursitis with appropriate IV antibiotics. 1. Introduction and relative superficial location, the olecranon and prepa- tellar bursae are the most common sites of septic bursitis The human body contains upwards of 150 bursae, many [3, 4].
    [Show full text]
  • Functional Outcome Following Modified Elmslie–Trillat Procedure ⁎ D
    The Knee 13 (2006) 464–468 www.elsevier.com/locate/knee Functional outcome following modified Elmslie–Trillat procedure ⁎ D. Karataglis , M.A. Green, D.J.A. Learmonth Royal Orthopaedic Hospital, Bristol Road South, Birmingham B31 2AP, UK Received 30 October 2005; received in revised form 20 August 2006; accepted 21 August 2006 Abstract The aim of this study was to evaluate the mid- and long-term outcome of the modified Elmslie–Trillat procedure, as well as to detect factors affecting it. Thirty-eight patients (44 procedures) with a mean age of 31 years were included in this study. The reason for operation was patellar instability in 10 cases, anterior knee pain with malalignment of the extensor mechanism in 15 cases and a combination of both in 19 cases. Patients were followed for an average of 40 months (range=18–130 months). The functional outcome was very satisfactory or satisfactory for 73% of patients. According to Cox's criteria it was excellent in 13 cases (30%), good in 18 (41%), fair in 7 (16%) and poor in the remaining 6 (13%). Patients scored an average of 3.5 (range=2–8) in their Tegner Activity Scale, while their score in Activities of Daily Living Scale of the Knee Outcome Survey ranged from 43 to 98 (average=76). Result analysis revealed a better functional outcome when the operation was performed for patellar instability, as well as in the absence of grade 3 or 4 chondral changes in the patellofemoral joint at the time of operation. Elmslie–Trillat procedure satisfactorily restores patellofemoral stability and offers a very good functional outcome, especially in the absence of significant chondral changes in the patellofemoral joint at the time of operation.
    [Show full text]
  • Approach to the Active Patient with Chronic Anterior Knee Pain
    No part of The Physician and Sportsmedicine may be reproduced or transmitted in any form without written permission from the publisher. All permission requests to reproduce or adapt published material must be directed to the journal office in Berwyn, PA, no other persons or offices are authorized to act on our behalf. CLINICAL FOCUS: ORTHOPEDICS AND SPORTS INJURIES Approach to the Active Patient with Chronic Anterior Knee Pain DOI: 10.3810/psm.2012.02.1950 Alfred Atanda Jr, MD1 Abstract: The diagnosis and management of chronic anterior knee pain in the active individual Devin Ruiz, BSc2 can be frustrating for both the patient and physician. Pain may be a result of a single traumatic event Christopher C. Dodson, or, more commonly, repetitive overuse. “Anterior knee pain,” “patellofemoral pain syndrome,” and MD2 “chondromalacia” are terms that are often used interchangeably to describe multiple conditions that Robert W. Frederick, MD2 occur in the same anatomic region but that can have significantly different etiologies. Potential pain sources include connective or soft tissue irritation, intra-articular cartilage damage, mechanical 1Department of Orthopaedic irritation, nerve-mediated abnormalities, systemic conditions, or psychosocial issues. Patients with Surgery, Nemours/Alfred I. duPont Hospital for Children, Wilmington, anterior knee pain often report pain during weightbearing activities that involve significant knee DE; 2Thomas Jefferson University flexion, such as squatting, running, jumping, and walking up stairs. A detailed history and thorough Hospital, Jefferson Medical College, Philadelphia, PA physical examination can improve the differential diagnosis. Plain radiographs (anteroposterior, anteroposterior flexion, lateral, and axial views) can be ordered in severe or recalcitrant cases.
    [Show full text]
  • Orthopedic Products Orthopedic
    ORTHOPEDIC PRODUCTS ORTHOPEDIC ORTHOPEDIC PRODUCTS ORLIMAN S. L. U. Follow us: C/ Ausias March, 3 EDITION 46185 La Pobla de Vallbona · Valencia (Spain) 05/2019 · TRAUMATOLOGY · RHEUMATOLOGY · REHABILITATION · Tel.: +34 96 272 57 04 - Fax: +34 96 275 87 00 E-mail: [email protected] · www.orliman.com EDITION: 05/2019 · SPORT MEDICINE · ORTHOPEDICS · ▍ INTRODUCTION A COMPANY WITH HISTORY - MISSION With over 70 years of experience in the field of orthopedics, Orliman undertakes the development and series production of orthopedic products, spearheading future recovery of mobility and rehabilitation, preventive healthcare and functional improvement. This work is carried out through the development of comprehensive solutions in conjunction with users, doctors, physiotherapists, suppliers, orthopedic establishments and designers. ▍ VISION Orliman’s vision is to be an innovative company that leads the non-invasive orthopedics market in Spain, France and international markets, that continually seeks new ways of satisfying the needs of orthopedic establishments, the medical community and users, providing technology and functionality to its products. This is how successful projects such as Orliman Sport and Orliman Pediatric were developed. ▍ PRODUCTS RANGE Our range includes: ▸ Orthosis for lower limbs ▸ Orthosis for the trunk ▸ Orthosis for upper limbs ▸ Thermo-compressor orthosis ▸ Insoles and heelpcups ▸ Podiatry ▸ Prosthesis 3000 references ▍ WE ARE INCREASING OUR SPACE on stock We are multiplying our premises with a new headquarters of over 10,000 m2 which contains all of the technological and professional means that a leading company requires. ▍ WORKFORCE The workforce at Orliman is made up of professionals within each speciality who receive continuous training to ensure they are suitably informed about products and technological and medical advances, who strive to better themselves on a daily basis in order to attend to the needs of our customers.
    [Show full text]
  • Lecture 58-Rheumatoid Arthritis and Osteoarthritis.Pdf
    Done By: Reviewed By: Ahlam Almutairi Wael Al Saleh COLOR GUIDE: • Females' Notes • Males' Notes • Important • Additional 432MedicineTeam Rheumatoid Arthritis and Osteoarthritis Objectives By the end of this lecture student should know: 1. Pathology, 2. Clinical features, 3. Laboratory and radiologic changes 4. Line of management of Rheumatoid Arthritis and Osteoarthritis 1 432MedicineTeam Rheumatoid Arthritis and Osteoarthritis Rheumatoid Arthritis Note: Systemic chronic inflammatory disease Sometimes it is called Mainly affects synovial joints rheumatoid disease because it is not • Variable expression confined to joints • Prevalence about 3% • Worldwide distribution • Female: male ratio 3:1 • Peak age of onset: 25-50 years • Unknown etiology • Genetics • Environmental • Possible infectious component • Autoimmune disorder THE PATHOLOGY OF RA o Synovitis (Joints, Tendon, sheaths& Bursae) o Nodules o Vasculitis RA Is Characterized by Synovitis and Joint Destruction Note: Pannus= part of the thickened synovia that will invade the cartilage and bone (will show in x-ray as erosion) 2 432MedicineTeam Rheumatoid Arthritis and Osteoarthritis Numerous Cellular Interactions Drive the RA Process "Trigger > activation of the T&B cells, Rheumatoid factor and autoantibodies >proteolytic enzymes, cytokines, ILs and TNF are produced> inflammation and synovial pannus formation, cartilage breakdown and bone resorption." IL-1 and TNF- Have a Number of Overlapping Proinflammatory Effects IL-1 Plays a Pivotal Role in the Inflammatory and Destructive Processes
    [Show full text]