A teenaged girl presented with complains of pain in the knee on climbing stairs and on getting up after sitting for a long time. What is the probable clinical diagnosis?
Chondromalacia patellae (Ref. Turek's orthopaedics: pg. 616)
a. Chondromalacia of the patella occurs in adolescents and young adults.
b. The condition is more common in females. It can be related to the abnormal position of the knee.
a. A grating or grinding sensation when the knee is flexed (moved so that the ankle is brought closer to the back of the thigh)
b. Knee pain in the front of the knee that occurs when you get up after sitting for a long period of time
c. Knee pain that worsens when you use stairs or get out of a chair
d. Knee tenderness
a. Temporarily resting the knee and taking nonsteroidal anti-inflammatory drugs (NSAIDs)
b. Stretch the muscles on the back (hamstrings) and front (quadriceps) of upper leg.
c. Avoid running straight down hills; walk down instead.
d. Bicycle or swim, instead of running.
e. Reduce the amount of exercise you do.
f. Run on a smooth, soft surface such as a track, rather than on cement.
g. Other techniques are:
h. Special shoe inserts and support devices (orthotics) may help people with flat feet.
i. Taping to realign the kneecap may help prevent symptoms.
a. Usually affects old age.
b. Increasing age, obesity, overuse, chronic joint instability, prior interarticular fractures, and systemic inflammatory conditions are risk factors for the development of arthritis in the hip, knee, patella, and other weight-bearing joints.
c. Patellofemoral arthritis can also occur in younger patients as a result of malalignment or trauma, but isles common.
d. Arthritis and conditions of malalignment typically result in pain that is worse with activity. Constant pain that does not vary with activity suggests a referred or nonmechanical origin.
e. Isolated patellofemoral arthritis may cause anterior knee pain that worsens with stair climbing or when rising from a seated position and is not present with other activities, such as walking or running on level surfaces.
f. Patella instability is associated with intermittent sharp pain at the kneecap. A feeling of "giving way" may be related to muscle weakness or to instability. Recurrent patellar subluxation or dislocation may cause an acute osteochondral fracture or chronic cartilage damage as a result of repeated microtrauma.
Patients typically present with anterior knee pain. Indications for surgical management include pain, loss of functional ability, arthritis that is correlated with the symptoms, and symptoms that do not respond to physical therapy. her postoperative rehabilitation. In patients with patellofemoral arthritis, the goal of surgical procedures should be to improve patellar biomechanics and to correct articular damage.
a. Plica syndrome of the knee is a constellation of signs and symptoms that occur secondary to injury or overuse.
b. An otherwise normal structure, a plica can be a significant source of anterior knee pain.
c. The etiology of symptomatic plica is unclear.
d. Potential causes of inflammation include repetitive stress, a single blunt trauma, loose bodies, osteochondritis dissecans, meniscal tears, or other aggravating knee pathology.
e. The most common symptomatic plica is medial plica; occasionally, suprapatellar plica may also be symptomatic.
This may be referred to as a positive TARP sign, in which TARP stands for the following:
a. T - Taut
b. A - Articular band
c. R – Reproduces
d. P – Pain
The most common symptomatic plica is medial parapatellar plica.
Surgical intervention for plica syndrome should be considered when symptoms have persisted and efforts at nonoperative management have failed for a period typically approaching 6 months.
Permanent modification of athletic activity is usually another option, but patients rarely find this cceptable.
a. Bipartite patella refers to the presence of a second ossification center for the patella that fails to unite osseously to the main body of the patella, usually being joined with fibrocartilagenous tissue (synchondrosis). The most common location for the accessory ossification center is the supero-lateral aspect of the patella. Smooth, corticated margins along the adjoining surfaces usually provide easy differentiation from acute fracture.