Anterior PFJ line pain that disappear when knee is bent!

[Fiona H]

The Pt is male, 64yrs and presents with local pain (++) of insidious onset on the anterior patellofemoral joint line (1/24). The pain is present on palpation and on loading of the PFJ on walking up and down stairs. The pain disappears completely when the knee is palpated in 80-90 degrees of flexion (I didn't try less flexion than this). He describes the pain as sharp, not diffuse, and patient has no red flags. There is no swelling, inflammation or deformity present.

Any ideas?

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[Bijingo]

OA or bursitis? Patellofemoral joint osteoarthritis - has he got excessive crepitus while extending knee? If pain persists, a knee X-ray could be helpful.

[Fiona H]

Thanks Bijingo,

I considered both of these, although unfortunately didn't have time to do a full knee assessment and some accessory movements obviously would have helped. (I did test patella compression when doing something else though, and that elicited no pain at all).

The question I'm asking myself, is if it were either bursitis or OA, why would direct palpation only cause pain when the knee was extended?

The superior translation of the patella in flexion is doing something but my brain is too muddled to get the connection, which is probably obvious. Though maybe I should be paying more attention to the functional (weightbearing) movements which are problematic?

And PS- no crepitus.

[kcho]

Maybe the problematic site is located on the femeral head rather than the patella surface, so only symtomatic when the patella is higher up?
Pain is very subjective. What he thinks "sharp" could actually be a small localised diffuse pain.