Kasitinon Donald, Li Wei-Xian, Wang Eric Xue Song, Fredericson Michael
Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, USA.
Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Curr Rev Musculoskelet Med. 2021 Dec;14(6):406-412. doi: 10.1007/s12178-021-09730-7. Epub 2021 Oct 29.
Patellofemoral pain syndrome (PFPS) accounts for 25 to 40% of all knee disorders. Diagnosis of PFPS is primarily based on history and physical examination, but the findings on physical examination are often subtle and do not consistently correlate with symptoms described. Yoon and Fredericson published a review article in 2006 detailing the physical examination maneuvers most frequently used to assist clinicians in the accurate diagnosis and treatment of PFPS, and our aim in this review is to provide an update on this previous article focusing on the literature published over the past 15 years regarding the topic.
Since publication of Fredericson's original review article, there have been studies building on the literature specifically surrounding Q angle, patellar tilt, crepitus, strength and functional testing, and physical examination maneuver clustering. Additionally, multiple studies have been conducted on the use of musculoskeletal ultrasound (US) as a diagnostic tool for PFPS. Recent literature has further supported Q angle (when measured utilizing a standardized protocol), crepitus, weakness of hip abductors and extensors, and weakness detected in functional testing as predictors of PFPS while finding inconsistent evidence behind lateral patellar tilt as a predictor of PFPS. The reliability of most physical examination tests alone remain low, but clustering physical examination findings may provide better sensitivities and specificities in diagnosing PFPS. Musculoskeletal US is rapidly gaining popularity, and decreased vastus medialis obliquus (VMO) volume, asymmetry in gluteus medius thickness, intra-articular effusions, and quadriceps and patellar tendon thicknesses have shown value in diagnosing those with PFPS. Additionally, US has the advantage of providing dynamic examination as well as evaluation of the patellofemoral joint in newborns and infants as a predictor of future patellofemoral instability. Further studies are needed to establish the gold standard for diagnosing PFPS and what US findings are truly predictive of PFPS.
髌股关节疼痛综合征（PFPS）占所有膝关节疾病的25%至40%。PFPS的诊断主要基于病史和体格检查，但体格检查的结果往往不明显，且与所描述的症状并不总是一致相关。Yoon和Fredericson在2006年发表了一篇综述文章，详细介绍了最常用于协助临床医生准确诊断和治疗PFPS的体格检查手法，我们本次综述的目的是更新这篇之前的文章，重点关注过去15年中关于该主题发表的文献。
自Fredericson的原始综述文章发表以来，已有研究在围绕Q角、髌骨倾斜、摩擦音、力量和功能测试以及体格检查手法聚类的文献基础上展开。此外，还进行了多项关于使用肌肉骨骼超声（US）作为PFPS诊断工具的研究。最近的文献进一步支持了Q角（当采用标准化方案测量时）、摩擦音、髋外展肌和伸肌无力以及功能测试中检测到的无力作为PFPS的预测指标，同时发现髌骨外侧倾斜作为PFPS预测指标的证据并不一致。大多数单独的体格检查测试的可靠性仍然较低，但将体格检查结果聚类可能在诊断PFPS时提供更好的敏感性和特异性。肌肉骨骼超声正迅速普及，股内侧斜肌（VMO）体积减小、臀中肌厚度不对称、关节内积液以及股四头肌和髌腱厚度在诊断PFPS患者时已显示出价值。此外，超声具有提供动态检查以及评估新生儿和婴儿髌股关节以预测未来髌股关节不稳定的优势。需要进一步研究以确立诊断PFPS的金标准以及哪些超声检查结果真正可预测PFPS。
