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Patellar hypertension syndrome in adolescence: a three-year follow up
O Miltner1, C H Siebert, U Schneider
1Department of Orthopedic Surgery, University of Aachen, Pauwelsstrasse 30, D-52074 Aachen, Germany. Miltner.Heuter@t-online.de
Introduction:
Anterior knee pain is one of the major causes of knee pain in an adolescent population. It has been suggested that raised intraosseous pressure may play an important role in the development of anterior knee pain in the young patient.
Material And Methods:
A prospective clinical multicentre study with 27 adolescent patients presenting with anterior knee pain was performed. After failure to respond to conservative treatment, all patients agreed to undergo minimally invasive intraosseous pressure measurements in local anaesthesia. All 27 patients demonstrated a positive "pain provocation test" as a response to increased intrapatellar pressure and were decompressed with a new intraosseous drilling technique.
Results:
The repeat intraosseous pressure measurement in 27 patients 1 year postoperatively revealed a significant reduction from 43.3+/-13.4 preoperatively to 24.1+/-4.2 mmHg (p<0.001). The pain relief was documented in the form of a reduced VAS from 7.6+/-1.4 to 2.1+/-1.1 cm after 3 years (p<0.001).
Conclusion:
Patients with anterior knee pain and a positive "pain provocation test" were diagnosed as suffering from a hypertension syndrome of the patella. We conclude that simple extraarticular patellar decompression may offer a valuable new form of treatment in this select group of adolescent patients with anterior knee pain.