Inaba Yutaka, Numazaki Shin, Koshino Tomihisa, Saito Tomoyuki
Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan.
Knee. 2003 Dec;10(4):351-5. doi: 10.1016/s0968-0160(03)00008-5.
The incidence and the causes of provoked anterior knee pain in medial osteoarthritis (OA) of the knee were investigated clinically and radiographically. A retrospective study was performed in 179 primary osteoarthritic knees of 129 patients. Provocative tests were conducted on the patellofemoral (PF) joint to induce retropatellar crepitation, grating pain, tenderness around the patella, and pain on deviating the patella. The femorotibial angle (FTA) was measured on standing anteroposterior radiographs as a parameter of limb alignment. The widths of the medial and lateral joint space of the PF joint were measured on skyline views of standing or 30, 60 or 90 degrees knee flexion. The angle of flexion contracture was measured on lateral radiographs of knees with maximum extension. The lateral shift and tilt of the patella were measured on standing skyline views. Retropatellar crepitation was found in 70% of knees, while provoked anterior knee pain was observed in 35-45% of knees with medial OA of the knee. Standing FTA was significantly greater in knees with tenderness around the patella and pain on deviating the patella than in those without these symptoms (P<0.05). The angle of flexion contracture was significantly greater in knees with provoked symptoms in the PF joint than in those without symptoms (P<0.05). The degree of lateral shift was greater in knees with provoked symptoms (P<0.05). Flexion contracture and varus deformity of the knee with lateralization of the patella may be factors aggravating provoked PF symptoms in medial OA of the knee. The radiographic assessment in this series failed to show a significant relationship between the width of the PF joint space and the incidence of provoked PF symptoms.
我们通过临床和影像学方法对膝关节内侧骨关节炎（OA）中激发性前膝痛的发病率及病因进行了研究。对129例患者的179个原发性骨关节炎膝关节进行了一项回顾性研究。对髌股（PF）关节进行激发试验，以诱发髌后摩擦音、摩擦痛、髌骨周围压痛以及髌骨偏移时的疼痛。在站立位前后位X线片上测量股胫角（FTA），作为肢体对线的参数。在站立位或膝关节屈曲30°、60°或90°时的髌股关节天际线视图上测量PF关节内侧和外侧关节间隙的宽度。在膝关节最大伸展位的侧位X线片上测量屈曲挛缩角。在站立位天际线视图上测量髌骨的外侧移位和倾斜度。70%的膝关节出现髌后摩擦音，而在膝关节内侧OA患者中，35 - 45%的膝关节出现激发性前膝痛。髌骨周围压痛和髌骨偏移时疼痛的膝关节，其站立位FTA显著大于无这些症状的膝关节（P<0.05）。PF关节有激发症状的膝关节，其屈曲挛缩角显著大于无症状的膝关节（P<0.05）。有激发症状的膝关节，其外侧移位程度更大（P<0.05）。膝关节的屈曲挛缩和内翻畸形以及髌骨外侧移位可能是加重膝关节内侧OA中激发性PF症状的因素。本系列的影像学评估未能显示PF关节间隙宽度与激发性PF症状发生率之间存在显著关系。
