The Patellofemoral Joint
The patellofemoral joint has traditionally been poorly understood and interventions for patellofemoral joint problems have generally been less successful than those employed for the tibiofemoral joint. Pathologies affecting the patellofemoral joint in the
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The Patellofemoral Joint Farhad Iranpour, Arash Aframian, and Justin P. Cobb
Abstract
The patellofemoral joint has traditionally been poorly understood and interventions for patellofemoral joint problems have generally been less successful than those employed for the tibiofemoral joint. Pathologies affecting the patellofemoral joint in the adult can be largely divided into three groups: instability, osteochondral defects and osteoarthritis. These three conditions share a number of aetiological factors and all represent disorders of the normal mechanics of the patellofemoral articulation. As such, understanding the normal and abnormal anatomy and kinematics of the joint are vital to clinicians treating patellofemoral disorders. Treating the symptoms of these conditions without addressing the underlying disorder of kinematics will be likely to fail. In this chapter, the normal and abnormal anatomy and physiology of the joint are discussed as are the clinical features and treatments for the three commonly encountered pathologies of the patellofemoral joint. Keywords
Patellofemoral joint • Disorders • Diagnosis • Treatment
5.1
F. Iranpour (*) • A. Aframian • J.P. Cobb Department of Musculoskeletal Surgery, Division of Surgery, Oncology, Reproductive Biology and Anaesthetics, Imperial College London, 7th Floor, Charing Cross Hospital, Fulham Palace Road, W6 8RF London, UK e-mail: [email protected]; a.aframian@ imperial.ac.uk; [email protected]
Introduction
The patellofemoral joint is an important generator of symptoms within the knee joint in patients of all ages. In adults, the major pathologies are instability, osteochondral injuries and osteoarthritis. Common to all are disruptions to the complex biomechanics of the articulation. Understanding of the anatomy and physiology of the patellofemoral joint has lagged behind that of the tibiofemoral joint, but over recent years a
© Springer International Publishing Switzerland 2017 E.C. Rodríguez-Merchán, A.D. Liddle (eds.), Joint Preservation in the Adult Knee, DOI 10.1007/978-3-319-41808-7_5
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great deal of research has been focussed on understanding the patellofemoral joint. The aim of this chapter is to describe the geometry and kinematics of the joint, and to apply these to the major pathologies encountered in the patellofemoral joint. By understanding the disorders of normal mechanics of the joint the surgeon can better understand the strategies for treatment of these traditionally difficult to treat pathologies.
5.2
Biomechanics
5.2.1
Geometry
While the bicondylar knee joint dates back to Eryops, an ancestor of reptiles, birds and mammals some 320 million years ago [1] the patellofemoral joint is a relatively recent development, dating back only 65 million years [2]. The patella is the largest sesamoid bone in the body and centralises the four converging heads of the quadriceps muscle group, transmitting their force and acting as a fulcrum. By extending the moment arm, it increases the power of knee extension [3–6]
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