بررسی ارتباط بین درد و تغییرات پرتونگاری در بیماران مبتلا به درد مفصل کشککی ـ رانی در سنین 40-15 سال

    Background & Aim: More attention has been paid to the maltracking of patella in the sulcus as the etiology of the anterior knee pain. Those patients with patellofemoral pain and with no known cause could be called as patellofemoral syndrome. In this study we investigated the relationship between pain and radiographic changes in patellofemoral joint. Patients and Methods: In a cohort study, we studied 64 knees (18 males, 28 females) of 46 patients with patellofemoral syndrome. Duration, severity & quality of pain as well as axial patellofemoral Xray in 20 & 45 degrees of knee flexion was studied before & after a 6 weeks course of physiotherapy and analysed with Mode & Chi square test. Results: Before the treatment mean of pain duration was 6.5 months(SD: 4.8), mean of pain severity 5.5(SD, 1.7), mean of sulcus angle was 129(SD: 8) and mean of congruence angle was 14.8(SD: 11). Six patients had patellofemoral index of more than 1.6. After treatment 22 patients had no pain, 28 had mild pain and no pain relief in 4 patients. Mean of pain severity was 1.4 months(SD, 1.5). There was no relation between sex and age with pain severity before treatment and pain response. However correlation between pain duration and pain relif was significant(P<0.0005). In other works, the lesser the pain duration, the more the therapeutic response. Mean of congruence angle improved to -16.6(SD, 8), which means reduction of the angle as much as 1.8 degree(P=0.041). Patello femoral index was greater than 1.6 in 6 cases after treatment it reduced to 4 cases. Four patient had patellofemoral index of more than 1.6. There was no relation between pain severity and relief of pain with xray changes. However correlation between relief of pain & congruence changes was found in patients who improved with treatment. Congruence angle reduced to 2.3(P=0.028), but this reduction was in only 0.375 of the patients not happy with the treatment, which statistically is not significant(P=0.83). Conclusion: Axial radiography is not correlated with severity of pain and response to treatment. There was significant relation btween response to treatment and change in mean of congruence angle after treatment. After the onset of the symptoms early initiation of treatment, is associated with better therapeutic response.