Physical examination and patellofemoral pain syndrome

Patellofemoral pain syndrome, which accounts for 25% of all sports-related knee injuries, is multifactorial in origin. A combination of variables, including abnormal lower limb biomechanics, soft-tissue tightness, muscle weakness, and excessive exercise, may result in increased cartilage and subchondral bone stress, patellofemoral pain, and subtle or more overt patellar maltracking. Because of the multiple forces affecting the patellofemoral joint, the clinical evaluation and treatment of this disorder is challenging. An extensive search of the literature revealed no single gold-standard test maneuver for that disorder, and the reliability of the maneuvers described was generally low or untested. An abnormal Q-angle, generalized ligamentous laxity, hypomobile or hypermobile tenderness of the lateral patellar retinaculum, patellar tilt or mediolateral displacement, decreased flexibility of the iliotibial band and quadriceps, and quadriceps, hip abductor, and external rotator weakness were most often correlated with patellofemoral pain syndrome.     

The relationship between patella position and length of the iliotibial band as assessed using Ober's test

The purpose of the study was to investigate the relationship between length of the iliotibial band (ITB) and the medio-lateral position patella. Eighty subjects (37 male, 43 female) were examined for patella position and ITB length. All subjects were physically active, asymptomatic and aged between 18 and 34 years (mean 21.5 years). ITB length was assessed using the Ober's test and modified Ober's test, with hip adduction angle being measured using a fluid goniometer. Patella position was assessed using the method first described by McConnell [The management of chondromalacia patellae: a long term solution. Australian Journal of Physiotherapy 1986;32:215-22]. Patella position had a weak correlation (r=0.28) with modified Ober's (extended knee) test and a poor correlation with Ober's (knee flexed) test (r=0.1). In the group of 47 subjects with laterally displaced patellae, patella position had a moderate statistically significant correlation to ITB length measured by modified Ober's test (r=0.34, P=0.012). Only a poor relationship existed between Ober's test and patella position in the laterally displaced group. The results of this study only partially support the hypothesis that there is a relationship between ITB length and lateral patella displacement. The relationship was not strong enough to confirm ITB length as the only cause of lateral patella displacement.     

限弧等速肌力训练对于髌股关节炎髌骨轨迹的影响

目的:探讨不同限弧等速肌力训练对髌股关节炎患者髌骨轨迹的影响。方法:诊断为髌股关节炎患者60例,按接诊顺序分为A组(0°~30°)、B组(30°~60°)和C组(60°~90°)不同角度限弧运动训练组,每组各20例,采用德国ISOMED 2000等速肌力训练系统按分组对患者膝关节周围肌肉进行4周的限弧等速肌力训练。训练前、后拍摄膝关节负重正侧位及屈膝45°轴位片,测量髌骨轨迹参数(即髌股指数、外侧髌股角、髌骨合适角);记录每个膝关节的等速肌力测定值,即峰力矩(PT)、总功(TW)及平均功率(AP);采用西安大略和麦克马斯特大学骨关节炎指数(WOMAC)(包括疼痛、僵硬、日常功能)评定膝关节功能。结果:训练4周后,A组髌股指数、髌骨合适角较训练前明显降低,外侧髌股角较训练前明显提高(P<0.05);A、B、C组峰力矩PT、总功TW及平均功率AP值均较训练前明显提高(P<0.05);WOMAC评分比较,A组疼痛、日常功能评分较训练前明显降低(P<0.05)。训练后,髌骨轨迹参数比较:髌股指数、髌骨合适角A组明显低于B、C组(P<0.05),外侧髌股角明显高于B、C组(P<0005);等速肌力测定值比较:A组PT值明显高于B、C组(P<0.05);WOMAC评分比较:疼痛评分A组明显低于B、C组(P<0.05)。B组与C组间各评分差异无统计学意义。结论:膝关节屈曲范围0°~30°的股四头肌等速训练可有效改善髌股关节炎髌骨轨迹,提高膝关节功能。     

Time dependence of changes of two cartilage layers in anterior cruciate ligament insertion after resection on chondrocyte apoptosis and decrease in glycosaminoglycan

Stress fracture of the patella is rare. In this report, a case of patellar stress fracture occurring in an amateur athlete is presented, and an operative adjunct to the surgical management of this condition is proposed. A review of the English literature identified 21 previous cases of stress fracture of the patella, the majority in young athletes. None of these reports discussed treatment addressing the pathological process contributing to patellar stress fracture. The subject of this case report is a young male netballer who presented with a transverse stress fracture in the inferior third of his patella, on a background of patellofemoral overload. The patient underwent open reduction and internal fixation of his patella, combined with release of the iliotibial band. He returned to training after 6 weeks. The previous literature suggests that operative fixation is indicated for the treatment of displaced patellar stress fractures. Iliotibial band release, as a surgical adjunct to this treatment, may address the pathology of these fractures, and facilitate a return to sport at the highest level.     

Irreducible lateral patellar dislocation: the importance of impaction fracture recognition

Irreducible lateral patellar dislocation may occur in the older patient with a previous history of patellofemoral arthritis. The only subtle finding on physical examination to suggest this diagnosis will be positioning of the knee in less flexion than a typical lateral patellar dislocation, anterolateral position of the patella and internal rotation of the patella from the coronal plane. That is, the patella is dislocated laterally but the lateral border comes to lie in a position of variable degrees of anterior displacement relative to the medial patellar border. Plain x-rays may reveal the rotation of the patella along the vertical axis and an anterolateral rather than lateral positioning of the patella. Computed tomographic scanning is of benefit if the diagnosis is suspected or if an initial attempt at closed reduction is unsuccessful. Open reduction is recommended, if a single closed reduction attempt is not successful, to prevent any potential worsening of the patellar impaction fracture. A laterally dislocated patella that displays internal rotation about the vertical axis or the "flipped patella" sign is pathognomonic of an irreducible patellar dislocation and suggests patellar impaction on a lateral femoral condylar ridge osteophyte. Open reduction is easily achieved through a vertically oriented quadriceps tenotomy without the need for medial repair.     

Patellar taping: is clinical success supported by scientific evidence?

Patellofemoral pain syndrome (PFPS) is a common condition presenting to physiotherapy and sports medicine practices. Despite its prevalence, the aetiology, pathogenesis, and recommended treatment remain unclear. One component of treatment for PFPS that has been subjected to scrutiny is patellar taping. This taping was designed to realign the patella within the femoral trochlea, thus reducing pain from PFPS and improving both quadriceps and patellofemoral joint function. Clinical and research findings confirm that the pain associated with PFPS is significantly reduced with patellar taping. Therefore, research has aimed at determining the mechanisms of this pain relief. The means by which patellar tape can relieve pain may provide insight into the aetiology and risk factors for PFPS, thus allowing more appropriately designed treatment regimes and preventative strategies. There is evidence to suggest that patellar tape improves patella alignment (measured radiographically) and quadriceps function (torque production and extensor moments). Evidence that patellar tape enhances the activation of individual vastii (magnitude or timing) is limited in quality and quantity, which probably reflects the difficulties inherent in measuring this complex question. There is preliminary evidence for improved knee control during gait in association with patellar tape. This paper critically reviews the studies that have examined the effects of patellar taping and makes informed recommendations for further research and clinical practice.     

Infrared thermographic imaging in the detection of sympathetic dysfunction in patients with patellofemoral pain syndrome.

OBJECTIVE: This study investigates the clinical utility of infrared thermography in the detection of sympathetic dysautonomia in patients with patellofemoral pain syndrome. The patients exhibited anterior knee pain, radiographic evidence of patella alta and the clinical signs and symptoms of patellofemoral pain syndrome. DESIGN: A case control study was carried out with two groups of patients: patients with anterior knee pain, and patients with no knee pain as a control SETTING: Private practice. PATIENTS: Group 1 consisted of 30 patients with patellofemoral pain syndrome. Group 2 consisted of 40 control patients with no history or presence of knee pain. Control patients were consecutively selected, and the knee pain patients were consecutively selected from a population-based sample. OUTCOME MEASURE: Infrared thermography scans were obtained on the knee pain patients and control patients to determine the sensitivity and specificity of infrared thermography for detecting patellofemoral pain syndrome. RESULTS: Twenty-nine of the 30 knee pain patients in group 1 had patellar thermal asymmetry from right to left sides (sensitivity 97%). Thirty-six of the 40 control patients exhibited thermal symmetry from right to left sides (specificity 90%). The incidence of patellar thermal asymmetry was found to be statistically significant when tested by chi 2 analysis (p less than .001). CONCLUSION: Infrared thermography appears to be a useful, noninvasive diagnostic test in the diagnosis and management of patellofemoral pain syndrome. The high incidence of patellar thermal asymmetry and dysautonomia at the patella in patients with patellofemoral pain syndrome implicates somatosympathetic mediation in this disorder. This may be helpful in understanding the evolution of patellofemoral disorders.     

可吸收内固定材料植入髌骨横断性骨折局部:与金属植入物生物力学性能的比较

背景:可吸收内固定材料具有手术简便、恢复快及无需二次手术等诸多优点,受到骨科界的青睐,并在临床上有一定的应用,但仍缺乏可靠的系统实验依据.目的:通过对可吸收材料(可吸收张力带加可吸收棒或螺钉)和钢丝张力带加克氏针在髌骨横断性骨折修复固定中的生物力学比较,研究可吸收材料替代钢丝张力带加克氏针的可行性.设计、时间及地点:随机分组对照实验,生物力学分析,于2007-03/2008-01在上海大学生物力学研究所实验室完成.材料:采新鲜成年尸体髌骨标本8个,保留完整髌骨、关节囊、髌韧带3.0～4.0 cm和股四头肌4.0～5.0 cm.方法:随机分成AO钢丝组2个和可吸收张力带组6个,制成横断骨折模型.分别用可吸收张力带、钢丝张力带加克氏针进行内固定,测定它们的生物力学性能,骨折端分离1.0 mm为固定失效.主要观察指标:髌韧带拉力、股四头肌拉力、髌骨分离性位移、股四头肌位移、髌韧带位移及髌骨拉应变在外载荷作用下的变化.结果:在外载荷作用下,可吸收张力带组的总体位移与AO钢丝组相差不大(两者相差9%～10%),可吸收张力带组髌骨的应变与AO钢丝组相差不大(两者相差9%～10%),可吸收张力带组的髌股关节力与AO钢丝组基本相似,且髌骨骨折内固定位移1 mm时,可吸收张力带组载荷为587 N,AO钢丝组载荷为650 N,经统计学处理差异均无显著性意义(P>0.05).结论:可吸收材料具有优越的生物性能和良好的骨折断端稳定性,在髌骨横断性骨折内固定中替代钢丝张力带和克氏针是可行的.     

Laterale Retinakulumverlängerung bei arthroskopischen Eingriffen

Increased pain in the lateral patellofemoral joint during loaded flexion may be caused by shortened and too tight lateral structures (e.g. retinacula, capsule, iliotibial tract, lateral vastus muscle) due to intraarticular pathologies, such as plicae, cartilage damage and osteoarthritis. The mobility of the patella is decreased and accentuated on the lateral side with a negative patella tilt, therefore creating lateral hypercompression and pain in the patellofemoral joint. In combination with the arthroscopic treatment for the intraarticular pathology, mini-open lengthening of the lateral retinaculum decreases the compression forces and normalizes the patellofemoral gliding mechanism. This procedure has the same therapeutic benefits as lateral retinacular release but the secondary medial patellar instability, as frequently seen after lateral retinacular release, can be avoided and individual soft tissue balancing is possible.     

Q-angle undervalued? The relationship between Q-angle and medio-lateral position of the patella

Background. For an accurate quadriceps angle measurement, the patella must be centralised in the femoral trochlear groove, numerous authors have described lateral displacement of the patella in patellofemoral pain patients, this leads to the intriguing possibility that the Q-angle might be undervalued within patellofemoral pain patients who have laterally displaced patella.

Method. 109 asymptomatic subjects (51 male, 58 female) were assessed. Medio-lateral patella position was measured using a previous validated method and Q-angle was measured in standing with the quadriceps relaxed.

Findings. Mean Q-angle was 11.6° (SD 5.2) left knee, 11.3° (SD 4.9) right knee in the male subjects and 14.4° (SD 5.2) left knee, 13.3° (SD 5.5) right knee for female subjects. 40 females and 28 males had laterally displaced patellae. 13 subjects had centrally placed patellae (7 females, 6 males) with 28 subjects having medially displaced patellae (11 females, 17 males). Recalculation of Q-angle for the laterally displaced group brought about a statistically significant increase in angle. In the medial displaced group failed to produce a statistically significant decrease.

Interpretation. The adjusted Q-angle values for medially and neutral placed patellae brought the values very much into the centre of the reported ranges for Q-angles. After adjustment for lateral patella displacement, Q-angle values were towards the under end of values reported as normal, especially female values which were close to the previously reported pathological cut off point. Because of the inverse relationship between quadriceps strength and the magnitude of Q-angle and quadriceps crucial role in the aetiology of patellofemoral pain, any method which improves the reliability and applicability of Q-angle measurement could prove useful in investigations into the aetiology of and outcome from treatment of patellofemoral pain syndrome.     

Removal of the lateral or medial third of patellar tendon alters the patellofemoral contact pressure and area: an in vitro experimental study in dogs

OBJECTIVES: To compare patellofemoral contact pressure and areas after immediate removal of the lateral, central, or medial third of patellar tendon. DESIGN: In vitro experiment in 12 dogs. BACKGROUND: Alteration of the vector sum of the quadriceps muscle contraction after removal of partial patellar tendon might result in changes of patellar tracking in the trochlea. METHODS: Patellofemoral contact pressure and areas were recorded using Fuji pressure-sensitive film at 45 degrees, 60 degrees, and 90 degrees of knee flexion under an isometric quadriceps force of 100% body weight. The patellofemoral contact imprint from the intact knees were obtained as control, and the lateral (n=4), central (n=4), and medial (n=4) third of the patellar tendon were subsequently removed and the patellofemoral contact imprint was recorded. RESULTS: The patellofemoral contact area was found to increase with increasing knee flexion angles. No change in patellofemoral contact pressure and areas was found after removal of the central third patellar tendon. However, after removal of either lateral or medial third of patellar tendon, the patellofemoral contact was rotated with increasing knee flexion angles. This was due to the altered vector sum of the quadriceps force, resulting in significantly decreased patellofemoral contact areas and simultaneously a significantly increased contact pressure, characterized with concentration of patellofemoral contact pressure on both lateral and medial facets of the patellofemoral joint. CONCLUSIONS: The results suggest that removal of the central third of patellar tendon may not alter the patellofemoral contact pressure and areas as compared with removal of either lateral or medial third of patellar tendon that may result in an altered postoperative tracking mechanism of the patellofemoral joint immediately after operation. RELEVANCE: Findings of this in vitro animal study supports the use of central third of patellar tendon as autograft for anterior cruciate ligament reconstruction. However, further experimental studies are needed to investigate how the postoperative healing of the host patellar tendon will influence the findings obtained from this in vitro study.     

MRI 对一过性髌骨外侧脱位的诊断价值

【目的】探讨一过性髌骨外侧脱位(TLPD)患者的 MRI 影像特征。【方法】回顾性分析本院收治的56例 TLPD 患者的临床 MRI 资料,对有无骨或软骨损伤、关节内游离体、内侧髌股韧带损伤、关节积液、髌骨半脱位和外倾、解剖异常等进行判断分析,并结合临床资料、X 线片及关节镜图像分析,总结该类患者影像学特征。【结果】初次就诊时被误诊、漏诊有26例(46.4%)。MRI 显示56例(100%)患者均存在“对吻征”所致不同程度的骨软骨损伤,其中股骨外髁外侧前缘有10例(17.9%)软骨骨折,骨软骨骨折6例(10.8%);髌骨下极内侧缘有16例(28.6%)软骨骨折,10例(17.9%)骨软骨骨折。关节内游离体20例(35.7%);50例(89.3%)有不同程度的内侧髌股韧带损伤和关节积液;髌骨半脱位和外倾36例(64.3%);56例患者中存在股骨滑车发育不良者 16例(28.6%),高位髌骨者14例(25.0%),TT-TG>20 mm 者6例(10.7%)。【结论】TLPD 患者误诊、漏诊率较高,MRI 能准确地显示各解剖结构的损伤及程度,有助于明确诊断,应作为该病的首选检查方法。     

The relationships between the geometrical features of the patellofemoral joint and patellar mobility in able-bodied subjects

This study examined the correlations between patellar mobility and geometry of the patella and femoral condyle. Using a custom designed patellar gliding instrument, the lateral mobility of patella in 17 able-bodied subjects was measured and these measurements were compared with the relative patellar tendon length and the inclination of lateral femoral groove obtained from conventional MR imaging. The data showed that there was significant correlation between patellar mobility and inclination of lateral femoral groove (r= -0.671, P=0.01). Because hip rotation angle would alter the inclination of lateral femoral groove, clinicians who perform patellar gliding test should be mindful that the hip position is critical for the accuracy of the test.     

The inter-tester reliability of a clinical measurement used to determine the medial-lateral orientation of the patella

An important aspect of the patellar taping technique, a common treatment for patellofemoral pain is the assessment of patellar position. The inter-tester reliability of the assessment method has been regarded as poor, as has the validity (Powers et al. 1999). The purpose of the study was to determine inter-tester reliability of a group of trained manual physiotherapists. This was achieved using a clinical measurement to assess the medial/lateral orientation of the patella and compare these findings against a known criterion valid measurement of patella position. Twenty experienced manual physiotherapists evaluated medial/lateral orientation of the patella. The findings of the clinical assessment were then compared to the position of the patella as determined through magnetic resonance imaging (MRI). The MRI and the clinical assessment were carried out on the right knee of a single subject, who was supine with the knee in 20 degree flexion with the quadriceps relaxed. Both measures found the patella to be laterally displaced. Using the clinical method the mean difference between medial and lateral measurements was 6.4 mm (+/- 3.9 mm). The MRI measure of lateral patella displacement found the patella to be displaced 5 mm laterally. The inter-tester reliability of the clinical test showed good agreement, r = 0.91 for the medial measure and r = 0.94 for the lateral measure. The agreement between the clinical and MRI measures was (r = 0.9) which was also a significant agreement. This study appears to demonstrate that experienced manual physiotherapists can reliably measure relative patella medial/lateral position.     

The quantitative influence of current treatment options on patellofemoral stability in patients with trochlear dysplasia and symptomatic patellofemoral instability - a finite element simulation

BackgroundTrochlear dysplasia is highly associated with patellofemoral instability. The goal of conservative and surgical treatment is to stabilize the patella while minimizing adverse effects. However, there is no literature investigating the quantitative influence of different treatment options on patellofemoral stability in knees with trochlear dysplasia. We created and exploited a range of finite element models to address this gap in knowledge.MethodsMRI data of 5 knees with trochlear dysplasia and symptomatic patellofemoral instability were adapted into this previously established model. Vastus medialis obliquus strengthening as well as double-bundle medial patellofemoral ligament reconstruction and the combination of medial patellofemoral ligament reconstruction and trochleoplasty were simulated. The force necessary to dislocate the patella by 10 mm and fully dislocate the patella was calculated in different flexion angles.FindingsOur model predicts a significant increase of patellofemoral stability at the investigated flexion angles (0°-45°) for a dislocation of 10 mm and a full dislocation after medial patellofemoral ligament reconstruction and the combination of medial patellofemoral ligament reconstruction and trochleoplasty compared to trochleodysplastic (P = 0.01) and healthy knees (P = 0.01–0.02). Vastus medialis obliquus strengthening has a negligible effect on patellofemoral stability.InterpretationsThis is the first objective quantitative biomechanical evidence supporting the place of medial patellofemoral ligament reconstruction and medial patellofemoral ligament reconstruction combined with trochleoplasty in patients with symptomatic patellofemoral instability and trochlear dysplasia type B. Vastus medialis obliquus strengthening has a negligible effect on patellar stability at a low total quadriceps load of 175 N.     

Management of patellofemoral pain syndrome

Patellofemoral pain syndrome (PFPS) is the most common cause of knee pain in the outpatient setting. It is caused by imbalances in the forces controlling patellar tracking during knee flexion and extension, particularly with overloading of the joint. Risk factors include overuse, trauma, muscle dysfunction, tight lateral restraints, patellar hypermobility, and poor quadriceps flexibility. Typical symptoms include pain behind or around the patella that is increased with running and activities that involve knee flexion. Findings in patients with PFPS range from limited patellar mobility to a hypermobile patella. To confirm the diagnosis, an examination of the knee focusing on the patella and surrounding structures is essential. For many patients with the clinical diagnosis of PFPS, imaging studies are not necessary before beginning treatment. Radiography is recommended in patients with a history of trauma or surgery, those with an effusion, those older than 50 years (to rule out osteoarthritis), and those whose pain does not improve with treatment. Recent research has shown that physical therapy is effective in treating PFPS. There is little evidence to support the routine use of knee braces or nonsteroidal anti-inflammatory drugs. Surgery should be considered only after failure of a comprehensive rehabilitation program. Educating patients about modification of risk factors is important in preventing recurrence.     

保留髌骨膝关节置换的症状及影像学评价

背景：膝关节置换中是否置换髌骨是一个持续争论的话题。目的：侧重评价保留髌骨膝关节置换后髌骨的影像学稳定性和症状改善。方法：对39例（48膝）骨关节炎及类风湿性关节炎患者行保留髌骨的全膝关节置换。结果与结论：术中记录髌骨软骨退变分级Ⅲ级和IV级达36膝,占75%,置换后HSS评分及FELLER髌骨评分较置换前明显改善,明显膝前痛病例为5例,占10%,其髌骨病理分级均达到Ⅳ级。保留髌骨膝关节置换前后影像学评价髌股关节的对线差异无显著性意义,下肢力线校正满意。提示对于置换前髌股轨迹不良、术中软骨病理分级较低者应该进行选择性的髌骨置换,恰当选择病例采用保留髌骨的膝关节置换可减少髌股关节并发症,置换前仔细评估,综合考虑多种因素操作可进一步改善髌股轨迹。     

The patellofemoral joint and its implications in the rehabilitation of the knee.

The normal mechanics of patellar motion lead to an eventual age-dependent degeneration of the patellofemoral joint in the majority of persons. This review explores the relationships between normal patellar mechanics, patellofemoral joint disease, and findings of quadriceps femoris muscle-function studies. Implications of these relationships are then discussed with regard to the rehabilitation of all patients.     

Evaluation of the isometry of different points of the patella and femur for medial patellofemoral ligament reconstruction

BackgroundThe location of patellar and femoral fixation of the graft in medial patellofemoral ligament reconstructions has been widely discussed. This study aimed to assess the distances between different patellar and femoral fixation points to identify the least anisometric pairs of points.MethodsTen cadaver knees were attached to an apparatus that simulated an active range of motion of 120°, with three metallic markers fixed onto the medial side of the patella, and seven markings onto the medial epicondyle. The examined points included the proximal patella pole (1), the patellar center (3), the midpoint between points 1 and 3 (2), a point directly on the epicondyle (6), points 5 mm anterior (5) and posterior (7) to the epicondyle, points 5 mm anterior to point 5 (4) and 5 mm posterior to point 7 (8), and points 5 mm proximal (9) and distal (10) to the epicondyle. The distances between patella and femur points were measured by a photogrammetry system at 15° intervals.FindingsThe pair of points that exhibited the lowest average variability in distance, and hence was the most isometric, was the patella center combined with the anterior to the medial femoral epicondyle. The pairs of points that exhibited the highest average variability in distance, and hence were the least isometric, were the ones located distal or posterior to the medial femoral epicondyle, with less influence by the patellar location.InterpretationSurgeons should avoid positioning the graft distally or posterior to the epicondyle due to the increase in anisometry.     

股骨滑车及髌骨发育不良的MRI表现及其临床意义分析

目的：探讨股骨滑车及髌骨发育不良的MRI表现及其与髌股关节紊乱症的相关性。方法膝关节病例组26例（30个膝）及对照组30例（30个膝）均行MRI检查,在股胫关节上方3 cm层面进行测量,对TT-TG间距、股骨滑车前上侧突起、内外侧滑车关节面比例、外侧倾斜角、髌骨Wiberg分型及指数进行定性及定量分析（注释：在观察的指标中,TT-TG间距、股骨滑车前上侧突起、内外侧滑车关节面比例、外侧倾斜角、髌骨Wiber指数为定量分析,髌骨Wiberg分型为定性分析）。结果两组别TT-TG间距（P＝0.02）、滑车前上缘突起（P＝0.00）、外侧倾斜角（P＝0.00）、内外侧关节面比值（P＝0.01）、髌骨Wiberg指数（P＝0.00）的测量值差异均具有非常显著的统计学差异;WibergⅠ-Ⅱ型组与WibergⅢ-Ⅳ型组Wiberg指数的均值具有显著的统计学差异（P＝0.00）。髌骨Wiberg指数与股骨滑车发育形态、髌骨Wiberg分型呈负相关;股骨滑车发育类型与髌骨分型呈正相关。结论股骨滑车与髌骨发育不良常常同时存在（P＝0.00）,成为髌股关节紊乱症的骨发育结构不良的直接原因。MRI横轴位对股骨滑车发育不良的诊断具有非常重要的价值,应纳入膝关节检查的常规扫描。