This 26-year-old male has anterior knee pain since a golf injury nine weeks ago and his knee gives out with steps but there is no locking.
Q1 – What do you think has happened?
Q2 – Why did this happen?
Q3 – You are shown one blue horizontal arrow. What do you think it indicates?
Q4 – Who gets lateral pressure syndrome and lateral patellofemoral impingement (“pressure”) syndrome?
A1 – He subluxed his patella. You shouldn’t read an acute or recent dislocation, as there would likely be a larger effusion or hemarthrosis and you would have been shown more detail such as a tear of the medial patellofemoral ligament, medial patellar fracture, and lateral femoral bone injury.
A2 – This is a dysplastic patella that is broad and flat. Both the medial facet and lateral facet of the patella are too large and too thick in the AP dimension. This anomaly is often associated with a shallow trochlea which this patient has (not shown). The green arrows are pointing to the deficient cartilage surface which occupied almost 80 percent of the area of the patella.
A3 – Attempted prior lateral retinacular release. The lateral retinaculum is attenuated.
A4 – Middle-aged women who are overweight. This is obviously a young athletic individual, age 26 and male. However, when males do get lateral pressure syndrome, it is because they have patellofemoral dysplasias or are severely overweight. The most common of these dysplasias is bipartite patella.
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