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CONDITION/DISORDER SYNONYMS

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  • Chondromalacia

  • Chondropathy

  • Anterior knee pain

  • Patellofemoral dysfunction

  • Patellofemoral stress syndrome

  • Patellofemoral lateral tracking

  • Patellofemoral pain syndrome (PFPS)

  • Patellofemoral arthralgia

  • Patellofemoral compression syndrome

  • Lateral patellar compression syndrome

  • Excessive lateral pressure syndrome

  • Patellar misalignment syndrome

  • Patellalgia

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ICD-9-CM CODES

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  • 717.7 Chondromalacia of patella

  • 733.92 Chondromalacia

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ICD-10-CM CODES

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  • M22.40 Chondromalacia patellae, unspecified knee

  • M94.20 Chondromalacia, unspecified site

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PREFERRED PRACTICE PATTERN

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  • Pattern 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Localized Inflammation1

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PATIENT PRESENTATION

Patient is a 14-year-old ballet dancer. Patient presents with medial knee pain. She has been training 2 hours a day for the last 3 weeks as the spring show is approaching. The pain is anterior and along the medial knee cap. The patient has very good flexibility with decreased quadriceps control. The patient received a knee brace with a patella buttress to stabilize the patella. The patient has a muscular imbalance from the vastus medialis to the vastus lateralis.

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FIGURE 190-1

Measuring the Q angle. (A) The normal Q angle is approximately 15 degrees. (B) A Q angle of >20 degrees is considered to be abnormal. Patellar malalignment is determined clinically by measuring the Q angle. The Q angle is formed by a line drawn from the midpoint of the patella through the midpoint of the femoral shaft and a second line, drawn from the midpoint of the patella through the tibial tuberosity. (Reproduced with permission from Simon RR, Sherman SC, Koenigsknecht SJ. Emergency Orthopedics, The Extremities. 5th ed. © 2007. New York, NY: McGraw-Hill Inc.)

Graphic Jump Location
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FIGURE 190-2

In this bilateral sunrise or skyline view, note the difference in positioning of the patellae. The image on the right shows much more lateral positioning. (From Malone TR, Hazle C, Grey ML. Imaging in Rehabilitation. www.accessphysiotherapy.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

Graphic Jump Location
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KEY FEATURES

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Description
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  • Chondromalacia: Softening of cartilage on articular surface of patella at the patellofemoral joint.

  • Retropatellar knee pain with patellar cartilage damage.2

  • Insidious onset typically defined by pain in the retropatellar or peripatellar region.3

  • Also known as patellofemoral pain syndrome (PFPS), “anterior knee pain syndrome.”2

    • PFPS applies to patients with retropatellar pain and no cartilage damage; chondromalacia applies to patients with patellar damage.2

  • Structures most likely to generate patellofemoral pain: Anterior synovium, infrapatellar fat pad, subchondral bone, medial or lateral retinaculum.4,5

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Essentials of Diagnosis
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  • Insidious onset aggravated by repetitive impact6

  • Decreased hip stability due to muscular weakness, especially gluteus medius, may affect ...

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