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Examination of Knee Joint in a Child
Published in Nirmal Raj Gopinathan, Clinical Orthopedic Examination of a Child, 2021
The patellofemoral joint is part of the quadriceps mechanism. The patella lies between the quadriceps muscle superiorly and the patellar tendon distally, which anchors it to the tuberosity of the tibia. The quadriceps angle (Q angle) is formed by the intersecting lines formed by the pull of the quadriceps mechanism and patellar tendon. Clinically, the angle is calculated in an extended knee position (standing patient). A straight line is drawn from the anterior superior iliac spine to the center of the patella and another line from the center of the tibial tuberosity to the patella’s center (Figure 10.3). A significant variation in the Q angle (normal is approximately 6°) indicates altered quadriceps pull. This may predispose to patellar subluxation.
Knee and Patella Radiography
Published in Russell L. Wilson, Chiropractic Radiography and Quality Assurance Handbook, 2020
Anterior knee pain and the potential for patellofemoral joint instability are common complaints from patients with knee pain. The routine sunrise or Settegast view will reduce any subluxation of the patella resulting in a false negative X-ray.
A to Z Entries
Published in Clare E. Milner, Functional Anatomy for Sport and Exercise, 2019
The knee consists of the tibiofemoral joint between the long bones of the lower extremity, where the femoral condyles articulate with the tibial plateau. The patellofemoral joint lies between the intertrochanteric groove of the femur and the patella (kneecap). The primary movement at the knee is flexion-extension in the sagittal plane (see planes and axes of movement). Typically, the knee has a range of motion of about 140° of flexion-extension, from about 5° of hyperextension to 135° of flexion. Secondary movements at the knee are abduction-adduction and internal-external rotation.
Monopolar dielectric diathermy by emission of radiofrequency in Patellofemoral pain. A single-blind-randomized clinical trial
Published in Electromagnetic Biology and Medicine, 2020
M Albornoz-Cabello, AJ Ibáñez-Vera, ME Aguilar-Ferrándiz, L Espejo-Antúnez
Patellofemoral Pain Syndrome (PFPS) is a health condition characterized by pain in the anterior surface of the knee and which tends to chronicity (Collins et al. 2010). Although it affects all population groups, its incidence is higher in adolescents and young adults (Satkunskiene et al. 2017). Patients usually describe an increment in the severity of their symptoms (especially pain) when walking upstairs or downstairs, squatting, running, or when sitting for a long time. This could be due to the fact that these activities increase compression forces in the patellofemoral joint (Rothermich et al. 2015). PFPS has usually been associated with knee osteoarthritis and elevated body mass index, but a recent study observed that this relation is not true (Hart et al. 2017) and it is known that joint cartilage is aneural (Insall 1982). For this reason, it can be considered that causes of this pain are still unknown.
Particulated juvenile articular cartilage allograft transplantation for osteochondral lesions of the knee and ankle
Published in Expert Review of Medical Devices, 2020
Colleen M. Wixted, Travis J. Dekker, Samuel B. Adams
Surgical treatment options available for osteochondral lesions of the knee closely resemble those available for OLTs. The patellofemoral joint contains the thickest articular cartilage, and injury to this area most often results in osteochondral lesions affecting the patella and trochlea [37,38]. Over the last 5 years, use of newer generation ACI and MACI techniques to treat these lesions has increased while the use of conventional microfracture has decreased. ACI and MACI require two procedures: the first to obtain a cartilage biopsy that is placed in cryopreservation and the second to implant the cultured chondrocytes. For MACI, the chondrocytes are delivered on a pre-seeded collagen membrane that is sized according to the defect rather than in a cell suspension. Extensive clinical evidence demonstrates favorable long-term outcomes for both of these techniques, providing a safe and durable means of cartilage repair with an 86% survival rate after 10 years[39]. Randomized controlled trials that compare ACI/MACI to microfracture have been contradictory since studies of smaller lesions and studies with shorter follow-up have not observed a clinically significant difference in outcomes [40–43]. However, as was seen with OLTs, studies of larger lesions and studies with longer follow-up noted superior outcomes with ACI and MACI compared to microfracture [44–47]. Although the downside to both ACI and MACI is the need for two procedures, they result in the development of hyaline-like cartilage rather than fibrocartilage.
Predicting no return to sports after three months in patients with traumatic knee complaints in general practice by combining patient characteristics, trauma characteristics and knee complaints
Published in European Journal of General Practice, 2019
Nynke M. Swart, Kim van Oudenaarde, Sita M. A. Bierma-Zeinstra, Johan L. Bloem, Patrick J. E. Bindels, Paul R. Algra, Monique Reijnierse, Pim A. J. Luijsterburg
Patients visiting their GP with knee complaints due to a trauma in the preceding six months were eligible for the TACKLE Trial. Patients had to be 18–45 years old; the restriction of 45 years was chosen to exclude patients with osteoarthritis as much as possible. Excluded from the study were patients with: (i) an indication for direct referral to an orthopaedic surgeon (e.g. fracture, locked knee or severe complaints after patella dislocation), (ii) knee complaints already treated in secondary care, (iii) previous surgical intervention of the affected knee, (iv) knee osteoarthritis diagnosed by a medical specialist, (v) other non-traumatic arthropathy (i.e. isolated patellofemoral joint pain), (vi) a previous MR scan for current knee complaints, or (vii) a contraindication for an MR scan. Furthermore, also excluded were patients: (i) who did not participate in sports before the knee trauma, and (ii) who did not return to sports after the knee trauma due to reasons other than knee complaints.