There is no clear consensus in the literature concerning the terminology, aetiology and treatment for pain in the anterior part of the knee. The term ‘anterior knee pain’ is suggested to encompass all pain-related problems. By excluding anterior knee pain due to intra-articular pathology, peripatellar tendinitis or bursitis, plica syndromes, Sinding Larsen’s disease,Osgood Schlatter’s disease, neuromas and other rarely occurring pathologies, it is suggested that remaining patients with a clinical presentation of anterior knee pain could be diagnosed with patello-femoral pain syndrome (PFPS). Three major contributing factors of PFPS are discussed: (i) malalignment of the lower extremity and/or the patella; (ii) muscular imbalance of the lower extremity; and (iii) overactivity.

Patellofemoral pain syndrome: a review of current issues.

Mechanical abnormalities of the patellofemoral joint are among the many causes that have been suggested for adolescent knee pain. This study seeks to identify these factors. Measurements of joint mobility and lower limb morphology were made on 446 pupils at a comprehensive school, 136 of whom had suffered knee pain in the previous year. The pupils with symptoms enjoyed sporting activities significantly more than their symptom-free contemporaries. Joint mobility, the Q-angle, genu valgum and anteversion of the femoral neck were not significantly different between those pupils with and those without anterior knee pain. Data on lower limb morphology of normal adolescents are presented. Examination of 52 hospital outpatients aged 13 to 36 years with anterior knee pain produced results comparable with those for the pupils. It is concluded that chronic overloading, rather than faulty mechanics, is the dominant factor in the genesis of anterior knee pain in adolescent patients.

Mechanical factors in the incidence of knee pain in adolescents and young adults

Over a five year period, 137 athletes presented to a Sports Injury Clinic with patello-femoral arthralgia. This was 5.4% of the total injuries seen and a quarter of all knee problems treated. Running contributed to 32% of the athletes with patello-femoral pain. There was a 4:1 male:female ratio and nearly 70% were in the 16-25 year age range. A follow-up questionnaire was sent to 72 athletes seen in the last two years with a 78% response rate. Symptoms and treatment are discussed. After conservative therapy only 28.6% were entirely symptom free with a mean follow up of 13.1 months.

https://bjsm.bmj.com/content/bjsports/18/1/18.full.pdf

Patello-femoral arthralgia in athletes attending a Sports Injury Clinic.

OBJECTIVES
To present the original descriptions of common orthopedic physical examination maneuvers of the knee and then to review the literature to support the scientific validity of these tests.


DATA SOURCES
MEDLINE (1970-2000) searches were performed, as were reviews of various musculoskeletal examination textbooks that describe physical examination maneuvers of the knee. These references were then reviewed for additional references and crossed back to the original description (when possible) of these named tests.


STUDY SELECTION
All articles that discussed the sensitivity and specificity of the physical examination maneuvers were extracted. This information was reviewed for accuracy and then summarized.


DATA EXTRACTION
Multiple MEDLINE and text searches were performed by using the terms of the test maneuver, the joint tested, and the term physical examination. Any article with this information was reviewed until the article describing the original description was found. Articles dating from that original article to the present were reviewed for information on the sensitivity and specificity of the test.


DATA SYNTHESIS
Literature reviewing the sensitivity and specificity of the tests reviewed is summarized in text and table form. The Lachman test seems to be very sensitive and specific for the detection of anterior cruciate ligament tears. For posterior cruciate ligament tears, the posterior drawer test is also very sensitive and specific and is enhanced with other tests, such as the posterior sag sign. For meniscal tears, the McMurray test is very specific but has a very low sensitivity, whereas joint line tenderness has fairly good sensitivity but lacks good specificity. Although collateral ligament testing seems to be sensitive and specific, there is a lack of well-designed studies that scientifically validate the sensitivity and specificity of these tests. Common tests for patellofemoral pain and patellar instability lack sensitivity when correlated with pathologic operative findings.


CONCLUSIONS
Most physical examination tests could be referenced back to an original description, with variable information on the sensitivity and specificity along with other information about the validity of these tests in clinical practice. To standardize how physical examinations are performed and compared, they should follow the original description or agreed-on standards. In addition, the significance of a physical examination finding must be understood to ensure that patients with knee complaints are accurately diagnosed and properly treated.

http://link.springer.com/content/pdf/10.1007%2FBF03076122.pdf

Physical examination of the knee: A review of the original test description and scientific validity of common orthopedic tests (Arch Phys Med Rehabil 2003;84:592-603):Vertaling: L. Eenkhoorn

Physical examination of the knee: A review of the original test description and scientific validity of common orthopedic tests

Chondromalacia patellae is difficult to diagnosis clinically with accuracy. In order to clarify the relevant symptoms and signs, 78 patients presenting with a clinical diagnosis of chondromalacia were examined by arthroscopy. In 49% of the knees no abnormalities were found. Presenting symptoms were similar in the normal and abnormal groups. Physical signs were more helpful in diagnosis and it is considered that the presence of an effusion, quadriceps wasting, and patello-femoral crepitus are the most important clinical findings in the diagnosis of chondromalacia patellae. The arthroscope is valuable instrument in establishing the diagnosis of chondromalacia patellae especially in the teenage female.

https://ard.bmj.com/content/annrheumdis/37/6/540.full.pdf

I J Leslie

Papers

Arthroscopy in the diagnosis of chondromalacia patellae.