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The Journal of Bone and Joint Surgery 78:193-203 (1996)
© 1996 The Journal of Bone and Joint Surgery, Inc.

Stress Radiographs of the Patellofemoral Joint*

ROBERT A. TEITGE, M.D.{dagger}, WARREN, WADE FAERBER, D.O.{ddagger}, DETROIT, PATRICIA DES MADRYL, R.T.(R){dagger}, WARREN and THOMAS M. MATELIC, M.D.§, DETROIT, MICHIGAN

Investigation performed at the Division of Sports Medicine, Department of Orthopaedic Surgery, Hutzel Hospital, Wayne State University School of Medicine, Detroit, and Teitge Orthopaedic Associates, Warren

Patellar instability is usually diagnosed on the basis of the clinical presentation without radiographic confirmation. In the present report, we describe a new radiographic method to demonstrate patellar instability. Axial radiographs were made of the patellofemoral joint of ninety individuals (180 knees) and were then repeated while a medial or lateral force was applied to the patella. The applied force was kept constant with use of a specially designed instrument. The ninety individuals were divided into four groups on the basis of the clinical findings: normal, lateral instability, medial instability, and multidirectional instability. Stress radiographs differentiated the four groups and confirmed the clinical diagnosis in all patients who had unilateral symptoms. A four-millimeter increase in medial or lateral excursion of the patella of the symptomatic knee compared with the patellar excursion of the asymptomatic knee was significant (p < 0.0001). Stress radiographs offer a simple method for the measurement of force-displacement relationships in the patellofemoral joint and for the demonstration of patellofemoral instability.


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