title: Clinically insignificant association between anterior knee pain and patellofemoral lesions which are found incidentally.
abstract: BACKGROUND
  Patellofemoral chondral lesions are frequently identified incidentally during the arthroscopic treatment of other knee pathologies. A role has been described for arthroscopic debridement when symptoms are known to originate from pathology of the patellofemoral joint. However, it remains unclear how to manage lesions which are found incidentally whilst tackling other pathologies. The purpose of this study was to establish the strength of association between anterior knee pain and patellofemoral lesions identified incidentally in a typical arthroscopic population.
  
  
  METHODS
  A consecutive series of patients undergoing arthroscopy for a range of standard indications formed the basis of this cross section study. We excluded those with patellofemoral conditions in order to identify patellofemoral lesions which were solely incidental. Pre-operative assessments were performed on 64 patients, where anterior knee pain was sought by three methods: an annotated photographic knee pain map (PKPM), patient indication with one finger and by palpated tenderness. A single blinded surgeon, performed standard arthroscopies and recorded patellofemoral lesions. Statistical correlations were performed to identify the association magnitude.
  
  
  RESULTS
  Associations were identified between incidental patellofemoral lesions and tenderness palpated on the medial patella (P = 0.007, χ(2) = 0.32) and the quadriceps tendon (P = 0.029, χ(2) = 0.26), but these associations were at best fair, which could be interpreted as clinically insignificant.
  
  
  CONCLUSIONS
  Incidental patellofemoral lesions are not necessarily associated with anterior knee pain, we suggest that they could be left alone. This recommendation is only applicable to patellofemoral lesions which are found incidentally whilst addressing other pathology.
authors.affiliation: North East Orthopaedic and Sports Injury Research Group, Tyne and Wear, UK; Department of Orthopaedics, Queen Elizabeth Hospital, Gateshead, UK. Electronic address: davidelson@yahoo.com.
authors.forename: D W
authors.initials: DW
authors.lastname: Elson
authors.forename: S
authors.initials: S
authors.lastname: Jones
authors.forename: N
authors.initials: N
authors.lastname: Caplan
authors.forename: A
authors.initials: A
authors.lastname: St Clair Gibson
authors.forename: S
authors.initials: S
authors.lastname: Stewart
authors.forename: D F
authors.initials: DF
authors.lastname: Kader
mesh_terms: D000328:Adult; D000368:Aged; D001182:Arthroscopy / Q000379:methods*; D046789:Chondromalacia Patellae / Q000150:complications / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D003430:Cross-Sectional Studies; D003646:Debridement / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D033162:Incidental Findings; D007718:Knee Injuries / Q000175:diagnosis* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D046788:Patellofemoral Pain Syndrome / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D020127:Recovery of Function; D018570:Risk Assessment; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
keywords: Anterior knee pain; Chondral pathology; Chondromalacia patella; Incidental patellofemoral lesions