Anterior Knee Pain in Osteoarthritis of the Knee

PURPOSE: The purpose of this study were to evaluate the relationship between anterior knee pain and changes of patellofemoral joint in osteoarthritic knee. MATERIALS AND METHODS: We analyzed 200 patients who had undergone total knee arthroplasty and divided them into two groups ; the group 1(100 cases) with anterior knee pain and the group 2(100 cases) without it. We prospectively measured congruence angle and patellar height, and compared radiologic degenerative changes and operative findings(Outerbridge classification) of patella. RESULTS: The average congruence angle of patella was 11.2+/-1.6degrees in the group 1 and 2.8+/-1.3degrees in the group 2(p<0.05). Patellar height had no significant difference between two groups(p=0.62).For radiologic patellofemoral(PF) degenerative change, the group 1 showed mild degenerative change in 16 , moderate change in 47 and severe change in 37 in plain radiographs. The group 2 showed mild degenerative change in 53 and moderate change in 47 in plain radiographs(p<0.05). For cartilage degenerative change in patella(Outerbridge classification), whereas grade 3&4 were dominant in the group 1 with 71 cases, grade 1&2 were representative in the group 2 with 91 cases(p<0.05). CONCLUSION: Anterior knee pain seemed to be related with congruence angle and degenerative changes in radiologic and operative findings.

A Radiological Analysis of the Patients with Patellofemoral Pain Syndrome / 대한정형외과학회잡지

PURPOSE: We intend to provide more objective data for diagnosis of the patellofemoral pain syndrome by analyzing the positional changes of the patella radiologically. MATERIALS AND METHODS: In 42 normal knees and in 91 knees of patients with the patellofemoral pain syndrome, the following 6 parameters were analyzed using a 30 degree flexion lateral view and a Merchant axial view: 1) the Insall and Salvati method, 2) the Blackburne and Peel method, 3) the Saille method, 4) the depth of the trochlea, 5) the sulcus angle, 6) and the congruence angle. RESULTS: Using the Blackburne and Peel method of assessing the height of patella, the ratio was 0.86 in the control group, in contrast to 0.92 in the patellofemoral pain syndrome group (P<0.05). The average value of the congruence angle was 2.9 in the control group, while it was -9.2 in patellofemoral pain syndrome group (P<0.05). The other parameters showed no statistical significance. CONCLUSION: This indicates that the patella alta by the Blackburne and Peel method and the increase of congruence angle are useful in the diagnosis of the patellofemoral pain syndrome.

The Value of Radiolographic Assessment in Patellofemoral Pain Syndrome

Patellofemoral pain syndrome (PFS) is one of the most common types of anterior knee pain and many studies reported the patellofemoral malalignments (such as high patella, increased sulcus angle and increased congruence angle) as possible causes of the syndrone. In order to confirm this hypothesis, the difference of congruence, sulcus angles and patella height ratio in normal subjects and PFS patients was evaluated. The PFS subjects were selected according to the criterias of anterior knee pain, pain aggravation after the repeated knee flexion and extension motion. A combined knee injury was screened by MRI. We have compared our data to the previous studies of Merchant et al.(1974), Aglietti et al.(1983), and Dowd and Bently(1986). The radiographic studies were done on lateral view, Merchant view, and patella height was measured by Insall-Salvati method and Blackburn-Peel method. The sulcus angle and the congruence angle were measured on a Merchant view. The results showed that the average patella height of normal group was 1.00+/-0.17 by the Insall test and the patella index was 1.02?0.23. There was no statistical difference between normal and patient group of which the patella height was 0.96+/-0.16 by Insall test with patella index of 1.04?0.17. On Merchant view, the congruence angle was +/-7 +/-11 degrees, and the sulcus angle was 135.5+/-6 degrees in PFS patient group, and in normal group the congruence angle was +/-2 +/-14 degrees, and the sulcus angle was 136+/-5. A little statistical variation was noted in both group. Our results were not much different from previous studies except for the Aglietti's study in congruence angle. We concluded that the Insall test, patella index, congruence angle and sulcus angle could not help to idetify patellofemoral malalignment of knee joint in PFS patients.

The Comparison of Sulcus Angle and Congruence Angle in the Patient with and without the Patella Pain Syndrome / 대한정형외과학회잡지

Chondromalacia patella is a symptom complex characterized by aching pain behind the knee cap, retropatella tenderness that is aggravated by the stair climbing. Malalignment is an important factor causing chondromalacia patella. And to recognize it, is important in the diagnosis and treatment. We studied 3 parameters in the chondromalacic knee and nonchondromalacic knee and the following results was obtained. l. In nonchondromalacic knee, the sulcus angle is 141° 7′ and the congruence angle is −5° 1′ 2. In chonduomalacic knee the sulcus sagle is 139° 2′ and the congruence angle is +5° 3′ 3. In the group with abnormal congruence angle, there was much degenerative changes in the patellofemaral joint. So, it can be inferred that chondromalacia is a precursor of the osteoarthritis and the patient with abnormal congruence angle should be treated actively at the early stage if the conservative treatment had failed.