A 24-year-old female soccer player comes to the office with right anterior knee pain. The pain has been present for 3-4 months with gradual onset and a persistent course. It is worsened by climbing and descending stairs and prolonged sitting. A trial of over-the-counter ibuprofen was not helpful. The patient reports several previous minor lower-extremity injuries from playing soccer but no significant trauma. Her past medical history is otherwise negative. There is crepitation and pain on extension of the knee with anterior patellar compression. Which of the following is the most likely diagnosis in this patient?

Question

A 24-year-old female soccer player comes to the office with right anterior knee pain.  The pain has been present for 3-4 months with gradual onset and a persistent course.  It is worsened by climbing and descending stairs and prolonged sitting.  A trial of over-the-counter ibuprofen was not helpful.  The patient reports several previous minor lower-extremity injuries from playing soccer but no significant trauma.  Her past medical history is otherwise negative.  There is crepitation and pain on extension of the knee with anterior patellar compression.  Which of the following is the most likely diagnosis in this patient?

Quizplus · Accepted Answer

Explanation: 11ec2b69_c1d4_77a4_8f63_21713dd9a6ba_MD0005_00 Patellofemoral pain syndrome (PFPS) is the most common cause of knee pain in young adults. It is much more common in women than men, likely due to the greater angle between the main axis of the quadriceps group and the generally vertical axis of the patellofemoral groove. Patients with PFPS have poorly localized pain at the anterior knee that is worsened by activities that involve quadriceps contraction such as squatting or ascending and descending stairs. The course is usually subacute to chronic. The diagnosis of PFPS is primarily clinical and may be challenging as objective findings are often minimal. The patellofemoral compression test (pain elicited by extending the knee while compressing the patella) and reproduction of pain with squatting are highly suggestive. Imaging tests such as x-ray and magnetic resonance imaging of the knee are usually normal and are generally needed only if the diagnosis is in doubt or the patient fails to improve as expected. Patellofemoral pain syndrome (PFPS) Management of PFPS is primarily biomechanical - exercises to stretch and strengthen the thigh muscles -and avoiding activities that aggravate the pain. Nonsteroidal anti-inflammatory drugs are often prescribed but frequently are not helpful. Persistence is required on the part of the patient as resolution of symptoms may take weeks to months. (Choice A) Anserine bursitis is a common cause of medial knee pain. Patients have localized pain and tenderness at the medial aspect of the knee joint distal to the joint line. Symptoms are usually acute/episodic rather than chronic and are not usually felt at the anterior knee. Anserine bursitis (Choice B) Osgood-Schlatter syndrome causes pain at the insertion of the patellar tendon at the anterior tibial tubercle. It occurs almost exclusively in adolescent and preadolescent patients, frequently following a rapid growth spurt. Patients will have localized tenderness at the tibial tubercle. Osgood-Schlatter syndrome (Choice C) Patellar tendonitis ("jumper's knee") is most common in patients who participate in jumping sports (eg, volleyball, basketball). Pain is episodic and localized to the inferior patella and patellar tendon. Tenderness at the inferior margin of the patella is a typical finding. Patellar tendonitis ("jumper's knee") (Choice E) Prepatellar bursitis ("housemaid's knee") is a common cause of anterior knee pain in patients who work extensively on their knees. Unlike PFPS, the pain of prepatellar bursitis is typically acute and highly localized with visible swelling anterior to the patella. Prepatellar bursitis is frequently complicated by secondary infection (septic bursitis) due to Staphylococcus aureus. Prepatellar bursitis ("housemaid's knee") Educational objective: Patellofemoral pain syndrome is the most common cause of knee pain in young adults, especially women. Pain is subacute to chronic and poorly localized. Diagnosis is clinical and may be challenging. Patients may have reproduction of pain by extension of the knee with anterior pressure on the patella (patellofemoral compression test). Treatment is primarily biomechanical with stretching and strengthening exercises of the thigh muscles. References: Patellofemoral pain syndrome. (http://www.ncbi.nlm.nih.gov/pubmed/20610028)

A 24-Year-Old Female Soccer Player Comes to the Office with Right