AANA Lab Course 910 - Patellofemoral Joint Preservation-Clinical Evaluation of the Patellofemoral Patient-Dr. Jason L. Koh, M.D.

Clinical Evaluation of the Patellofemoral Patient-Dr. Jason L. Koh, M.D.

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This document presents a structured clinical evaluation framework for patients with patellofemoral disorders, developed by the ISAKOS Patellofemoral Task Force—a multidisciplinary group of international experts. The task force aims to standardize assessment and scoring of patellofemoral joint pathology to improve consistency in clinical practice and research.<br /><br />The development process involved three key steps. First, the task force identified potentially important evaluation factors, encompassing physical examination and radiographic findings. Second, a 50-item survey (30 physical exam elements, 20 radiographic elements) was distributed to task force members and affiliated experts, who rated each item's criticality from 0 ("never heard of") to 5 ("must always assess and report"). Third, results from 29 respondents were analyzed, with consensus reached on the most important elements.<br /><br />Top physical examination elements included the lateral apprehension test, presence of obligatory patellar dislocation during flexion, J sign, knee range of motion, lower limb alignment, patella tracking and mobility, generalized laxity (e.g., Beighton score), effusion, and quadriceps atrophy. Radiographic evaluation prioritized patella height (Caton-Deschamps/Insall-Salvati indices), tibial tubercle–trochlear groove (TT-TG) distance, assessment methods (CT/MRI), patellofemoral joint space, skeletal maturity (physeal status), flexion angle during axial imaging, subluxation presence, trochlear dysplasia grading, cartilage lesion mapping, and crossing sign presence.<br /><br />Additional clinical insights noted include that patella instability often relates to anatomic and biomechanical factors such as patella alta and trochlear dysplasia, with a high recurrence risk especially in skeletally immature patients. Tests like the Beighton scale help evaluate generalized ligamentous laxity. Functional assessments (e.g., step-down test) and examination of adjacent joints are considered but Q-angle measurement is regarded as inconsistent for patellofemoral disorders.<br /><br />In conclusion, the study identifies key standardized physical and imaging exam elements deserving clinician and researcher focus. This consensus approach aims to enable comparable data collection for improved understanding and treatment of patellofemoral conditions.

Keywords

patellofemoral disorders

clinical evaluation framework

ISAKOS Patellofemoral Task Force

physical examination

radiographic assessment

lateral apprehension test

patella tracking

trochlear dysplasia

TT-TG distance

Beighton score