Patellar hypertension syndrome--nomenclature, diagnosis and therapy

Abstract

Complaints in the area of the patella have been abundantly described in the literature. However, a uniform nomenclature with regard to either diagnosis or therapy does not exist. With the help of a standardized measuring method (intrapatellar pressure measurement and provocation test), it is possible to describe and classify patellar pain. An intrapatellar pressure increase over 25 mmHg and/or a positive provocation test defines the term of Patella Hypertension Syndrome. Within a prospective study we carried out a special intraosseous drilling in 20 cases with the typical symptoms of the Patella Hypertension Syndrome. The drilling, which was carried out via the Hoffa fat body from distal, resulted in a distinct alleviation of symptoms in all cases and even in a complete absence of pain in most cases. This phenomenon was objectified by a pressure-check-up after 6 weeks, 6 months and 1 year following the drilling. In all 20 cases so far examined a decrease of between 40-70% of the original pressure level was achieved. In all cases the postoperative artificial pressure increase (provocation test) of the intraosseous pressure did not lead to the typical pain symptoms. We therefore have a relatively minor operation at our disposal enabling us to achieve an impressive therapeutic success, in cases where conventional treatment was neither causal nor successful.