[Clinical examination for patellofemoral problems]

Patellofemoral pain and instability account for 25% of all sports-related knee problems. However, definitive analysis seems to be difficult. Descriptive findings like "anterior knee pain", "patellofemoral pain syndrome", or "chondromalacia" are used instead of diagnosis. One reason may be the complex pathomechanics of the patellofemoral joint which is suspended between the pelvis, the femur, and the tibia and subsequently is influenced by the whole lower extremity from the hip down to the foot. On the other hand, different signs and functional tests are in use with at times lack of quantification and ambiguous interpretation. The current manuscript reviews the commonly used signs and functional tests, analyzes them based on the current literature, and arranges them in a practical manner for physical examination. A MEDLINE literature search and special textbooks regarding patellofemoral disorders were used; 43 signs and tests were found. The examiner can quantify 18 of these findings on a nominal and 15 on an ordinal scale. Thus, this manuscript provides a standardized algorithm for physical examination with a collection of quantifiable findings, which are of growing importance to justify adequate diagnostics and treatment.