Patellofemoral Syndrome and Osteoarthritis

by Charles Vega, MD

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    00:01 So, Patellofemoral syndrome, let’s put that on the spotlight because it is really important.

    00:06 It is the most common cause of anterior knee pain, both in general and among athletes specifically.

    00:12 The classic is that movie sign.

    00:15 You’re in a movie for two hours or so.

    00:18 You first stand up, it's really stiff, very painful, you walk a little bit, that anterior knee pain gets better.

    00:24 Also another one that’s worse with climbing stairs, but unlike the iliotibial band, this is going to be more of a central pain under the patella and kind of hard to describe.

    00:33 It's usually a dull pain and kind of vague, but it can be really debilitating as well.

    00:38 Doesn't mean it's always so benign or a mild type pain.

    00:41 I’ve seen mild to severe patellofemoral syndrome pain as well.

    00:46 On exam, one of the interesting things, and this might be on your exam, is the J sign.

    00:51 So, as the knee is extended from 90° to full flexion, there will be a lateral patellar tracking.

    00:57 There is patellar laxity in a lot of these cases.

    00:59 So, you’ll actually see that the patella migrate more laterally.

    01:04 And so, of course, you’re going to check for the stability of the patella.

    01:08 Patients with patellofemoral syndrome are more likely to have a little bit more laxity in their patella.

    01:14 You don't really need x-rays among these patients if you have – particularly when you have these other findings, the symptoms and the signs all suggest patellofemoral syndrome.

    01:24 So, again, rest is important.

    01:26 And it's important to actually recommend physical therapy for these patients.

    01:31 And I was always of the mind, well, it’s always just about quad strengthening.

    01:34 Actually sometimes quad strength in these patients is absolutely perfect.

    01:39 It's just that they are too tight over that complex of muscles, and so therefore, they actually need more stretching.

    01:46 And a physical therapist can be really helpful in determining which particular types of exercises your patient needs.

    01:52 There is less evidence, however, for things like knee braces or patellar taping.

    01:56 So, physical therapy on the exam would be the right answer if you had a list of potential interventions for patellofemoral syndrome.

    02:06 And I have to mention osteoarthritis because among patients who are 50 and over, this is going to be the most common cause of knee pain.

    02:12 So, certainly, think about exercise therapy for these individuals as well.

    02:16 Generally, weight loss is certainly going to help and exercise therapy can really help to help stabilize the joint and, therefore, reduce pain in everyday activities.

    02:27 As I’ve mentioned for other musculoskeletal disorders, acetaminophen has better safety, but is probably slightly less effective than NSAIDs overall, but I still use acetaminophen as my first go-to drug in cases where patients haven't tried anything for it.

    02:43 Glucosamine and chondroitin are commonly used.

    02:46 They are very much promoted for osteoarthritis.

    02:49 They have a pretty mixed record of efficacy overall.

    02:53 There's few studies that have shown that they’ve worked.

    02:56 And the studies of higher quality tend to show no improvement.

    02:59 That said, in my clinical practice, I can say that patients really like glucosamine in particular.

    03:03 They think it works great.

    03:05 So, that was an introduction to knee pain and some of its common causes.

    03:11 I think as you review, just think about those atypical causes.

    03:14 Those are going to be the ones that come up on the exam, less so osteoarthritis.

    03:18 But iliotibial band syndrome, patellofemoral syndrome, those are things you should know something about and be ready to answer for because you could well see them coming up.

    03:28 Thank you.

    About the Lecture

    The lecture Patellofemoral Syndrome and Osteoarthritis by Charles Vega, MD is from the course Acute Care. It contains the following chapters:

    • Patellofemoral Syndrome
    • Osteoarthritis

    Included Quiz Questions

    1. When the knee is extended form 90 degrees flexion, the patella moves laterally at terminal knee extension.
    2. Lateral patellar tracking, as the knee is flexed from full extension to 90 degrees
    3. Tenderness along the medial joint line of the knee as it is extended
    4. A positive Thessaly test
    5. A positive anterior drawer test
    1. Quadriceps strengthening
    2. Iliotibial band stretching
    3. Knee brace
    4. Patellar taping
    5. Local steroid injection
    1. Weight loss and exercise therapy
    2. Rest and reduced activity
    3. Corticosteroid joint injection
    4. Non-steroidal anti-inflammatory drugs
    5. Glucosamine

    Author of lecture Patellofemoral Syndrome and Osteoarthritis

     Charles Vega, MD

    Charles Vega, MD

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