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Most anterior knee pain has a specific source, identifiable by careful examination

KOHALA COAST, Hawaii — To properly identify and treat patellofemoral pain, orthopedists need to carefully check the soft tissues and remember that excessive lateral pressure is common, said a presenter here at Orthopedics Today Hawaii 2013.

“Most anterior knee pain has a specific, definable source that we can identify by careful examination,” John P. Fulkerson, MD, said. “Most anterior knee pain can be treated effectively.”

He said that orthopedic surgeons need to think about the retinaculum, synovium and innervated structures as important sources of pain. Surgeons should also palpate all scars and peripatellar structures, including the quadriceps, vastus lateralis tendon, patellar tendon, lateral retinaculum, and iliotibial band.

“A scar is a common source of neuroma and can be easily missed,” Fulkerson said.

 

John P. Fulkerson

Surgeons also need to check for a painful synovial band/plica, and examine the knee through a full range of motion. Pain in early flexion indicates a distal articular lesion, whereas pain past 90° flexion could signal a proximal patella lesion. A common cause of pain is chronically lateralized patella tracking that places an inordinate load chronically on the patella and trochlea lateral facets. Sometimes this is subtle, he said, and a patient often tolerates it for many years until the lateral patellofemoral joint degrades.

In addition, orthopedic surgeons should consider the distal pole of the patella.

Reference:
Fulkerson JP. Identifying and treating patellofemoral pain. Presented at Orthopedics Today Hawaii 2013; Jan. 13-16, 2013; Kohala Coast, Hawaii.

Disclosure:
Fulkerson receives royalties from and is a patent holder for DJO Global.

KOHALA COAST, Hawaii — To properly identify and treat patellofemoral pain, orthopedists need to carefully check the soft tissues and remember that excessive lateral pressure is common, said a presenter here at Orthopedics Today Hawaii 2013.

“Most anterior knee pain has a specific, definable source that we can identify by careful examination,” John P. Fulkerson, MD, said. “Most anterior knee pain can be treated effectively.”

He said that orthopedic surgeons need to think about the retinaculum, synovium and innervated structures as important sources of pain. Surgeons should also palpate all scars and peripatellar structures, including the quadriceps, vastus lateralis tendon, patellar tendon, lateral retinaculum, and iliotibial band.

“A scar is a common source of neuroma and can be easily missed,” Fulkerson said.

 

John P. Fulkerson

Surgeons also need to check for a painful synovial band/plica, and examine the knee through a full range of motion. Pain in early flexion indicates a distal articular lesion, whereas pain past 90° flexion could signal a proximal patella lesion. A common cause of pain is chronically lateralized patella tracking that places an inordinate load chronically on the patella and trochlea lateral facets. Sometimes this is subtle, he said, and a patient often tolerates it for many years until the lateral patellofemoral joint degrades.

In addition, orthopedic surgeons should consider the distal pole of the patella.

Reference:
Fulkerson JP. Identifying and treating patellofemoral pain. Presented at Orthopedics Today Hawaii 2013; Jan. 13-16, 2013; Kohala Coast, Hawaii.

Disclosure:
Fulkerson receives royalties from and is a patent holder for DJO Global.

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