Patellofemoral Syndrome Workup

  • Author: Patrick J Potter, MD, FRCP(C); Chief Editor: Consuelo T Lorenzo, MD   more...
 
Updated: Feb 16, 2012
 

Laboratory Studies

  • Laboratory studies generally are not indicated for the diagnosis of patellofemoral syndrome.
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Imaging Studies

  • Imaging studies usually are not necessary in order for a physician to diagnose or recommend treatment for patellofemoral syndrome (PFS). Imaging studies should be considered for unusual presentations and for persons in whom the syndrome is refractory to conservative management.
    • Skyline views should be included with anterior-posterior (AP) and lateral radiographic imaging of the knee. Limited positions of flexion are available for such viewing. These radiographs provide more of an indirect observation of what is happening within the articulation.
    • Lateral patellar tilt and a high-riding patella (patella alta) may be observed.
    • Osteophytes or joint space narrowing may be identified, suggesting arthritic changes in the articular cartilage.[4]
  • Nuclear scans are less likely to be of value in defining PFS and are more useful in helping to identify other, less common conditions that may mimic PFS, as outlined in the differential diagnoses. When changes have occurred in the retropatellar cartilage, mild increases in uptake of radionucleotide may be observed. Increased uptake of radionucleotide is not limited to the patella; it may be seen in the proximal tibia, distal femur, or patella.[5]
  • Computed tomography (CT) scanning and magnetic resonance imaging (MRI)
    • CT scanning and MRI allow for imaging at various angles of flexion.
    • CT scanning with the knee in full extension has been demonstrated to more accurately detect patellar subluxation.
    • Cross-sectional viewing allows more direct visualization of the articulation between the patella and femur.
    • Schutzer et al identified 3 patterns of malalignment using CT scanning[6] :
      • Type 1 includes patellar subluxation without tilt.
      • Type 2 is described as patellar subluxation with tilt.
      • Type 3 is patellar tilt without subluxation.
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Other Tests

  • Serology, joint aspiration, and related tests are indicated only when alternative diagnoses are suspected. Such investigations are not likely to provide useful information in this syndrome, as it is not a disease entity but rather a group of symptoms occurring sometimes in association with multiple factors (intrinsic and extrinsic).[7]
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Procedures

  • Arthroscopy
    • Arthroscopy helps to confirm the diagnosis patellofemoral syndrome (PFS) by allowing direct visualization of the cartilage surface. Arthroscopic evaluation also provides assessment of joint structures that may cause symptoms that mimic PFS when they are impaired.
    • Arthroscopy also has the ability to facilitate surgical alteration of patellar tracking (eg, lateral release). Visualization of the patella may allow for some revision of the cartilage surface. However, most authors agree that surgical treatment is rarely indicated.
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Histologic Findings

Histologic findings are dependent on the extent to which the cartilage surfaces have been compromised. Shearing stresses may result in changes in subchondral bone and dysplasia of the cartilage surface. More severe cartilage changes have been identified in persons with patellofemoral syndrome that has been refractory to conservative measures.

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Contributor Information and Disclosures
Author

Patrick J Potter, MD, FRCP(C)  Associate Professor, Department of Physical Medicine and Rehabilitation, University of Western Ontario School of Medicine; Consulting Staff, Department of Physical Medicine and Rehabilitation, St Joseph's Health Care Centre

Patrick J Potter, MD, FRCP(C) is a member of the following medical societies: American Paraplegia Society, Canadian Association of Physical Medicine and Rehabilitation, Canadian Medical Association, College of Physicians and Surgeons of Ontario, Ontario Medical Association, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Coauthor(s)

Keith Aj Sequeira  MD, FRCPC, Associate Professor, Director of Education, Department of Physical Medicine and Rehabilitation, Parkwood Hospistal, University of Western Ontario

Disclosure: Nothing to disclose.

Specialty Editor Board

Robert E Windsor, MD, FAAPMR, FAAEM, FAAPM  President and Director, Georgia Pain Physicians, PC; Clinical Associate Professor, Department of Physical Medicine and Rehabilitation, Emory University School of Medicine

Robert E Windsor, MD, FAAPMR, FAAEM, FAAPM is a member of the following medical societies: American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine, American Medical Association, International Association for the Study of Pain, and Texas Medical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Patrick M Foye, MD  Associate Professor of Physical Medicine and Rehabilitation, Co-Director of Musculoskeletal Fellowship, Co-Director of Back Pain Clinic, Director of Coccyx Pain Service (Tailbone Pain Service: www.TailboneDoctor.com), University of Medicine and Dentistry of New Jersey, New Jersey Medical School

Patrick M Foye, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, Association of Academic Physiatrists, and International Spine Intervention Society

Disclosure: Nothing to disclose.

Kelly L Allen, MD  Medical Director, Medevals

Disclosure: Nothing to disclose.

Chief Editor

Consuelo T Lorenzo, MD  Physiatrist, Department of Physical Medicine and Rehabilitation, Alegent Health Immanuel Rehabilitation Center

Consuelo T Lorenzo, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

References

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  9. Chiu JK, Wong YM, Yung PS, Ng GY. The effects of quadriceps strengthening on pain, function, and patellofemoral joint contact area in persons with patellofemoral pain. Am J Phys Med Rehabil. Feb 2012;91(2):98-106. [Medline].

  10. Collins N, Crossley K, Beller E, Darnell R, McPoil T, Vicenzino B. Foot orthoses and physiotherapy in the treatment of patellofemoral pain syndrome: randomised clinical trial. BMJ. Oct 24 2008;337:a1735. [Medline]. [Full Text].

  11. Barton CJ, Menz HB, Crossley KM. Clinical Predictors of Foot Orthoses Efficacy in Individuals with Patellofemoral Pain. Med Sci Sports Exerc. Feb 8 2011;[Medline].

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