Stress radiographs of the patellofemoral joint

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 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.