Luhmann Scott J, Schoenecker Perry L, Dobbs Matthew B, Eric Gordon J
Department of Orthopaedic Surgery, Shriner's Hospital for Children, St Louis Children's Hospital, Washington University School of Medicine, 660 S. Euclid Ave., Campus Box 8233, St Louis, 63110, MO, USA,
J Child Orthop. 2008 Aug;2(4):269-77. doi: 10.1007/s11832-008-0104-2. Epub 2008 Jun 11.
The purpose of this study is to define the clinical presentation of adolescent patellofemoral pain.
A review was completed of all patients with patellofemoral pain at a children's hospital sports clinic over a 3-year period.
One hundred and one patients (91 female) with 136 symptomatic knees were identified. Mean age was 14.4 years. Knee pain was localized to the anteromedial or anterior region of the knee in 96% of patients and was typically produced with running (94%), jumping (92%) and stair use (69%). On physical examination there was usually a non antalgic gait (99%), no patellofemoral crepitation (98%), normal lower extremity angular (84%) and rotational alignment (94%), with no foot malalignment (>97%). The medial patellofemoral ligament (MPFL) was the most palpably tender area of the knee in 98% of patients. During "lateral apprehension" testing, 89% had pain at the MPFL, but not true apprehension. A "J-sign" was present at terminal knee extension in 65%. Mean Q-angle was 18.7 degrees . Means of all radiographic measures were within normal ranges.
The prototypical patient had anterior/anteromedial knee pain of insidious onset during running and jumping. The most consistent physical findings were focal tenderness at the MPFL, positive terminal J-sign, and an elevated Q-angle. Most patients required only nonsurgical treatments, but 18% underwent surgical interventions for persistent pain.
本研究的目的是明确青少年髌股疼痛的临床表现。
对一家儿童医院运动诊所3年内所有患有髌股疼痛的患者进行了回顾性研究。
共确定了101例患者（91名女性），有136个膝关节出现症状。平均年龄为14.4岁。96%的患者膝关节疼痛局限于膝关节的前内侧或前部区域，通常在跑步（94%）、跳跃（92%）和上下楼梯（69%）时出现。体格检查时，通常步态无疼痛（99%），无髌股摩擦音（98%），下肢角度（84%）和旋转对线正常（94%），足部无对线不良（>97%）。98%的患者髌股内侧韧带（MPFL）是膝关节最明显压痛的部位。在“外侧恐惧”试验中，89%的患者在MPFL处有疼痛，但无真正的恐惧。65%的患者在膝关节终末伸展时出现“J征”。平均Q角为18.7度。所有影像学测量结果均在正常范围内。
典型患者在跑步和跳跃时出现隐匿性发作的膝关节前/前内侧疼痛。最一致的体格检查发现是MPFL处局限性压痛、终末J征阳性和Q角增大。大多数患者仅需非手术治疗，但18%的患者因持续性疼痛接受了手术干预。
