pmc logo image
Logo of brjsmedBritish Journal of Sports MedicineCurrent TOCInstructions for authors
Journal List > Br J Sports Med > v.39(3); Mar 2005

Formats:
Br J Sports Med. 2005 March; 39(3): 162–165.
doi: 10.1136/bjsm.2004.012336.
PMCID: PMC1725140
Copyright notice
Diffusely increased bone scintigraphic uptake in patellofemoral pain syndrome
J Naslund, S Odenbring, U Naslund, and T Lundeberg
Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden. j.naslund@mailbox.calypso.net <j.naslund/at/mailbox.calypso.net>
Abstract
Objectives: Painful disorders of the patellofemoral joint are one of the most frequent complaints in orthopaedic and sports medicine. The aims of this study were to determine whether bone scintigrams of patients suffering from patellofemoral pain syndrome (PFPS) show diffuse uptake and in what bony compartment of the knee uptake, if any, was localised.
Methods: Fifty eight patients with chronic PFPS were examined. All patients underwent a detailed clinical history and a thorough physical examination of the knee. Anterior and lateral static images of both knees were made using a gamma camera 3 h after injection of 550 MBq of 99mTc-HMDP. Two experienced radiologists visually evaluated the scans blindly and separately. As 51 patients had bilateral pain, 109 painful knees are included in the results.
Results: Diffuse uptake on bone scintigrams was found in 48 knees in 30 of the patients. In 33 knees the uptake was localised to only one bone compartment, in 10 knees diffuse uptake was found in two of the bones forming the knee joint, and in six knees all three bone compartments (the distal femur, the patella, and the proximal tibia) exhibited diffuse uptake.
Conclusions: Scintigrams of approximately half of the patients with PFPS will show diffuse uptake in one or more of the bony compartments of the knee joint and radioactive tracer accumulation will occur as often in the proximal tibia as in the patella.
Full Text
The Full Text of this article is available as a PDF (72K).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
  • Arroll B, Ellis-Pegler E, Edwards A, Sutcliffe G. Patellofemoral pain syndrome. A critical review of the clinical trials on nonoperative therapy. Am J Sports Med. 1997 Mar–Apr;25(2):207–212. [PubMed]
  • Cutbill JW, Ladly KO, Bray RC, Thorne P, Verhoef M. Anterior knee pain: a review. Clin J Sport Med. 1997 Jan;7(1):40–45. [PubMed]
  • Kannus P, Aho H, Järvinen M, Niittymäki S. Computerized recording of visits to an outpatient sports clinic. Am J Sports Med. 1987 Jan–Feb;15(1):79–85. [PubMed]
  • Lindberg U, Lysholm J, Gillquist J. The correlation between arthroscopic findings and the patellofemoral pain syndrome. Arthroscopy. 1986;2(2):103–107. [PubMed]
  • Yates C, Grana WA. Patellofemoral pain--a prospective study. Orthopedics. 1986 May;9(5):663–667. [PubMed]
  • Arnoldi CC. Patellar pain. Acta Orthop Scand Suppl. 1991;244:1–29. [PubMed]
  • Mori Y, Fujimoto A, Okumo H, Kuroki Y. Lateral retinaculum release in adolescent patellofemoral disorders: its relationship to peripheral nerve injury in the lateral retinaculum. Bull Hosp Jt Dis Orthop Inst. 1991 Fall;51(2):218–229. [PubMed]
  • Sanchis-Alfonso V, Roselló-Sastre E. Immunohistochemical analysis for neural markers of the lateral retinaculum in patients with isolated symptomatic patellofemoral malalignment. A neuroanatomic basis for anterior knee pain in the active young patient. Am J Sports Med. 2000 Sep–Oct;28(5):725–731. [PubMed]
  • Merchant AC. Classification of patellofemoral disorders. Arthroscopy. 1988;4(4):235–240. [PubMed]
  • Butler-Manuel PA, Justins D, Heatley FW. Sympathetically mediated anterior knee pain. Scintigraphy and anesthetic blockade in 19 patients. Acta Orthop Scand. 1992 Feb;63(1):90–93. [PubMed]
  • Dye SF. Imaging of the knee. Orthop Rev. 1993 Aug;22(8):901. [PubMed]
  • Hejgaard N, Diemer H. Bone scan in the patellofemoral pain syndrome. Int Orthop. 1987;11(1):29–33. [PubMed]
  • Dye SF, Boll DA. Radionuclide imaging of the patellofemoral joint in young adults with anterior knee pain. Orthop Clin North Am. 1986 Apr;17(2):249–262. [PubMed]
  • Boegård T, Rudling O, Dahlström J, Dirksen H, Petersson IF, Jonsson K. Bone scintigraphy in chronic knee pain: comparison with magnetic resonance imaging. Ann Rheum Dis. 1999 Jan;58(1):20–26. [PubMed]
  • Näslund Jan, Näslund Ulla-Britt, Odenbring Sten, Lundeberg Thomas. Sensory stimulation (acupuncture) for the treatment of idiopathic anterior knee pain. J Rehabil Med. 2002 Sep;34(5):231–238. [PubMed]
  • Lorberboym M, Ami D Ben, Zin D, Nikolov G, Adar E. Incremental diagnostic value of 99mTc methylene diphosphonate bone SPECT in patients with patellofemoral pain disorders. Nucl Med Commun. 2003 Apr;24(4):403–410. [PubMed]
  • McCarthy EF. Histopathologic correlates of a positive bone scan. Semin Nucl Med. 1997 Oct;27(4):309–320. [PubMed]
  • Minoves Montserrat. Bone and joint sports injuries: the role of bone scintigraphy. Nucl Med Commun. 2003 Jan;24(1):3–10. [PubMed]
  • Matheson GO, Clement DB, McKenzie DC, Taunton JE, Lloyd-Smith DR, Macintyre JG. Scintigraphic uptake of 99mTc at non-painful sites in athletes with stress fractures. The concept of bone strain. Sports Med. 1987 Jan–Feb;4(1):65–75. [PubMed]
  • Miltner O, Siebert CH, Schneider U, Niethard FU, Graf J. Patellar hypertension syndrome in adolescence: a three-year follow up. Arch Orthop Trauma Surg. 2003 Nov;123(9):455–459. [PubMed]
  • Otter MW, Qin YX, Rubin CT, McLeod KJ. Does bone perfusion/reperfusion initiate bone remodeling and the stress fracture syndrome? Med Hypotheses. 1999 Nov;53(5):363–368. [PubMed]
  • Kirschner MH, Menck J, Nerlich A, Walser R, Bühren V, Hofmann GO. The arterial blood supply of the human patella. Its clinical importance for the operating technique in vascularized knee joint transplantations. Surg Radiol Anat. 1997;19(6):345–351. [PubMed]
  • Magnusson Håkan I, Ahlborg Henrik G, Karlsson Caroline, Nyquist Fredrik, Karlsson Magnus K. Low regional tibial bone density in athletes with medial tibial stress syndrome normalizes after recovery from symptoms. Am J Sports Med. 2003 Jul–Aug;31(4):596–600. [PubMed]
  • Murphy E, FitzGerald O, Saxne T, Bresnihan B. Increased serum cartilage oligomeric matrix protein levels and decreased patellar bone mineral density in patients with chondromalacia patellae. Ann Rheum Dis. 2002 Nov;61(11):981–985. [PubMed]
  • Magnusson HI, Westlin NE, Nyqvist F, Gärdsell P, Seeman E, Karlsson MK. Abnormally decreased regional bone density in athletes with medial tibial stress syndrome. Am J Sports Med. 2001 Nov–Dec;29(6):712–715. [PubMed]
  • Leppälä J, Kannus P, Natri A, Sievänen H, Järvinen M, Vuori I. Bone mineral density in the chronic patellofemoral pain syndrome. Calcif Tissue Int. 1998 Jun;62(6):548–553. [PubMed]
  • Lichota Derek K. Anterior knee pain: symptom or syndrome? Curr Womens Health Rep. 2003 Feb;3(1):81–86. [PubMed]
  • Davidson K. Patellofemoral pain syndrome. Am Fam Physician. 1993 Nov 15;48(7):1254–1262. [PubMed]
  • Holmes SW, Jr, Clancy WG., Jr Clinical classification of patellofemoral pain and dysfunction. J Orthop Sports Phys Ther. 1998 Nov;28(5):299–306. [PubMed]
  • Goldberg B. Patellofemoral malalignment. Pediatr Ann. 1997 Jan;26(1):32–35. [PubMed]
  • Grana WA, Kriegshauser LA. Scientific basis of extensor mechanism disorders. Clin Sports Med. 1985 Apr;4(2):247–257. [PubMed]
  • Finestone A, Radin EL, Lev B, Shlamkovitch N, Wiener M, Milgrom C. Treatment of overuse patellofemoral pain. Prospective randomized controlled clinical trial in a military setting. Clin Orthop Relat Res. 1993 Aug;(293):208–210. [PubMed]
Articles from British Journal of Sports Medicine are provided here courtesy of
BMJ Group