Pediatric emergency medicine trisk 3968 3968
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age (girls younger than 10 years, boys younger than 12 years) is a very significant
predictor for development of a contralateral slip.
PATELLOFEMORAL PAIN SYNDROME AND
CHONDROMALACIA PATELLAE
Current Evidence
Patellofemoral pain syndrome describes a constellation of symptoms, principally
anterior knee pain, arising from the patellofemoral joint. Chondromalacia patella
is a pathologic diagnosis referring to damage of the articular cartilage of the
patella. Specific changes include softening, fissures, and erosions. Whether the
two conditions are actually related is the subject of debate. They share a number
of symptoms and precipitating factors. Patellofemoral pain syndrome may
represent the early end of the spectrum of injury, which ultimately may or may
not progress to true pathologic changes within the cartilage.
Patellofemoral pain syndrome is first seen in early adolescents, especially in
runners. The rise in incidence tends to parallel the growth spurt. A number of
underlying causes or associated factors have been identified. Malalignment of the
patella and an abnormal tracking of the patella over the femoral condyles appear
to be the major contributors to patellofemoral disorders. The quadriceps or Q
angle is the angle between a line from the center of the tibial tubercle to the center
of the patella and a second line from the center of the patella to the anterior
superior iliac spine. A Q angle greater than 20 degrees has been found in a
significant number of affected individuals and results in disproportionate lateral
traction applied to the patella during extension. The wider pelvic bones in females
result in a generally wider Q angle, which may account for the higher proportion
of patellofemoral problems in females. Relative weakness of the vastus medialis
is highly associated with the condition and strengthening of this muscle through
rehabilitation is associated with clinical improvement. A shallow femoral
intracondylar sulcus has also been associated with the disorder.
Clinical Considerations
Clinical Recognition
Patellofemoral pain syndrome is often classified as an overuse syndrome because
individuals exposed to repetitive trauma are at higher risk for this disorder.
Runners are particularly predisposed to develop this condition especially those
running hills or stadium stairs. Poor training regimens, rapid increases in duration
