Rating Patellofemoral Arthritis

Saturday, January 27, 2007 | 0

By Dr. Christopher Brigham

Question:

My patient has patellofemoral knee pain but the joint interval on X-ray looks normal. Does the patient have a ratable impairment?

Answer:

Possibly.

Although Table 17-31 on page 544 of the Guides indicates that a cartilage interval of 2 mm or less is required for a ratable impairment for knee arthritis, do not overlook the footnote that states a 5% lower extremity impairment can be given if there is a history of direct trauma AND complaints of patellofemoral pain AND crepitation on exam.

All three conditions must be met and documented to support your rating. Direct trauma requires a forceful contusion to the anterior knee over the patella.

Crepitation is a common finding as we age and may be unrelated to the injury.

Apply Table 17-2 on page 526 to determine what arthritic impairment can be combined with; it cannot be combined with gait, muscle atrophy, muscle strength, or abnormal motion.

(Don't forget to order your sunrise view X-ray at 40 degrees of flexion or a true lateral view of the knee to assess the patellofemoral joint.)

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Brigham is the editor of the Guides Newsletter and Guides Casebook. To view more of these tips visit:

www.impairment.com/tips

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