| Presentation |
 Characterized by idiopathic articular changes of the patella
- this term is falling out of favor.
- Associated conditions
- miserable malalignment syndrome
- a term coined for anatomic characteristics that lead to and increased Q angle and an exacerbation of patellofemoral dysplasia. They include
- femoral anteversion
- genu valgum
- external tibial torsion / pronated feet
|
| Presentation |
- Symptoms
- pain with stair climbing
- theatre sign (pain with sitting for long periods of time)
- Physical exam
- pain with compression of patella
|
| Imaging |
- Radiographs
- may see chondrosis on xray
|
| Classification |
|
| Treatment |
- Nonoperative
- rest, rehab, and NSAIDS
- indications
- mainstay of treatment and should be done for a minimum of one year
- technique
- NSAIDS
- activity modification
- rehabilitation with emphasis on
- vastus medialis obiquus strengthening
- closed chain short arc quadriceps exercises
- Operative
- patellar realignment surgery
- indications
- severe symptoms that have failed to improve with extensive physical therapy
- techniques
- Maquet (anterior tubercle elevation)
- only elevate 1 cm or else risk of skin necrosis
- Fulkerson (anterior-medialization)
- indications (controversial)
- increased Q angle
- patellar instability
- contraindications
- superior medial arthrosis (scope before you perform the surgery)
- skeletal immaturity
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