and Iain McNamara1
(1)
Trauma & Orthopaedics, Norfolk & Norwich University Hospital, Norwich, United Kingdom
A 31-year-old man has been referred to the clinic by a physiotherapist with an MRI diagnosis of chondromalacia patellae. He presents to the clinic with 1-year history of left anterior knee pain. It is associated with exercise and tends to settle with rest. It is not associated with any swelling. The knee does not lock. He has reduced his activities; particularly he has stopped playing soccer which he feels was the origin of the problem. He usually walks 3 or 4 miles a couple of times a week and even this he has had to curtail. He has noticed at work if he lifts a weight from a squatting position, he can get severe pain which causes him to drop the object he is carrying. Apart from this he is fit and well.
Question 1
What is the significance of the absence of swelling of the knee?
Question 2
What significance is the MRI finding?
Past Medical History
He did describe having problems with his knee in his late teens.
On Examination
He had a Beighton score of 7 out of 9. His BMI is 24.
He had no internal rotation of his hips. He had 70° of external rotation on the right and 40° on the left. Rotational movements of the hip precipitated his pain. He had no effusion in either knee. His VMOs were present and strong at MRC grade 5. The patellofemoral joints were normal with an ML glide of +, no crepitus, no local tenderness, and tracking straight. He had a full range of knee movements 0°/0°/140°. He had no tibiofemoral ligamentous instability. He had poor balance on each leg and was unable to do a single-leg squat on the left.
Question 3
If screening a normal knee, what tests exclude significant pathology?
Question 4
Summarise the history and examination in one sentence each.
Question 5
What imaging will you ask for?
Question 6
What do the images show?
