eMedicine Specialties > Sports Medicine > Knee

Patellofemoral Joint Syndromes: Differential Diagnoses & Workup

Author: Jane T Servi, MD, Consulting Staff, Northern Colorado Orthopedic Associates
Contributor Information and Disclosures

Updated: Jul 15, 2009

Differential Diagnoses

Osgood-Schlatter Disease
Slipped Capital Femoral Epiphysis

Other Problems to Be Considered

Chondromalacia patella
Complex regional pain syndrome type I (Reflex sympathetic dystrophy)
Crystal arthropathy
Excessive lateral pressure syndrome
Infection
Legg-Calve-Perthes Disease
Loose body
Meniscal tear
Neoplasm
Osteochondritis dissecans
Rheumatoid arthritis /Psoriatic arthritis
Patellar/quadriceps tendinitis
Patellar subluxation
Plica
Postoperative considerations (after ACL reconstruction)
Sinding-Larsen-Johansson disease
Stress fracture of the hip or femur
Suprapatellar/prepatellar/infrapatellar tendinitis
Trauma from a direct blow to the knee

Workup

Laboratory Studies

  • Laboratory studies are not indicated for patellofemoral joint syndromes, unless there is a need to rule out other potential causes, such as systemic, inflammatory, or metabolic disease.
    • Erythrocyte sedimentation rate (ESR) is elevated in an inflammatory process.
    • Liver and renal function may be abnormal in metabolic disease.
    • Antibody tests are elevated for rheumatoid arthritis or ankylosing spondylitis.
    • Knee aspirates show an elevated white blood cell (WBC) count in an inflammatory process, an abnormal Gram stain and culture in infection, and crystals when crystal arthropathy is present.

Imaging Studies

  • Radiographic imaging is not necessary to make the diagnosis of patellofemoral joint syndrome, but these studies can be helpful to the physician when excluding other potential causes (see Differentials and Other Problems to Be Considered). Particular findings can support the diagnosis, including the following:
    • Lateral plain films show the presence of patella alta or patella baja.
    • A sunrise or Merchant's view reveals lateral tilt and the relative height of the femoral condyles.
    • Magnetic resonance imaging (MRI), computed tomography (CT) scanning, and bone scanning are not needed in the evaluation of patellofemoral joint syndromes, but these imaging modalities may be used to evaluate other pathologic conditions of the knee if the diagnosis is in doubt. Dynamic CT scanning, 0-120 º, is useful in assessing patellar tracking in recalcitrant cases in which surgery is being considered. This study can be used in the rare patient who is suspected of having a patellar tilt or subluxation but whose radiographs are normal.

More on Patellofemoral Joint Syndromes

Overview: Patellofemoral Joint Syndromes
Differential Diagnoses & Workup: Patellofemoral Joint Syndromes
Treatment & Medication: Patellofemoral Joint Syndromes
Follow-up: Patellofemoral Joint Syndromes
References
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References

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Further Reading

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Keywords

anterior knee pain, chondromalacia patella, patellalgia, patellar compression syndrome, patellofemoral dysfunction, patellofemoral pain syndrome, PFPS, peripatellar knee pain, retropatellar knee pain, global or generalized knee pain, joint line pain, posterior knee pain, patellar maltracking syndrome, miserable malalignment syndrome

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Contributor Information and Disclosures

Author

Jane T Servi, MD, Consulting Staff, Northern Colorado Orthopedic Associates
Jane T Servi, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, and American Medical Society for Sports Medicine
Disclosure: Ferring Pharmaceuticals Honoraria Speaking and teaching

Medical Editor

Andrew L Sherman, MD, MS, Associate Professor of Clinical Rehabilitation Medicine, Vice Chairman, Chief of Spine and Musculoskeletal Services, Program Director, SCI Fellowship and PMR Residency Programs, Department of Rehabilitation Medicine, Leonard A Miller School of Medicine, University of Miami
Andrew L Sherman, MD, MS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American College of Sports Medicine, American Medical Association, American Paraplegia Society, American Spinal Injury Association, and Association of Academic Physiatrists
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Russell D White, MD, Professor of Medicine, Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Truman Medical Center Lakewood
Disclosure: Nothing to disclose.

CME Editor

Jon B Whitehurst, MD, Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner and Executive Board Member, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital
Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

Chief Editor

Sherwin SW Ho, MD, Associate Professor, Department of Surgery, Section of Orthopedic Surgery and Rehabilitation Medicine, University of Chicago
Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

 
 
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