Pediatrics in Review
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 Vol. 27 No. 7, July 2006
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(Pediatrics in Review. 2006;27:264-270.)
© 2006 American Academy of Pediatrics

Consultation With the Specialist: Patellofemoral Conditions in Childhood


Theodore J. Ganley, MD*
Rebecca L. Gaugles*
Leslie A. Moroz*
 * Division of Orthopaedic Surgery, The Children’s Hospital of Philadelphia, Philadelphia, Pa

The first 300 words of the full text of this article appear below.


   Objectives
 
After completing this article, readers should be able to:

  1. Describe the signs, symptoms, and risk factors related to patellofemoral instability and pain.
  2. Discuss the elements of physical examination and the radiographic features that can help diagnose these conditions.
  3. Assess the risk for recurrent instability and pain.
  4. Provide patients with an overview of treatment options.


   Introduction
 
Patellofemoral instability and patellofemoral pain are seen commonly in the outpatient setting. An understanding of knee anatomy and accurate interpretation of clinical findings are necessary to evaluate and manage patellofemoral pain and instability properly and to help young patients return safely to sports. In this article, we discuss how to distinguish patellofemoral instability from patellofemoral pain and offer our approach to managing these conditions.


   Patellofemoral Pain
 
Patients who have increased hip internal rotation, lower leg external rotation, knock knee alignment, flat foot, tight hamstrings, tight heel cords, and poor quadriceps muscle tone are at increased risk for anterior knee pain. This condition is referred to as patellofemoral or anterior knee pain syndrome. The previous term, chondromalacia patella, has fallen out of favor because it refers only to the anatomic changes of the undersurface of the patella and not to the soft tissue or afferent and efferent pain fibers.

The physical examination for this condition follows the general protocol for assessment of knee pain. All patients should be evaluated to be sure that they have level shoulders and pelvis without evidence of spinal asymmetry. An observation of walking and running can help rule out quadriceps atrophy and identify painful or antalgic gait patterns as well as foot progression angles that show intoeing or out-toeing. Patients are evaluated prone and supine to ensure that hip, knee, and ankle strength and range of motion are symmetric. A standing evaluation checks for evidence of malalignment, including genu valgum, calcaneovalgus, and pes planus. . . . [Full Text of this Article]






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