Summary
Eighty patients who complained of retropatellar pain underwent evaluation by bone scintigraphy, intraosseous pressure determination, radiography, arthroscopy and physical diagnostic tests. The bone scans showed that 48% of the painful knees had an increased uptake compared with 9% for the normal joints. A highly significant correlation was evident between an increased uptake and established chondromalacia. For the diagnosis of a high pressure patella, radiography was only 7% sensitive (6/88), compared with 44% (39/88) for bone scintigraphy and 78% for the clinical “sustained flexion” test. The positive predictive value of a bone scan for detecting a high pressure patella was 0.72 (39/54). The best predictor was a positive sustained flexion test with a predictive value of 0.85 (69/81).
Résumé
Dix-huit malades se plaignant de douleurs rétro-patellaires ont été examinés par scintigraphie, mesure de la pression intra-osseuse, radiographie, arthroscopie et tests cliniques. La scintigraphie a montré que 48% des genoux douloureux présentaient une hyperfixation contre 9% des articulations normales. Il existait une corrélation évidente, hautement significative, entre l'hyperfixation et la chondropathie rotulienne. Pour le diagnostic d'hyperpression intrapatellaire, la radiographie n'était démonstrative que dans 7% des cas (6/88) alors que la scintigraphie l'était dans 44% (30/88) et le test clinique de «flexion prolongée» dans 78%. La valeur d'une scintigraphie positive en faveur du diagnostic d'hyperpression intra-patellaire est de 0.72 (39/54). L'élément le plus fiable est la positivité du test de flexion prolongée qui a une valeur prédictive de 0.85 (69/81).
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References
Arnoldi CC, Lemperg RK, Linderholm H (1975) Intraosseous hypertension and pain in the knee. J Bone Joint Surg [Br] 57: 360–363
Arnoldi CC, Djurhuus JC, Heerfordt J, Karle A (1980) Intraosseous phlebography, intraosseous pressure measurements and 99mTc-polyphosphate scintigraphy in patients with various painful conditions in the hip and knee. Acta Orthop Scand 51: 19–28
Christensen SB (1983) Localization of bone-seeking agents in developing, experimentally induced osteoarthritis in the knee joint in the rabbit. Scand J Rheumatol 12: 343–349
Conklin JJ, Alderson PO, Zizic TM et al (1983) Comparison of bone scan and radiograph sensitivity in detection of steroid-induced ischemic necrosis of bone. Radiology 147: 221–226
Ficat RP, Hungerford DS (1977) Disorders of the patellofemoral joint. Williams and Wilkins, Baltimore
Fogelman I, McKillip JH, Gray HW (1983) The “Hot Patella” sign: Is it of any clinical significance? Concise Communication. J Nucl Med 24: 312–315
Hejgaard (1982) La chondromalacie rotulienne. Un syndrome résultant de différentes étiologies. Acta Orthop Belg 48: 486–494
Hejgaard N, Arnoldi CC (1984) Osteotomy of the patella in the patellofemoral pain syndrome. The significance of increased intraosseous pressure during sustained knee flexion. Int Orthop 8: 189–194
Insall J (1982) Current concept review. Patellar pain. J Bone Joint Surg [Am] 64: 147–152
Kipper MS, Alazraki NP, Feiglin DH (1982) The “hot” patella. Clin Nucl Med 7: 28–32
Kirchner PT, Simon MA (1981) Current Concepts Review. Radioisotopic evaluation of skeletal disease. J Bone Joint Surg [Am] 63: 673–681
Lemperg RK, Arnoldi CC (1978) The significance of intraosseous pressure in normal and diseased states with special reference to the intraosseous engorgement-pain syndrome. Clin Orthop 136: 143–156
Lin D, Alavi A, Dalinka M (1981) Bone scan evaluation of patellar activity. Int J Nucl Med Biol 8: 105–109
Perrild C, Hejgaard N, Rosenklint A (1982) Chondromalacia patellae. A radiographic study of the femoropatellar joint. Acta Orthop Scand 53: 131 “H 134
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Hejgaard, N., Diemer, H. Bone scan in the patellofemoral pain syndrome. International Orthopaedics 11, 29–33 (1987). https://doi.org/10.1007/BF00266055
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DOI: https://doi.org/10.1007/BF00266055