How is the physical exam to evaluate patellofemoral arthritis performed?

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

A thorough examination of both the affected and nonaffected knees should be performed. The presence of crepitus is nonspecific. A standard knee examination should be performed. Passive and active range of motion should be recorded. Strength and tightness of hamstring and quadriceps muscle groups should be determined.

Assess for the presence of ligamentous laxity, instability, and patella maltracking and attempt to elucidate the source of pain. The goal of palpating the structures of the anterior knee is to determine whether the patient's complaints are related to arthritic changes or to the underlying soft tissues. [20] Attention should be focused on the lateral retinaculum, the quadriceps and patellar tendons, and the quadriceps muscle.

The patella is compressed as the patient flexes the knee. Pain often is elicited by this maneuver if arthritis is present. Resisted knee extension also may reproduce the patient's symptoms in arthritic conditions.

Attempt to laterally displace the patella with the knee in extension. Patients with instability contract their quadriceps muscles or complain of pain because of the feeling of subluxation

Knee stability to varus and valgus stress should be assessed. Stability of the ACL can be determined by anterior drawer and Lachman tests. The stability of the patella to medial and lateral stress should be determined, as should the lateral patella tilt.

The patella normally enters the trochlea from a lateral position and becomes centralized with increasing knee flexion, traveling in a J pattern. Abnormalities observed include excessive lateral tracking increasing the angle at which the patella enters the trochlea.

Perform a hip and spine examination. Additionally, look for a prominent superolateral patellalike bipartite patella or a high-riding patella.

Patellar tendinitis, which is swelling at the inferior pole of the patella tendon, is also a possibility and must be evaluated.


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