Elson D W, Jones S, Caplan N, St Clair Gibson A, Stewart S, Kader D F
North East Orthopaedic and Sports Injury Research Group, Tyne and Wear, UK; Department of Orthopaedics, Queen Elizabeth Hospital, Gateshead, UK.
Knee. 2013 Dec;20(6):471-5. doi: 10.1016/j.knee.2013.02.002. Epub 2013 Apr 25.
Patellofemoral chondral lesions are frequently identified incidentally during the arthroscopic treatment of other knee pathologies. A role has been described for arthroscopic debridement when symptoms are known to originate from pathology of the patellofemoral joint. However, it remains unclear how to manage lesions which are found incidentally whilst tackling other pathologies. The purpose of this study was to establish the strength of association between anterior knee pain and patellofemoral lesions identified incidentally in a typical arthroscopic population.
A consecutive series of patients undergoing arthroscopy for a range of standard indications formed the basis of this cross section study. We excluded those with patellofemoral conditions in order to identify patellofemoral lesions which were solely incidental. Pre-operative assessments were performed on 64 patients, where anterior knee pain was sought by three methods: an annotated photographic knee pain map (PKPM), patient indication with one finger and by palpated tenderness. A single blinded surgeon, performed standard arthroscopies and recorded patellofemoral lesions. Statistical correlations were performed to identify the association magnitude.
Associations were identified between incidental patellofemoral lesions and tenderness palpated on the medial patella (P = 0.007, χ(2) = 0.32) and the quadriceps tendon (P = 0.029, χ(2) = 0.26), but these associations were at best fair, which could be interpreted as clinically insignificant.
Incidental patellofemoral lesions are not necessarily associated with anterior knee pain, we suggest that they could be left alone. This recommendation is only applicable to patellofemoral lesions which are found incidentally whilst addressing other pathology.
髌股关节软骨损伤常在其他膝关节疾病的关节镜治疗过程中被偶然发现。当已知症状源自髌股关节病变时，关节镜下清创术已被描述具有一定作用。然而，对于在处理其他病变时偶然发现的损伤如何处理仍不明确。本研究的目的是确定在典型的关节镜检查人群中，前膝痛与偶然发现的髌股关节损伤之间的关联强度。
一系列因各种标准指征接受关节镜检查的连续患者构成了本横断面研究的基础。我们排除了患有髌股关节疾病的患者，以便识别单纯偶然出现的髌股关节损伤。对64例患者进行了术前评估，通过三种方法寻找前膝痛：带注释的膝关节疼痛照片图谱（PKPM）、单指指示和触压痛。一名单盲外科医生进行标准关节镜检查并记录髌股关节损伤情况。进行统计相关性分析以确定关联程度。
偶然发现的髌股关节损伤与髌骨内侧触压痛（P = 0.007，χ(2)= 0.32）和股四头肌肌腱触压痛（P = 0.029，χ(2)= 0.26）之间存在关联，但这些关联充其量只是一般，可解释为临床意义不大。
偶然发现的髌股关节损伤不一定与前膝痛相关，我们建议对此可不予处理。该建议仅适用于在处理其他病变时偶然发现的髌股关节损伤。
