Skip to main content
Erschienen in: Arthroskopie 6/2023

29.11.2023 | Femoropatellare Instabilität | Leitthema

Klinische Untersuchung des Patellofemoralgelenks

verfasst von: Dr. Florian Dirisamer, René Attal, Geert Pagenstert

Erschienen in: Arthroskopie | Ausgabe 6/2023

Einloggen, um Zugang zu erhalten

Zusammenfassung

Die klinische Untersuchung des Patellofemoralgelenks (PFG) ist zusammen mit der Anamnese der Schlüssel zum Verständnis von Pathologien in diesem Kniegelenkabschnitt. Sie soll auch wegweisend für die Entscheidung über die notwendige weitere apparative Diagnostik sein und deshalb immer vor der Bildgebung erfolgen.
Literatur
1.
Zurück zum Zitat Pagenstert GI, Bachmann M (2008) Klinische Untersuchung bei patellofemoralen Problemen. Orthopade 37(9):890–903PubMedCrossRef Pagenstert GI, Bachmann M (2008) Klinische Untersuchung bei patellofemoralen Problemen. Orthopade 37(9):890–903PubMedCrossRef
2.
Zurück zum Zitat Staheli LT, Corbett M, Wyss C, King H (1984) Lower-extremity rotational problems in children. Normal values to guide management. J Bone Joint Surg Am 67(1):39–47CrossRef Staheli LT, Corbett M, Wyss C, King H (1984) Lower-extremity rotational problems in children. Normal values to guide management. J Bone Joint Surg Am 67(1):39–47CrossRef
3.
Zurück zum Zitat Murphy SB, Simon SR, Kijewski PK, Wilkinson RH, Griscom NT (1987) Femoral anteversion. J Bone Joint Surg Am 69(8):1169–1176PubMedCrossRef Murphy SB, Simon SR, Kijewski PK, Wilkinson RH, Griscom NT (1987) Femoral anteversion. J Bone Joint Surg Am 69(8):1169–1176PubMedCrossRef
4.
Zurück zum Zitat Bruce WD, Stevens PM (2004) Surgical correction of miserable malalignment syndrome. J Pediatr Orthop 24(4):392–396PubMedCrossRef Bruce WD, Stevens PM (2004) Surgical correction of miserable malalignment syndrome. J Pediatr Orthop 24(4):392–396PubMedCrossRef
5.
Zurück zum Zitat Aglietti P, Insall JN, Cerulli G (1983) Patellar pain and incongruence. I: Measurements of incongruence. Clin Orthop Relat Res 176:217–224CrossRef Aglietti P, Insall JN, Cerulli G (1983) Patellar pain and incongruence. I: Measurements of incongruence. Clin Orthop Relat Res 176:217–224CrossRef
6.
Zurück zum Zitat Amis AA, Senavongse W, Bull AMJ (2006) Patellofemoral kinematics during knee flexion-extension: an in vitro study. J Orthop Res 24(12):2201–2211PubMedCrossRef Amis AA, Senavongse W, Bull AMJ (2006) Patellofemoral kinematics during knee flexion-extension: an in vitro study. J Orthop Res 24(12):2201–2211PubMedCrossRef
7.
Zurück zum Zitat Biedert RM, Warnke K (2001) Correlation between the Q angle and the patella position: a clinical and axial computed tomography evaluation. Arch Orthop Trauma Surg 121(6):346–349PubMedCrossRef Biedert RM, Warnke K (2001) Correlation between the Q angle and the patella position: a clinical and axial computed tomography evaluation. Arch Orthop Trauma Surg 121(6):346–349PubMedCrossRef
8.
Zurück zum Zitat Fithian DC, Mishra DK, Balen PF, Stone ML, Daniel DM (1995) Instrumented measurement of patellar mobility. Am J Sports Med 23(5):607–615PubMedCrossRef Fithian DC, Mishra DK, Balen PF, Stone ML, Daniel DM (1995) Instrumented measurement of patellar mobility. Am J Sports Med 23(5):607–615PubMedCrossRef
9.
Zurück zum Zitat Caylor D, Fites R, Worrell TW (1993) The relationship between quadriceps angle and anterior knee pain syndrome. J Orthop Sports Phys Ther 17(1):11–16PubMedCrossRef Caylor D, Fites R, Worrell TW (1993) The relationship between quadriceps angle and anterior knee pain syndrome. J Orthop Sports Phys Ther 17(1):11–16PubMedCrossRef
10.
Zurück zum Zitat Thomeé R, Renström P, Karlsson J, Grimby G (1995) Patellofemoral pain syndrome in young women. I. A clinical analysis of alignment, pain parameters, common symptoms and functional activity level. Scand J Med Sci Sports 5(4):237–244PubMedCrossRef Thomeé R, Renström P, Karlsson J, Grimby G (1995) Patellofemoral pain syndrome in young women. I. A clinical analysis of alignment, pain parameters, common symptoms and functional activity level. Scand J Med Sci Sports 5(4):237–244PubMedCrossRef
11.
Zurück zum Zitat France L, Nester C (2001) Effect of errors in the identification of anatomical landmarks on the accuracy of Q angle values. Clin Biomech 16(8):710–713CrossRef France L, Nester C (2001) Effect of errors in the identification of anatomical landmarks on the accuracy of Q angle values. Clin Biomech 16(8):710–713CrossRef
12.
Zurück zum Zitat Herrington L, Nester C (2004) Q‑angle undervalued? The relationship between Q‑angle and medio-lateral position of the patella. Clin Biomech 19(10):1070–1073CrossRef Herrington L, Nester C (2004) Q‑angle undervalued? The relationship between Q‑angle and medio-lateral position of the patella. Clin Biomech 19(10):1070–1073CrossRef
13.
Zurück zum Zitat Guerra JP, Arnold MJ, Gajdosik RL (1994) Q angle: effects of isometric quadriceps contraction and body position. J Orthop Sports Phys Ther 19(4):200–204PubMedCrossRef Guerra JP, Arnold MJ, Gajdosik RL (1994) Q angle: effects of isometric quadriceps contraction and body position. J Orthop Sports Phys Ther 19(4):200–204PubMedCrossRef
14.
Zurück zum Zitat Livingston LA, Mandigo JL (1996) Bilateral within-subject Q angle asymmetry in young adult females and males. Biomed Sci Instrum 33(31):112–117 Livingston LA, Mandigo JL (1996) Bilateral within-subject Q angle asymmetry in young adult females and males. Biomed Sci Instrum 33(31):112–117
15.
Zurück zum Zitat Kibler WB (1987) Strength and flexibility findings in anterior knee pain syndrome in athletes. Am J Sports Med Kibler WB (1987) Strength and flexibility findings in anterior knee pain syndrome in athletes. Am J Sports Med
16.
Zurück zum Zitat Witvrouw E, Lysens R, Bellemans J, Cambier D, Vanderstraeten G (2000) Intrinsic risk factors for the development of anterior knee pain in an athletic population. A two-year prospective study. Am J Sports Med 28(4):480–489PubMedCrossRef Witvrouw E, Lysens R, Bellemans J, Cambier D, Vanderstraeten G (2000) Intrinsic risk factors for the development of anterior knee pain in an athletic population. A two-year prospective study. Am J Sports Med 28(4):480–489PubMedCrossRef
17.
Zurück zum Zitat Scuderi GR (1992) Surgical treatment for patellar instability. Orthop Clin North Am 23(4):619–630PubMedCrossRef Scuderi GR (1992) Surgical treatment for patellar instability. Orthop Clin North Am 23(4):619–630PubMedCrossRef
18.
Zurück zum Zitat Thay Q, Lee P, Bruce Y, Yang B, Matthew D, Sandusky B, Patrick J, McMahon M (2001) The effects of tibial rotation on the patellofemoral joint. 30:1–7 Thay Q, Lee P, Bruce Y, Yang B, Matthew D, Sandusky B, Patrick J, McMahon M (2001) The effects of tibial rotation on the patellofemoral joint. 30:1–7
19.
Zurück zum Zitat al-Rawi Z, Nessan AH (1997) Joint hypermobility in patients with chondromalacia patellae. Br J Rheumatol 36(12):1324–1327PubMedCrossRef al-Rawi Z, Nessan AH (1997) Joint hypermobility in patients with chondromalacia patellae. Br J Rheumatol 36(12):1324–1327PubMedCrossRef
21.
Zurück zum Zitat James SL, Bates BT, Osternig LR (1978) Injuries to runners. Am J Sports Med 6(2):40–50PubMedCrossRef James SL, Bates BT, Osternig LR (1978) Injuries to runners. Am J Sports Med 6(2):40–50PubMedCrossRef
22.
Zurück zum Zitat Johnson KA, Strom DE (1989) Tibialis posterior tendon dysfunction. Clin Orthop Relat Res 239:196–206CrossRef Johnson KA, Strom DE (1989) Tibialis posterior tendon dysfunction. Clin Orthop Relat Res 239:196–206CrossRef
23.
Zurück zum Zitat Johnson LL, van Dyk GE, Green JR, Pittsley AW, Bays B, Gully SM et al (1998) Clinical assessment of asymptomatic knees: comparison of men and women. Arthroscopy 14(4):347–359PubMedCrossRef Johnson LL, van Dyk GE, Green JR, Pittsley AW, Bays B, Gully SM et al (1998) Clinical assessment of asymptomatic knees: comparison of men and women. Arthroscopy 14(4):347–359PubMedCrossRef
24.
Zurück zum Zitat Callaghan MJ, Oldham JA (2004) Quadriceps atrophy: to what extent does it exist in patellofemoral pain syndrome? Br J Sports Med 38(3):295–299 (Jun)PubMedPubMedCentralCrossRef Callaghan MJ, Oldham JA (2004) Quadriceps atrophy: to what extent does it exist in patellofemoral pain syndrome? Br J Sports Med 38(3):295–299 (Jun)PubMedPubMedCentralCrossRef
25.
Zurück zum Zitat Milgrom C, Finestone A, Eldad A, Shlamkovitch N (1991) Patellofemoral pain caused by overactivity. A prospective study of risk factors in infantry recruits. J Bone Joint Surg Am 73(7):1041–1043PubMedCrossRef Milgrom C, Finestone A, Eldad A, Shlamkovitch N (1991) Patellofemoral pain caused by overactivity. A prospective study of risk factors in infantry recruits. J Bone Joint Surg Am 73(7):1041–1043PubMedCrossRef
26.
Zurück zum Zitat Loudon JK, Wiesner D, Goist-Foley HL, Asjes C, Loudon KL (2002) Intrarater reliability of functional performance tests for subjects with patellofemoral pain syndrome. J Athl Train 37(3):256–261PubMedPubMedCentral Loudon JK, Wiesner D, Goist-Foley HL, Asjes C, Loudon KL (2002) Intrarater reliability of functional performance tests for subjects with patellofemoral pain syndrome. J Athl Train 37(3):256–261PubMedPubMedCentral
27.
Zurück zum Zitat Senavongse W, Amis AA (2005) The effects of articular, retinacular, or muscular deficiencies on patellofemoral joint stability: a biomechanical study in vitro. J Bone Joint Surg Br 87(4):577–582PubMedCrossRef Senavongse W, Amis AA (2005) The effects of articular, retinacular, or muscular deficiencies on patellofemoral joint stability: a biomechanical study in vitro. J Bone Joint Surg Br 87(4):577–582PubMedCrossRef
28.
Zurück zum Zitat Merchant AC (1987) Classification of patellofemoral disorders. Arthroscopy 4(4):235–240CrossRef Merchant AC (1987) Classification of patellofemoral disorders. Arthroscopy 4(4):235–240CrossRef
29.
30.
Zurück zum Zitat Kolowich PA, Paulos LE, Rosenberg TD, Farnsworth S (1990) Lateral release of the patella: indications and contraindications. Am J Sports Med 18(4):359–365PubMedCrossRef Kolowich PA, Paulos LE, Rosenberg TD, Farnsworth S (1990) Lateral release of the patella: indications and contraindications. Am J Sports Med 18(4):359–365PubMedCrossRef
31.
Zurück zum Zitat Post WR, Fulkerson JP (1992) Distal realignment of the patellofemoral joint. Indications, effects, results, and recommendations. Orthop Clin North Am 23(4):631–643PubMedCrossRef Post WR, Fulkerson JP (1992) Distal realignment of the patellofemoral joint. Indications, effects, results, and recommendations. Orthop Clin North Am 23(4):631–643PubMedCrossRef
32.
Zurück zum Zitat Biedert RM (2005) Patellofemoral disorders. John Wiley & Sons, S 1 Biedert RM (2005) Patellofemoral disorders. John Wiley & Sons, S 1
33.
Zurück zum Zitat Fulkerson JP (1983) The etiology of patellofemoral pain in young, active patients: a prospective study. Clin Orthop Relat Res 179:129–133CrossRef Fulkerson JP (1983) The etiology of patellofemoral pain in young, active patients: a prospective study. Clin Orthop Relat Res 179:129–133CrossRef
34.
Zurück zum Zitat Boden B, Pearsall A, Garrett W, Feagin J (1997) Patellofemoral instability: evaluation and management. J Am Acad Orthop Surg 5(1):47–57PubMedCrossRef Boden B, Pearsall A, Garrett W, Feagin J (1997) Patellofemoral instability: evaluation and management. J Am Acad Orthop Surg 5(1):47–57PubMedCrossRef
35.
Zurück zum Zitat Fulkerson J (2002) Diagnosis and treatment of patients with patellofemoral pain. Am J Sports Med Fulkerson J (2002) Diagnosis and treatment of patients with patellofemoral pain. Am J Sports Med
36.
Zurück zum Zitat Biedert RM, Stauffer E, Friederich NF (1992) Occurrence of free nerve endings in the soft tissue of the knee joint. A histologic investigation. Am J Sports Med 20(4):430–433PubMedCrossRef Biedert RM, Stauffer E, Friederich NF (1992) Occurrence of free nerve endings in the soft tissue of the knee joint. A histologic investigation. Am J Sports Med 20(4):430–433PubMedCrossRef
37.
Zurück zum Zitat Sanchis-Alfonso V, Roselló-Sastre E, Revert F, García A (2005) Histologic retinacular changes associated with ischemia in painful patellofemoral malalignment. Orthopedics 28(6):593–599PubMedCrossRef Sanchis-Alfonso V, Roselló-Sastre E, Revert F, García A (2005) Histologic retinacular changes associated with ischemia in painful patellofemoral malalignment. Orthopedics 28(6):593–599PubMedCrossRef
38.
Zurück zum Zitat Biedert RM, Albrecht S (2006) The patellotrochlear index: a new index for assessing patellar height. Knee Surg Sports Traumatol Arthrosc 14(8):707–712PubMedCrossRef Biedert RM, Albrecht S (2006) The patellotrochlear index: a new index for assessing patellar height. Knee Surg Sports Traumatol Arthrosc 14(8):707–712PubMedCrossRef
39.
Zurück zum Zitat Fairbank HA (1937) Internal derangement of the knee in children and adolescents: (section of orthopædics). Proc R Soc Med 30(4):427–432PubMedPubMedCentral Fairbank HA (1937) Internal derangement of the knee in children and adolescents: (section of orthopædics). Proc R Soc Med 30(4):427–432PubMedPubMedCentral
40.
Zurück zum Zitat Korkala OL, Isotalo TM, Lavonius MI, Niskanen RO (1994) Outcome and clinical signs of arthroscopically graded patellar chondromalacia with or without lateral release. Ann Chir Gynaecol 84(3):276–279 Korkala OL, Isotalo TM, Lavonius MI, Niskanen RO (1994) Outcome and clinical signs of arthroscopically graded patellar chondromalacia with or without lateral release. Ann Chir Gynaecol 84(3):276–279
41.
Zurück zum Zitat Zimmermann F, Liebensteiner MC, Balcarek P (2019) The reversed dynamic patellar apprehension test mimics anatomical complexity in lateral patellar instability. Knee Surg Sports Traumatol Arthrosc 27(2):604–610PubMedCrossRef Zimmermann F, Liebensteiner MC, Balcarek P (2019) The reversed dynamic patellar apprehension test mimics anatomical complexity in lateral patellar instability. Knee Surg Sports Traumatol Arthrosc 27(2):604–610PubMedCrossRef
42.
Zurück zum Zitat Fulkerson JP (1997) Anterolateralization of the Tibial Tubercle. Tech Orthop Fulkerson JP (1997) Anterolateralization of the Tibial Tubercle. Tech Orthop
43.
Zurück zum Zitat Hand CJ, Spalding TJW (2003) Association between anatomical features and anterior knee pain in a “fit” service population. J R Nav Med Serv 90(3):125–134CrossRef Hand CJ, Spalding TJW (2003) Association between anatomical features and anterior knee pain in a “fit” service population. J R Nav Med Serv 90(3):125–134CrossRef
44.
Zurück zum Zitat Ireland ML, Willson JD, Ballantyne BT, Davis IM (2003) Hip strength in females with and without patellofemoral pain. J Orthop Sports Phys Ther 33(11):671–676PubMedCrossRef Ireland ML, Willson JD, Ballantyne BT, Davis IM (2003) Hip strength in females with and without patellofemoral pain. J Orthop Sports Phys Ther 33(11):671–676PubMedCrossRef
45.
Zurück zum Zitat Powers CM, Ward SR, Fredericson M, Guillet M, Shellock FG (2003) Patellofemoral kinematics during weight-bearing and non-weight-bearing knee extension in persons with lateral subluxation of the patella: a preliminary study. J Orthop Sports Phys Ther 33(11):677–685PubMedCrossRef Powers CM, Ward SR, Fredericson M, Guillet M, Shellock FG (2003) Patellofemoral kinematics during weight-bearing and non-weight-bearing knee extension in persons with lateral subluxation of the patella: a preliminary study. J Orthop Sports Phys Ther 33(11):677–685PubMedCrossRef
46.
Zurück zum Zitat Ober FR (1936) The role of the iliotibial band and fascia lata as a factor in the causation of low-back disabilities and sciatica. J Bone Joint Surg Ober FR (1936) The role of the iliotibial band and fascia lata as a factor in the causation of low-back disabilities and sciatica. J Bone Joint Surg
47.
Zurück zum Zitat Puniello MS (1993) Iliotibial band tightness and medial patellar glide in patients with patellofemoral dysfunction. J Orthop Sports Phys Ther 17(3):144–148PubMedCrossRef Puniello MS (1993) Iliotibial band tightness and medial patellar glide in patients with patellofemoral dysfunction. J Orthop Sports Phys Ther 17(3):144–148PubMedCrossRef
48.
Zurück zum Zitat McConnell J (1985) The management of chondromalacia patellae: a long term solution. Aust J Physiother 32(4):215–223CrossRef McConnell J (1985) The management of chondromalacia patellae: a long term solution. Aust J Physiother 32(4):215–223CrossRef
49.
Zurück zum Zitat Gose JC, Schweizer P (1989) Iliotibial band tightness. J Orthop Sports Phys Ther 10(10):399–407PubMedCrossRef Gose JC, Schweizer P (1989) Iliotibial band tightness. J Orthop Sports Phys Ther 10(10):399–407PubMedCrossRef
50.
Zurück zum Zitat Nonweiler DE, DeLee JC (1994) The diagnosis and treatment of medial subluxation of the patella after lateral retinacular release. Am J Sports Med 22(5):680–686PubMedCrossRef Nonweiler DE, DeLee JC (1994) The diagnosis and treatment of medial subluxation of the patella after lateral retinacular release. Am J Sports Med 22(5):680–686PubMedCrossRef
51.
Zurück zum Zitat Stuberg W, Temme J, Kaplan P, Clarke A, Fuchs R (1991) Measurement of tibial torsion and thigh-foot angle using goniometry and computed tomography. Clin Orthop Relat Res 272:208–212 (Nov)CrossRef Stuberg W, Temme J, Kaplan P, Clarke A, Fuchs R (1991) Measurement of tibial torsion and thigh-foot angle using goniometry and computed tomography. Clin Orthop Relat Res 272:208–212 (Nov)CrossRef
Metadaten
Titel
Klinische Untersuchung des Patellofemoralgelenks
verfasst von
Dr. Florian Dirisamer
René Attal
Geert Pagenstert
Publikationsdatum
29.11.2023
Verlag
Springer Medizin
Erschienen in
Arthroskopie / Ausgabe 6/2023
Print ISSN: 0933-7946
Elektronische ISSN: 1434-3924
DOI
https://doi.org/10.1007/s00142-023-00651-w

Weitere Artikel der Ausgabe 6/2023

Arthroskopie 6/2023 Zur Ausgabe

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen. 
» Jetzt entdecken

Notfall-TEP der Hüfte ist auch bei 90-Jährigen machbar

26.04.2024 Hüft-TEP Nachrichten

Ob bei einer Notfalloperation nach Schenkelhalsfraktur eine Hemiarthroplastik oder eine totale Endoprothese (TEP) eingebaut wird, sollte nicht allein vom Alter der Patientinnen und Patienten abhängen. Auch über 90-Jährige können von der TEP profitieren.

Arthroskopie kann Knieprothese nicht hinauszögern

25.04.2024 Gonarthrose Nachrichten

Ein arthroskopischer Eingriff bei Kniearthrose macht im Hinblick darauf, ob und wann ein Gelenkersatz fällig wird, offenbar keinen Unterschied.

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

25.04.2024 Hypertonie Nachrichten

Beginnen ältere Männer im Pflegeheim eine Antihypertensiva-Therapie, dann ist die Frakturrate in den folgenden 30 Tagen mehr als verdoppelt. Besonders häufig stürzen Demenzkranke und Männer, die erstmals Blutdrucksenker nehmen. Dafür spricht eine Analyse unter US-Veteranen.

Ärztliche Empathie hilft gegen Rückenschmerzen

23.04.2024 Leitsymptom Rückenschmerzen Nachrichten

Personen mit chronischen Rückenschmerzen, die von einfühlsamen Ärzten und Ärztinnen betreut werden, berichten über weniger Beschwerden und eine bessere Lebensqualität.

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.