What observations should be made during the physical exam to evaluate patellofemoral arthritis?

Updated: Dec 11, 2019
  • Author: Dinesh Patel, MD, FACS; Chief Editor: Thomas M DeBerardino, MD  more...
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Answer

Astute observations of gait and of lower-extremity alignment are an essential component of the physical examination. Leg-length discrepancies, Q angle, and torsional deformities of the femur, tibia, and foot should be noted. Flexion contractures of the limb should be noted.

Gait, such as waddling gait, should be observed carefully, with the patient not wearing shoes. Excessive pronation of the feet, patella tracking, and rotation of the lower limb should be observed. Muscle tone and atrophy of the quadriceps and hamstrings should be assessed. Patella tracking with passive flexion and extension and with very careful semisquatting should be determined.

A study by Crossley et al found that, compared with normal controls, people with patellofemoral joint osteoarthritis demonstrated the following differences while walking [18] :

  • Greater anterior pelvic tilt throughout the stance phase,
  • Greater lateral pelvic tilt (ie, pelvis lower on the contralateral side)
  • Greater hip adduction
  • Lower hip extension during the late stance phase

Physical findings must be evaluated in the context of patient complaints. A study of 210 adults with asymptomatic knees revealed abnormal radiographic or physical examination findings in 95% of women and 79% of men. [19] Patellar crepitus, a hypermobile patella, and lateral position of the patella on the axial radiographs were common in this group of patients. Unfortunately, no long-term follow-up was performed to determine whether subjective complaints developed; however, these findings emphasize the point that a diagnosis cannot be based on physical findings alone.


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