Patellofemoral pain and patellar tendinopathy

Comparison of the clinical features of patellofemoral pain and patellar tendinopahty

(슬개대퇴증후군과 슬개건병증의 임상적 비교)

Signs	Patellofemoral pain	Patellar tendinopathy
Onset	Running (especially downhill), Steps/stairs, hills Any weight-bearing activities involving knee flexion(e.g. distance running)	Activities involving jumping and/or changing direction(e.g. basketball, volleyball, high jump, netball, bounding, ballet, climbing stairs)
pain	Non-specific or vague May be medial, lateral or infrapatellar, Aggravated by activities that load the Patellofemoral joint	Usually at the inferior pole of patella, Aggravated by jumping and early-to mid squat
Inspection	Generally normal or VMO wasting	Generalized quadriceps wasting
Tenderness	Usually medial or lateral facets of patella May be tender in infrapatellar region. May have no pain on palpation due to areas of patella being inaccessible	Commonly inferior pole of patellar tendon attachment. Occasionally at distal attachment to tibial tuberosity. Rarely in midtendon
swelling	May have small effusion with either suprapatellar or infrapatellar swelling	Rare Tendon may be increased in thickness
Clicks/clunks	Occasional	No
Crepitus	Occasionally under patella	No
Giving way	Due to subluxation of (occasionally) quadriceps inhibition	Occasionally due to quadriceps inhibition
Knee range of motion	Usually normal May be decreased in severe cases	Usually normal No pain with overpressure
Quadriceps contraction in extension	Note quality of movement Usually not painful	Some cases are painful
Patellofemoral joint movement	May be restricted in any direction. Commonly restricted medial glide due to tight lateral structures.	May have normal patellofemoral joint biomechanics, in combined problem will have patellofemoral joint signs
Vastus medialis obliquus	May have obvious wasting, weakness, or more subtle deficits in tone and timing	May have generalized quadriceps weakness
Functional testing	Squats, stairs may aggravate. Patellofemoral joint taping should decrease pain	Decline squats aggravate pain. Patellofemoral taping has less effect

Ref) Clinical sport medicine P 682

Patellofemoral Pain syndrome

Patellofemoral Pain syndrome

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l  Diagnosis

n  Patellofemoral joint syndrome, anterior knee pain, chondromalacia patellae

n  “Umbrella” term used absence of other pathologies

l  Contributing factor

n  Extrinsic factor

u  Body mass, speed of gait, surfaces, footwear

n  Remote intrinsic factors

u  Increased femoral internal rotation, increased apparent knee valgus, increased tibial rotation, pronated foot type, inadequate flexibility

n  Local intrinsic factor

u  Patella position, soft tissue contriction, neuromuscular control of the vasti

l  Treatment

n  Reduction pain

u  Resting+ Ice, medication, mobilization of patella, taping

n  Addressing extrinsic contributing factor

u  Reduce the load

n  Addressing intrinsic contributing factor

u  Remote factors: hip muscle retraining, improving musculotendinous compliance, foot orthoses.

u  Local factors: patella taping or bracing, improving lateral soft tissue compliance, generalized quadriceps strengthening or vasti retraining

Ref) Clinical Sports Medicine P.686,690,693