An Overview of Patellar Pain-Current concepts Review
摘要
Objective: The goal of this article is to overview the current concepts of patellar pain, including history, evaluation, and treatment options for patients with patellar pain. Methods: Based on literature review and clinical experience, the concepts of patellar pain is systemically discussed. Results: Patellar pains are dominated by patellofemoral pain syndrome (PFPS) which consists of 3 major contributing factors: 1. malignment of the lower extremity and／or the patella; 2. muscular imbalance of the lower extremity; and 3. overactivity. The diagnosis and treatments have been discussed. Conclusions: Patellar pain could have more than one cause and patellar malignment does not necessarily result in symptoms. A trigger is required for the symptom to come. Patellar malignment is usually under-diagnosed and over-operated. A exact diagnosis and multidisciplinary cooperation are necessary to successful management. A protocol for lateral release is developed. Based on a long term study of prognosticators for isolated lateral release, those with a stable patella. Definite sage sign, well-conformed patellofemoral joint, right exercise mode, and adequacy in doing exercise are good prognosticators, and vice versa. As evidence-based the author has created a practical algorithm for better case selection. If sage sign is definite, lateral release is proceeded without looking back. For those with negative Sage sign but well-conformed patellofemoral joint, lateral release is proceeded, too. For those with negative Sage sign, poorly conformed patellofemoral joint, and non-laxed patella lateral release is proceeded with hesitatation, and maybe some alternate is in favor. For those with negative Sage sign, poorly conformed patellofemoral joint, and laxed patella lateral release has no place in treating patellar malignment. As thus the author does not perform lateral release for all malignments and a more complex operation specific to pathology is considered for those lateral release is