Is there a biomechanical explanation for anterior knee pain in patients with patella alta?

Luyckx, Thomas; Didden, K.; Vandenneucker, Hilde; Labey, Luc; Innocenti, Bernardo; Bellemans, Johan

doi:10.1302/0301-620x.91b3.21592

Cited by 146 publications

(76 citation statements)

References 25 publications

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“…The synovium, lateral retinaculum, infrapatellar fat pad, periosteum and subchondral bone of patellae affected with degenerative disease are all richly supplied with type Ⅳa FNEs and fibres containing Substance P [2] . A key aim of this study was to identify literature evaluating the different determinants of AKP after a TKA was found [2,8,9,12,13,15,18,22,23,[25][26][27]30,34,[36][37][38][39][40][41] . The articles reviewed confirm this study's hypothesis that anything that alters the patellofemoral joint (PFJ) mechanics can activate these FNEs and thus induce AKP after TKA [22] .…”

Section: Discussionmentioning

confidence: 99%

“…One study found a lower prevalence of AKP due to the resection of Hoffa's fat pad [66] . Other factors contributing to AKP have been proposed; wear [21] , referred pain [21,22] , patella height [24,39] , patellar thickness [67,68] and patella baja (pseudonaja), but these studies could not demonstrate a correlation with AKP after TKA. This is often more a lack of power than proof.…”

Section: A B D Cmentioning

confidence: 97%

“…The PFJ loading is influenced both by changes in the joint line height and by selecting a femoral component that is too large [39,53] . Tibia-femoral instability, due to inappropriate placement or other causes, leads to increased pressure on the PFJ, especially in flexion [54] .…”

Section: Regeneration Of Nervesmentioning

confidence: 99%

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Anterior knee pain after a total knee arthroplasty: What can cause this pain?

Breugem¹,

Haverkamp²

2014

WJO

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Total Knee Arthroplasty has been shown to be a successful procedure for treating patients with osteoarthritis, and yet approximately 5%-10% of patients experience residual pain, especially in the anterior part of the knee. Many theories have been proposed to explain the etiology of this anterior knee pain (AKP) but, despite improvements having been made, AKP remains a problem. AKP can be described as retropatellar or peripatellar pain, which limits patients in their everyday lives. Patients suffering from AKP experience difficulty in standing up from a chair, walking up and down stairs and riding a bicycle. The question asked was: "How can a 'perfectly' placed total knee arthroplasty (TKA) still be painful: what can cause this pain?". To prevent AKP after TKA it is important to first identify the different anatomical structures that can cause this pain. Greater attention to and understanding of AKP should lead to significant pain relief and greater overall patient satisfaction after TKA. This article is a review of what pain is, how nerve signalling works and what is thought to cause Anterior Knee Pain after a Total Knee Arthroplasty.© 2014 Baishideng Publishing Group Inc. All rights reserved. Key words:Anterior knee pain; Patellofemoral pain; Total knee arthroplasty; Malrotation; Homeostasis Core tip: Total knee arthroplasty (TKA) has been shown to be a successful procedure for treating patients with osteoarthritis, and yet approximately 5%-10% of patients experience anterior knee pain (AKP). To prevent AKP after TKA it is important to first identify the different anatomical structures that can cause this pain. Greater attention to and understanding of AKP should lead to significant pain relief and greater overall patient satisfaction after TKA. This article is a review of what pain is, how nerve signalling works and what is thought to cause AKP after a TKA.Breugem SJM, Haverkamp D. Anterior knee pain after a total knee arthroplasty: What can cause this pain? World

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Section: Discussionmentioning

confidence: 99%

Section: A B D Cmentioning

confidence: 97%

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Anterior knee pain after a total knee arthroplasty: What can cause this pain?

Breugem¹,

Haverkamp²

2014

WJO

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“…Furthermore, patella alta has been biomechanically and clinically linked to increased incidence of AKP [28][29][30][31] and present in 30 % of patients with PF disorders and in 0 % of controls [15,22]. There are also reports of a group of patients with 'potential patellar instability', in whom trochlear dysplasia and/or patella alta are present and causing AKP but with no history of patellar dislocation [15].…”

Section: Introductionmentioning

confidence: 99%

The incidence of trochlear dysplasia in anterior cruciate ligament tears

Ntagiopoulos¹,

Bonin²,

Sonnery‐Cottet

et al. 2014

International Orthopaedics (SICOT)

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Purpose The purpose of the present epidemiologic study is to record the radiographic presence of trochlear dysplasia and patella alta in patients who undergo anterior cruciate ligament (ACL) reconstruction as a potential underlying factor for postoperative anterior knee pain (AKP). Methods All consecutive cases of skeletally-mature ACLdeficient knees that would undergo ACL reconstruction in three different hospitals were prospectively included during a six-month period. Inclusion criteria were acute and subacute ACL injury with no previous ipsilateral knee operation. Patients with chronic ACL tears, prior-to-ACL-injury history of patellar instability or other PF disorders were excluded from the study. Results A total of 299 knees were included (mean age 32± ten years). Forty-four (14.7 %) knees had a positive 'crossing sign' in the lateral X-rays and 255 (85.3 %) had no sign of trochlear dysplasia (p<0.01). Among the cases with trochlear dysplasia, 41 (93 %) had type A trochlear dysplasia with the presence only of the 'crossing sign' and three (7 %) had type C trochlear dysplasia. Patellar height results included a mean Caton-Deschamps index of 1.0± 0.14 (0.5-1.4). Twenty (6.6 %) knees had an index of less than 0.8, and two (0.6 %) knees had an index less than 0.6. In contrast, 15 (5.0 %) knees had an abnormal value of more than 1.2, indicating patella alta. ConclusionsThe most important finding of the study is the increased prevalence of trochlear dysplasia and patella alta in patients with ACL injury, when compared to the incidence of trochlear dysplasia and patella alta in the general population in the literature. This finding could sound as an alert of a possible additional risk factor for post-operative anterior knee pain after ACL reconstruction.

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“…докладывают, что при patella аlta нагрузка на суставные поверхности возрастает при сгибании в пре-делах 0-60°, достигая пика при 90° [57]. Luyckx, используя данные динамическо-го симулятора КС, демонстрировал мини-мальную нагрузку на фасетки при 35-70°, максимальную -при 70-120°, причём по сравнению с нагрузкой при нормальном надколеннике эта нагрузка многократно воз-растала, потому что в норме рычаг силы четырёхглавой мышцы превалирует над ры-чагом силы связки надколенника [58].…”

Section: Etiopathogenic Bases For Patellofemoral Arthritis Developmentunclassified

Etiopathogenic bases for patellofemoral arthritis development

Саид

М²,

Akhtyamov

et al. 2018

Kazan Med J

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Patellofemoral arthritis is nowadays an actual issue of traumatology and orthopedics. High prevalence of this pathology around the world (6.9 to 36.1%) is associated with multiple etiological causes, responsible for certain difficulties in diagnosis and complexity of determining an individualized pathogenetic method of treatment. The pathology, often occurring in the young age, is called «delayed or late arthritis», due to the fact that it is often ignored in the early stages of its development. This leads, in the final stages of disease, to manifestation of classic osteoarthritis involving all the structures of the knee joint in the process. The literature review is devoted to the study of etiology, pathogenesis and anatomical features of the development of patellofemoral arthritis. From the clinical point of view, the most important factors, influencing patellofemoral arthritis course, are analyzed. They include mechanisms of the disease, anatomical features of patella, trochlear surface and femoral condyles, which affect the disease course. The article discusses the risk factors of patellofemoral arthritis, such as weakness of vastus muscles of quadriceps femoris, increased knee Q-angle, increased femoral anteversion and tibial rotation, abnormalities of patellar and tibial epicondyles morphology. In addition the study presents some data about dysplasia of the condyles and femoral trochlea and patella, disposition of the patella and dysplasia of the quadriceps. Variations of configuration and position of patella affecting its stability are described and presented. The article also focuses on the influence of internal tibial rotation and femoral anteversion on the development of disease, as well as patellar instability as a multifactorial cause.

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Is there a biomechanical explanation for anterior knee pain in patients with patella alta?

Cited by 146 publications

References 25 publications

Anterior knee pain after a total knee arthroplasty: What can cause this pain?

Anterior knee pain after a total knee arthroplasty: What can cause this pain?

The incidence of trochlear dysplasia in anterior cruciate ligament tears

Etiopathogenic bases for patellofemoral arthritis development

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