*3.2.2 Supine examination*

The next stage of the patellofemoral examination consists of evaluation of the patella and related structures. Presence of joint effusion should be noted. The peripatellar soft tissues are carefully palpated. Tenderness over the medial femoral epicondyle region (Bassett's sign) may represent an injury to the MPFL in patients with acute or recurrent dislocations of the patella [53]. Tenderness on palpation of the inferior pole of the patella is often diagnostic of patellar tendinitis, whereas tenderness over the proximal pole of the patella may indicate quadriceps tendinitis. Tenderness within the substance of the distal quadriceps tendon or the proximal patellar tendon is suggestive of diffuse tendinosis. Tenderness along the medial border of the patella may represent injury to the medial patellar retinaculum and the MPFL. The MPFL should be palpated along its entire course from the femoral origin to the patellar insertion. The insertion of VMO should be palpated for tenderness or defect. Tenderness on the lateral border of the patella is often found in patients with excessive lateral pressure syndrome. Tenderness over the lateral femoral condyle

is indicative of osteochondral fracture. In patients who have undergone previous surgery, the surgical incision area should be examined for the presence of neuroma. A diagnostic lidocaine injection is helpful to confirm a clinically suspected diagnosis of neuroma. Retinacular tenderness, hypersensitivity to palpation, and decreased patellar mobility are suggestive of Complex Regional Pain Syndrome Type I (previously known as Reflex Sympathetic Dystrophy). Active and passive range of motion in the affected knee should be evaluated and any deficit or asymmetry (as compared with the opposite, normal knee) should be recorded. A resisted straight-leg raise test is performed to rule out disruption of the extensor mechanism (i.e. quadriceps tendon and patellar tendon). The neurological and vascular status of the extremity should be assessed.
